Corrigendum: How individual and situational factors influence measures of affective and cognitive theory of mind in psychiatric inpatients.

[This corrects the article DOI: 10.3389/fpsyg.2022.855038.].

"Empowering Hope: Non-Pharmacological Interventions for Borderline Personality Disorder (BPD) Communities": Scoping Review.

Aim: Borderline personality disorder (BPD) is defined by impulsive behaviour and instability in interpersonal relationships, self-image, mood, and emotions. BPD can be prevented and treated using a mix of medication and psychotherapy. Non-pharmacological interventions are essential for maintaining stable interpersonal interactions in individuals with BPD. Goal: The literature review tries to identify different methods of non-pharmacological management. Psychotherapy, particularly tailored to aid in the recovery from emotional disorders in individuals with BPD. The methodology employed is a scoping review that integrates papers from Semantic Scholars, Pubmed, and CINAHL databases. The keyword utilised is PICO. Outcomes: Four pieces of literature aligned with the research goals based on the literature review results. Three articles discuss therapies that focus on cognitive processes, such as mindfulness therapy, schema therapy, Dialectical Behavioural Therapy (DBT), and therapy groups that incorporate supplementing with Omega-3. Conclusion: Non-pharmacological therapies for patients with Borderline Personality Disorder (BPD) can enhance good psychosocial outcomes, dialectical effects, and decrease emotional instability.

The BRIDGE project: a feasibility randomised controlled trial of brief, intensive assessment and integrated formulation for young people (age 14-24) with features of borderline personality disorder (Protocol).

Background: Borderline personality disorder (BPD) is a severe mental disorder that is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and mood as well as marked impulsivity. BPD has its peak incidence and prevalence from puberty through to emerging adulthood. BPD is a controversial diagnosis in young people. Commonly, young people with BPD are under-diagnosed, untreated, are not in employment or training and are estranged from their families. Yet, they have complex needs and are at high suicide risk. Aim: To assess the feasibility of conducting a randomised controlled trial (f-RCT) of a BRIDGE, a brief intervention programme for young people (age 14-24) with BPD symptoms (sub-threshold or threshold) in a community sample from Scotland, UK. Method: Forty young people (age 14-24) meeting criteria for BPD symptoms, will be randomised in a 1:1 ratio to receive either a) the BRIDGE intervention plus service-as-usual or b) service-as-usual alone. Follow up will be 12 weeks and 24 weeks post-intervention. The study is carried out between 2021 to 2024. Outcome: The two primary outcomes of the MQ funded, BRIDGE project (f-RCT) are i. recruitment rates and ii. retention rates. The study will present the acceptability and appropriateness of our putative outcome measures for a future definitive randomised controlled trial (d-RCT). Impact: Young people with BPD benefit from good clinical care and targeted intervention, however are regularly missed or mislabelled. The community based feasibility trial would provide initial evidence of variable needs of young people with complex needs, who maybe missed or excluded from services as they don't "fit" a model/diagnosis. Workable multi-agency service model proposed in the trial would be a major advance in understanding care pathways regardless of trial outcome. Clinical Trial Registration: ClinicalTrial.gov, identifier NCT05023447.

Using Biosensor Devices and Ecological Momentary Assessment to Measure Emotion Regulation Processes: Pilot Observational Study With Dialectical Behavior Therapy.

Background: Novel technologies, such as ecological momentary assessment (EMA) and wearable biosensor wristwatches, are increasingly being used to assess outcomes and mechanisms of change in psychological treatments. However, there is still a dearth of information on the feasibility and acceptability of these technologies and whether they can be reliably used to measure variables of interest. Objective: Our objectives were to assess the feasibility and acceptability of incorporating these technologies into dialectical behavior therapy and conduct a pilot evaluation of whether these technologies can be used to assess emotion regulation processes and associated problems over the course of treatment. Methods: A total of 20 adults with borderline personality disorder were enrolled in a 6-month course of dialectical behavior therapy. For 1 week out of every treatment month, participants were asked to complete EMA 6 times a day and to wear a biosensor watch. Each EMA assessment included measures of several negative affect and suicidal thinking, among other items. We used multilevel correlations to assess the contemporaneous association between electrodermal activity and 11 negative emotional states reported via EMA. A multilevel regression was conducted in which changes in composite ratings of suicidal thinking were regressed onto changes in negative affect. Results: On average, participants completed 54.39% (SD 33.1%) of all EMA (range 4.7%-92.4%). They also wore the device for an average of 9.52 (SD 6.47) hours per day and for 92.6% of all days. Importantly, no associations were found between emotional state and electrodermal activity, whether examining a composite of all high-arousal negative emotions or individual emotional states (within-person r ranged from -0.026 to -0.109). Smaller changes in negative affect composite scores were associated with greater suicidal thinking ratings at the subsequent timepoint, beyond the effect of suicidal thinking at the initial timepoint. Conclusions: Results indicated moderate overall compliance with EMA and wearing the watch; however, there was no concurrence between EMA and wristwatch data on emotions. This pilot study raises questions about the reliability and validity of these technologies incorporated into treatment studies to evaluate emotion regulation mechanisms.

Implicit associations with non-suicidal self-injury: Examination in a clinical sample by borderline personality symptomatology.

OBJECTIVES: We examine correlates and predictors for implicit associations with non-suicidal self-injury (NSSI) with the Self-Injury Implicit Association Test (SI-IAT) in a treatment-seeking sample. We also examine group differences in the SI-IAT among those with low/none, moderate and high/clinically significant borderline personality disorder (BPD) symptomatology in a treatment-seeking sample. METHODS: Participants (N = 111; 58% female; 89% White; Mage = 30.25) completed the SI-IAT and self-report measures at two time points. RESULTS: Higher BPD symptom scores were significantly, positively correlated with implicit identification with NSSI, and predicted NSSI identity when controlling for depression indices, history of NSSI and other covariates. With Time 1 SI-IAT scores entered as a covariate, BPD scores no longer significantly predicted Time 2 SI-IAT scores. Individuals with moderate and high/clinically significant symptom counts of BPD had higher/stronger implicit associations with NSSI identity than those with no/low BPD symptoms. CONCLUSIONS: Individuals with symptoms of BPD may implicitly identify with NSSI more than other clinical groups; examination of implicit assessments in BPD in future research is needed to further explore implicit identification with NSSI in this patient group to further understand both cross-sectional and prospective relations.

'I'm ruined': Young people's and their mothers' experiences of living with, and receiving a diagnosis of, borderline personality disorder: An interpretative phenomenological analysis.

BACKGROUND: The adolescent borderline personality disorder (BPD) diagnosis has been widely debated for many years. Strikingly, young people's experiences of both receiving a diagnosis of BPD, and of living with BPD, are largely under-explored. The current study seeks to address these gaps in the literature in a multi-perspectival design utilising young people-parent dyads. METHODS: Young people (aged 16-18 years) with a diagnosis of BPD (n = 5) and their mothers (n = 5) were recruited from two NHS Community Mental Health Services in the West Midlands and participated in semi-structured interviews. Data were analysed using interpretative phenomenological analysis [IPA]. FINDINGS: Analysis identified two superordinate themes with five subthemes: (1) The "ugly" reality of living with BPD (providing a stark insight into what it is like to live with the unpredictable nature of experiences labelled as BPD), and (2) The diagnosis that dare not speak its name (highlighting the complexities of how the diagnosis itself is experienced by participants as a symbol of personal and permanent defectiveness and danger). DISCUSSION: Findings highlight a clear commonality of experience centred around the intensity of the young people's emotional distress and the accompanying pressure on parents to keep young people safe, both of which services must strive to do more to contain. Ultimately, the costs of receiving a BPD diagnosis appear to outweigh the benefits, and this paper adds support to calls for change in respect to how we conceptualise difficulties labelled as BPD and how we communicate about these difficulties, in order to avoid causing harm.

Change in emotion-based narrative as a potential mechanism of change in a brief treatment for borderline personality disorder.

Background: The move from inconsistent and problematic autobiographical narrative to a more coherent and reality-based narrative construction of the Self has been discussed as potential mechanism of change in psychotherapies for personality disorders. So far, little empirical evidence exists that demonstrates in a time-dependent design the role of narrative construction in the treatment of borderline personality disorder, in particular when it comes to understanding the integration of body-related information from the affective system with the autobiographical narrative. The present study aims at demonstrating change in emotion-based narrative markers over brief psychiatric treatment and to assess the impact of these changes on subsequent symptom change. Methods: A total of N = 57 clients with borderline personality disorder were assessed at three timepoint over the course of four months of brief psychiatric treatment, within the context of a secondary process-outcome analysis of a randomized controlled trial. Symptom change was assessed using the OQ-45.2 and emotion-narrative change was assessed using the Narrative-Emotion Process Coding System to code client's in-session speech in terms of problem, transition and change markers. Results: All three emotion-based marker categories evidenced significant changes in the assumed direction. The reduction in problem emotion-based narrative markers (e.g., empty story telling) between session 1 and 5 into the treatment predicted the symptom reduction assessed between session 5 and 10. Conclusions: Emotion-based narrative construction may be a suitable method to study the pathway of change toward a more coherent and reality-based narrative construction of the Self-in-interaction-with-the-Other. Reduction of emotion-based problem-marker may be a promising candidate for a mechanism of change in treatments for personality disorders which should be tested in a time-dependent controlled design.

A Novel Approach to Examining Working Alliance Instability During Psychotherapy for Borderline Personality Disorder.

OBJECTIVE: This study aimed to quantify the instability of psychotherapy process variables by using a novel data-analytic approach. The study explored instability of the working alliance over 10 treatment sessions and its relationship with self-esteem. METHODS: Data were extracted from a randomized controlled trial, conducted in Switzerland, of a short-term intervention for borderline personality disorder. Sixty clients diagnosed as having borderline personality disorder were randomly assigned to receive either 10 sessions of good psychiatric management-brief version (GPM-BV) or GPM-BV combined with a relational principle called motive-oriented therapeutic relationship. Square successive differences were calculated for client and therapist ratings of alliance instability. Multilevel models were used to test within- and between-person associations of alliance instability with self-esteem. RESULTS: Although some preliminary analyses showed an association between a more stable alliance and higher self-esteem at the start of psychotherapy, the alliance did not become more stable over time. Alliance instability was not associated with self-esteem at either the within- or between-person level. CONCLUSIONS: This study highlights the advantages, procedures, and challenges of applying square successive differences to psychotherapy research data. The results suggest that the working alliance develops in complex ways and indicate the importance of continuing to use novel methods to capture dynamic psychotherapy processes.

A systematic review and meta-analysis on the efficacy of dialectical behavior therapy variants for the treatment of post-traumatic stress disorder.

Background: While there are well-established treatments for post-traumatic stress disorder (PTSD), these interventions appear to be less effective for individuals with comorbid borderline personality disorder (BPD) symptoms. Dialectical Behavior Therapy (DBT) for PTSD and DBT Prolonged Exposure (PE) are both effective interventions for treating these patients, but a comprehensive analysis evaluating the efficacy of these two interventions is lacking.Objective: To determine the effect sizes of PTSD-specific DBT treatments.Methods: We conducted a systematic review and pre-registered meta-analysis of the DBT literature for treating PTSD (osf.io/62rfq). Eligible trials and treatment evaluations published before September 2023 were searched in SCOPUS, PubMed, and the Cochrane Library databases. Thirteen articles were identified, and data were extracted for primary (PTSD symptoms) and secondary outcomes (BPD, depression, dissociation, non-suicidal self-injury [NSSI]). Treatment effects were calculated for randomised controlled trials, controlled clinical trials, and pre-post evaluations.Results: Overall, the studies involved 663 participants. Compared with control groups, PTSD-specific DBT treatments showed moderate effects in reducing PTSD symptom severity g = -0.69 (95% CI -1.03 to -0.34, p < .001) and depression g = -0.62 (95% CI -1.13 to -0.12, p = .016). Moreover, the pre-post changes showed an overall effect size for dissociative symptoms of g = -0.72 (95% CI -1.05 to -0.40, p < .001), for BPD-associated symptoms of g = -0.82 (95% CI -1.06 to -0.59, p < .001), and for NSSI frequency (g = -0.70, 95% CI -1.12 to -0.28, p = .001).Conclusions: Based on the results of our meta-analysis, DBT-PTSD and DBT PE were effective in reducing PTSD symptom severity and comorbid depressive symptoms. Further research on stage-based treatments should focus on systematically assessing NSSI, BPD symptoms, and suicidality.

We conducted the first meta-analysis assessing the efficacy of Dialectical Behavior Therapy for PTSD (DBT-PTSD) and Dialectical Behavior Therapy Prolonged Exposure (DBT PE) for individuals with comorbid PTSD and BPD symptoms.Based on RCTs/CCTs, we found moderately beneficial effects on PTSD symptoms, and depression for both stage-based interventions and large effects on non-suicidal self-injury frequency for DBT PE.DBT-PTSD and DBT PE resulted in pre-post improvements in dissociative symptoms, BPD-associated symptoms, and non-suicidal self-injury frequency.

The Necessary Rapprochement of Negative Affectivity, Personality Disorder, and Depression.

PURPOSE OF REVIEW: The relationship between depression and personality has long been a topic of interest in the fields of psychiatry and psychology, but consensus remains elusive. This lack of consensus poses a significant challenge in both diagnosis and treatment, especially in situations when otherwise effective therapies for depression fail. Our article aims to address this issue by reviewing the historical and recent conceptualizations of the relationship between depression and personality pathology. Specifically, we focus on the trait domain of negative affectivity found in the International Classification of Diseases, 11th Edition (ICD-11) and the Alternative Model for Personality Disorders (AMPD) as a connecting link between the two phenomena. RECENT FINDINGS: We review recent empirical studies evaluating the association of negative affectivity, personality, and depression, along with investigations of the relationship between depressive disorders and personality disorders. Additionally, we describe the Hierarchical Taxonomy of Psychopathology (HiTOP) and the AMPD as organizing frameworks for understanding depression within a broader personality framework. Based on the available evidence, we propose that depressive disorders must be assessed within the context of the patient's personality in order to maximize treatment outcomes. Ultimately, this integrated approach can guide clinicians in developing unified treatment protocols and facilitate early detection and intervention for factors contributing to depression in order to minimize treatment resistance.

Antisocial Behavior and Antisocial Personality Disorder Among Youth in Ethnic Minority Areas in China: A Cross-sectional Study.

Objective: Antisocial behavior and antisocial personality disorder (ASPD) cause serious harm to society and families. Ethnicity may have an impact on an individual's antisocial behavior and the incidence of ASPD. Therefore, this study aimed to investigate the current status of antisocial behavior and ASPD among youth and its correlation with ethnicity in ethnic minority areas in China. Methods: A total of 2475 Chinese youth (1794 under 18 and 681 greater than or equal to 18) were recruited from December 1 to 30, 2021, in Yunnan, China. All participants completed a General Information Questionnaire and the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). Associations between antisocial behavior and ASPD and sociodemographic factors such as ethnicity were examined using binary logistic regression analysis. Results: The positive rate of antisocial behavior screening in youth was 5.4% (95% CI (confidence interval): 4.3-6.4), with a positive rate of ASPD screening of 4.4% (95% CI: 2.9-6.0). Male, single-child and maternal education level at senior high school and above were risk factors for positive antisocial behavior screening, while senior high school grade and medium subjective family economic status were protective factors for positive antisocial behavior screening. Being male and paternal educational background were risk factors for positive ASPD screening. Conclusion: This study found high rates of positive screening for antisocial behavior and ASPD in youth and no significant differences in ethnicity. These results can be used to inform personality development.

Gender bias of antisocial and borderline personality disorders among psychiatrists.

PURPOSE: Antisocial Personality Disorder (ASPD) and Borderline Personality Disorder (BPD) challenge mental health professionals with similar maladaptive behaviors. However, these two disorders differ regarding available evidence-based treatments. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been criticized as being gender-biased diagnostic construct. The present study aimed to determine the gender bias of ASPD and BPD among Turkish psychiatrists. METHODS: Three case vignettes were randomly presented as male or female to the psychiatrists online. The first case was a patient with schizophrenia case to confirm the participant's ability to diagnose. The second case was a patient with ASPD, and the third one was a patient with BPD. RESULTS: Two hundred fifty participants diagnosed the first case correctly (n = 250). The results with statistical significance demonstrated that a female case with ASPD was 5.1 times more likely to get misdiagnosed than a male case with ASPD (p˂0.0001). CONCLUSIONS: Categorical classification of personality disorders in DSM leads to gender bias in in the diagnosis of ASPD and BPD. The present study shows that female cases with ASPD are misdiagnosed as BPD which may result in treatment attempts without evidence.

Chronotype, sleep quality, impulsivity and aggression in patients with borderline personality disorder and healthy controls.

Impulsivity, aggression, and suicide are the major clinical symptoms of borderline personality disorder (BPD). Although previous studies indicated poor sleep quality and its relationship with clinical symptoms in patients with BPD, chronotype, an important sleep parameter, was not investigated in these patients. This study aimed to analyze chronotype and its relationship with clinical symptoms in patients with BPD. Participants in this study consisted of 68 BPD patients and 65 healthy controls. Subjective sleep characteristics, impulsivity, aggression, suicide probability, and chronotype were assessed using the Pittsburgh Sleep Quality Index (PSQI), Barratt Impulsivity Scale, Buss-Perry Aggression Scale (BPAQ), Suicide Probability Scale, and Morningness - Eveningness Questionnaire, respectively. PSQI total and subscale scores subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, and daytime drowsiness were significantly higher in the BPD group (p < 0.001). There was a positive correlation between the PSQI total score and the BPAQ total score (r = 0.268, p = 0.027). The rate of evening type was significantly higher in the control group (p = 0.004). Suicide attempts and the subscale of suicide probability hopelessness, suicidal ideation, and negative self-evaluation scores were significantly higher in evening type BPD patients. (p = 0.017, p = 0.009, p = 0.001, p = 0.047). Sleep quality is associated with aggression, and the eveningness chronotype is associated with suicide. It may be useful to focus on sleep problems in treating BPD patients.

Intelligence and Treatment Outcome of Mentalization-Based Treatment in Borderline Personality Disorder.

BACKGROUND: Mentalization-based treatment (MBT) is an evidence based treatment for patients diagnosed with borderline personality disorder (BPD). Although MBT is effective, on average, for individuals with BPD, there are large individual differences in treatment outcomes. Research on predictors of the treatment effect of MBT, such as intelligence, is needed to determine which treatment is most effective for which 'category' of BPD patients, providing more knowledge about optimal indications. OBJECTIVE: The study aimed to investigate whether intelligence is associated with MBT outcomes in patients with BPD and exploratively studying the difference between two variants of MBT. METHODS AND PROCEDURES: A pre-post intervention design was used to examine the effects of MBT on BPD severity. Personal and social recovery were measured as secondary outcome measures. The association between intelligence and the degree of recovery was examined. RESULTS: No significant correlation was found between intelligence level and treatment efficacy. In addition, a negative correlation between IQ and personal and social recovery was found, indicating that, as IQ increased, the level of recovery decreased. Secondary subanalyses showed the treatment effect of MBT was large and significant in reducing BPD symptoms (Cohen's d = 1.5) and that there was no significant difference between the 2-day MBT and 3-day MBT programmes in terms of a decrease in BPD severity. However, a significant medium positive correlational relationship was found between intelligence and a decrease in BPD severity level for the 3-day MBT, which was not found for the 2-day MBT programme. This indicates that in the 3-day MBT programme, the higher the IQ, the higher the decrease in BPD severity level. CONCLUSIONS AND IMPLICATIONS: This study is the first to examine the association between intelligence and the outcome of MBT in BPD patients. It shows that patients with a wide range of intelligence (72-124) can equally benefit from MBT and that effectiveness of MBT was not influenced negatively by lower intelligence. Secondary subanalyses showed that this was particularly evident when the intervention was delivered within the context of a 2-day MBT programme. Nevertheless, further randomized studies are required to ascertain the relationship between IQ and treatment effectiveness, as well as other predictors of MBT outcomes.

The neurobiology of antisocial personality disorder.

Despite increasing recognition that there is a neurobiological basis of antisocial behavior in addition to its psychosocial foundation, much less is known about the specificity of the neurobiological findings to the psychiatric condition of antisocial personality disorder (APD). This article provides a review of research on genetic, brain imaging, neurocognitive, and psychophysiological factors in relation to assessments of APD. Findings show that there are significant genetic effects on APD, particularly related to the serotonergic system, as well as abnormalities in brain regions such as the frontal lobe. Associations between psychophysiological measures of autonomic nervous system functioning and APD are more mixed. Results indicating that APD has a significant genetic basis and is characterized by abnormalities in brain structure/function and neurocognitive impairments provide additional evidence that supports the conceptualization of APD as a neurodevelopmental disorder. Findings may also help inform treatment approaches that target neurobiological risks for APD symptoms.

Obsessive-Compulsive Disorder Comorbid with or without Obsessive-Compulsive Personality Disorder: Conceptual Implications, Clinical Correlates and Brain Morphometries.

BACKGROUND: Obsessive-compulsive disorder (OCD) is often comorbid with obsessive-compulsive personality disorder (OCPD). The relationship between OCD and OCPD is complex, and the impact of comorbid OCPD on OCD remains underexplored, necessitating further research.. This study aims to investigate the clinical correlates and brain morphometries associated with comorbid OCPD in a large sample of unmedicated OCD patients. METHODS: A total of 248 unmedicated patients diagnosed with OCD (45 comorbid with OCPD) were included in this study. All participants were assessed for OCD symptoms, OCPD traits, obsessive beliefs, depression and anxiety. Among them, 145 patients (23 comorbid with OCPD) volunteered to receive magnetic resonance imaging (MRI) brain scans. RESULTS: Approximately 18% (45/248) of OCD patients were comorbid with OCPD. OCD comorbid with OCPD (OCD+OCPD) exhibited more severe OCD symptoms, obsessive beliefs, depression and anxiety than OCD comorbid without OCPD. Additionally, the severity of OCPD was positively correlated with OCD symptoms and obsessive beliefs. Furthermore, OCD+OCPD patients exhibited increased cortical complexity in the left superior parietal lobule and left precuneus, which mediated the relationship between OCPD and OCD symptoms only in OCD patients comorbid without OCPD. CONCLUSIONS: The co-occurrence of OCPD may contribute to the heightened severity of psychopathological symptoms and associated brain morphological alterations in OCD patients, indicating distinct but interrelated constructs between these two disorders.

Socio-demographic predictors of the time interval between successive hospitalizations among patients with borderline personality disorder.

Background: Borderline personality disorder (BPD) affects 0.7 to 2.7% of the adult population and higher rates are reported in inpatient care. Hospitalizations of BPD patients are a complex and controversial challenge for mental health professionals. Recurrent hospitalizations are common and it is essential to identify risk factors that characterize patients who benefit from their hospitalization and those who return to the ward shortly after discharge. Aim: To investigate the potential link between BPD patients' socio-demographic factors and the expected time interval between their successive hospitalizations. Methods: A retrospective analysis of 1051 hospitalization records from 174 BPD patients. Through univariate, bivariate, and multivariate analyses, we investigated the possible relationship between patients' primary socio-demographic factors and the time between their successive hospitalizations. Results: Patients' age, marital status, and living arrangement were found to be statistically connected with the time interval between successive hospitalizations. Specifically, being older, married and/or patients to live with one's spouse/partner seem to be linked with a longer time interval between successive hospitalizations compared to patients who are young, single/divorced and/or those who live with their parents. Conclusions: The expected time interval between successive hospitalization of BPD patients can be partly explained by their socio-demographic characteristics.

Validation of the Three-Factor Reflective Functioning Questionnaire for Youth in a Chinese Adolescent Sample.

Purpose: This study focused on the validation of the Three-Factor Reflective Functioning Questionnaire for Youth(RFQY) within a sample of Chinese adolescents. Patients and Methods: All the items of the RFQY were translated into Chinese language through the process of translation and back translation. A total of 532 adolescents aged between 12-20 years completed the Chinese version of RFQY, McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Basic Empathy Scale (BES), and the 20-item Toronto Alexithymia Scale (TAS-20). Results: Twenty items meeting psychometric standards were retained in the Chinese version of the RFQY. The indices for confirmatory factor analysis, including χ2/df (2.354), SRMR (0.053), GFI (0.930), CFI (0.921), TLI (0.910), and RMSEA (0.050), all conformed to the requirements of psychometrics. The Cronbach's alpha coefficients for the three factors, "uncertainty/confusion", "interest/curiosity", and "excessive certainty", were 0.820, 0.673, and 0.839, respectively, with test-retest reliability scores of 0.751, 0.643, and 0.764. A significant positive correlation was found between uncertainty/confusion and symptoms of borderline personality disorder (BPD), particularly in adolescents with high BPD traits. Excessive certainty was positively correlated with unstable interpersonal relationships, while the interest/curiosity factor shows no significant correlation with BPD symptoms. The uncertainty/confusion factor demonstrates a complex relationship with empathy, correlating positively with affective empathy but negatively with cognitive empathy. The uncertainty/confusion factor shows a significant positive correlation with alexithymia, while the factor of excessive certainty demonstrates the opposite effect. Additionally, a significant negative correlation exists between the interest/curiosity factor and the externally oriented thinking. Conclusion: This study validates the Chinese version of the Reflective Functioning Questionnaire for Youth (RFQY), demonstrating its reliability and validity in assessing reflective functioning among Chinese adolescents. This enhances the understanding of reflective functioning and its role in adolescent mental health.

Breaking the cycle with trauma-focused mentalization-based treatment: theory and practice of a trauma-focused group intervention.

Trauma-Focused mentalization-based treatment (MBT-TF) is an adaptation of mentalization-based treatment (MBT) specifically developed for patients suffering from attachment or complex trauma, with the possibility of co-occurring borderline personality pathology. The creation of MBT-TF was driven by previous research and observations that interventions centered on mentalizing could be significantly improved by directly addressing the impact of trauma. MBT-TF aims to mitigate symptoms that arise post-trauma, such as hyperarousal, hypervigilance, intrusions, flashbacks, avoidance behaviors, dissociative experiences, negative perceptions of self and others, and ensuing relational difficulties. Implemented as a group intervention, MBT-TF typically spans 6-12 months. From a mentalizing perspective, trauma, particularly attachment trauma, leads to a failure in processing the effects of trauma through and with others. Stress and attachment behavioral systems are disrupted, which undermines the capacity for epistemic trust, and impairs mentalizing abilities. This paper offers a concise summary of the reasoning for MBT-TF's creation, its theoretical underpinnings, and its clinical strategy for addressing the adverse impacts of trauma. It further details the treatment phases, their main goals, and their interventions, supplemented by clinical case examples that underscore MBT-TF's distinctive attributes and frequent clinical hurdles.

The interface of autism and (borderline) personality disorder.

SUMMARY: Prominent clinical perspectives posit that the interface of autism and (borderline) personality disorder manifests as either a misdiagnosis of the former as the latter or a comorbidity of both. In this editorial, we integrate these disparate viewpoints by arguing that personality difficulties are inherent to the autistic spectrum.