Multimodal assessment of emotional reactivity and regulation in response to social rejection among self-harming adults with and without borderline personality disorder.

Theories of borderline personality disorder (BPD) highlight the central role of emotional dysfunction in this disorder, with a particular emphasis on emotional reactivity and emotion regulation (ER) difficulties. However, research on emotion-related difficulties in BPD has produced mixed results, often related to the particular indices of emotional responding used in the studies. As such, the specific nature of emotional dysfunction in BPD, as well as the extent to which subjective emotion-related difficulties map onto corresponding physiological deficits, remains unclear. This study examined both subjective and physiological indices of emotional reactivity and ER difficulties in response to a social rejection emotion induction (relative to a neutral emotion induction) across three groups of participants: self-harming young adults with BPD, self-harming young adults without BPD, and clinical controls with no self-harm history or BPD. Consistent with the hypotheses, results revealed a lack of convergence between subjective and physiological indices of emotional reactivity and ER difficulties among participants with BPD. Whereas participants with BPD reported both greater emotional reactivity and greater ER difficulties in response to the negative emotion induction than participants without self-harm or BPD, there were no significant differences in physiological indices of emotional reactivity or ER between participants with BPD and either of the control groups. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Ecological Momentary Assessment of Affective and Interpersonal Instability in Adolescent Non-Suicidal Self-Injury.

Affective and interpersonal instability, both core features of Borderline Personality Disorder (BPD), have been suggested to underlie non-suicidal self-injury (NSSI). Ecological momentary assessment (EMA) is the method of choice when investigating dynamic processes. Previously no study addressed affective and interpersonal instability in daily life of adolescents engaging in NSSI. Female adolescents with NSSI (n = 26) and age- and sex-matched healthy controls (n = 20) carried e-diaries on 2 consecutive weekends and were prompted in hourly intervals to rate their momentary affective state and feelings of attachment towards their mother and best friend. The majority of participants in the NSSI group also fulfilled diagnostic criteria for BPD (73%). Squared successive differences were calculated to quantify instability. Adolescents with NSSI reported less positive affect, t (44) = 6.94, p < 0.01, lower levels of attachment to the mother, t (44) = 5.53, p < 0.01, and best friend, t (44) = 4.36, p < 0.01. Both affective, t (44) = -5.55, p < 0.01, and interpersonal instability, mother: t (44) = -4.10, p < 0.01; best friend: t (44) = -4.57, p < 0.01, were significantly greater in adolescents engaging in NSSI. In the NSSI group, the number of BPD criteria met was positively correlated with affective instability, r = 0.40, p < 0.05, and instability of attachment to the best friend, r = 0.42, p < 0.05, but not instability of attachment towards the mother, r = 0.06, p = 0.79. In line with previous work in adults, NSSI is associated with affective and interpersonal instability assessed by EMA in adolescents. Preliminary findings highlight the association of affective and interpersonal instability with diagnostic criteria for BPD. Clinical implications and avenues for further research are discussed.

The emotion regulation function of nonsuicidal self-injury: A momentary assessment study in inpatients with borderline personality disorder features.

Studies using retrospective self-report or proxies of nonsuicidal self-injury (NSSI) in the lab have shown that NSSI is often preceded by intense negative emotions and followed by a decrease in negative emotions/tension, suggesting an emotion regulation function of NSSI. To investigate this emotion regulation function of NSSI in a more ecologically valid way, we used experience sampling methods to examine the temporal relationship between NSSI behavior and emotional experiences throughout the day in 30 inpatients currently staying in psychiatric hospitals. Because NSSI is especially prevalent and severe in patients with a borderline personality disorder (BPD), we focused on patients with high levels of BPD symptomatology. Results confirmed that high levels of negative emotion prospectively predicted a higher probability of engaging in NSSI in the next time interval. However, the occurrence of NSSI itself was related to concurrent increases in negative emotion and decreases in positive emotion, and even prospectively predicted an increase in negative emotion in the consecutive time interval. These preliminary results show that on a time scale of hours, instead of resulting in emotional relief, NSSI seems to be associated with a further increase in negative emotionality, shedding light on the cyclic nature of NSSI. (PsycINFO Database Record

Self-Harm Intervention: Family Therapy (SHIFT), a study protocol for a randomised controlled trial of family therapy versus treatment as usual for young people seen after a second or subsequent episode of self-harm.

BACKGROUND: Self-harm is common in the community with a lifetime prevalence of 13 %. It is associated with an elevated risk of overall mortality and suicide. People who harm themselves are high users of public services. Estimates of the 1-year risk of repetition vary between 5 and 15 % per year. Currently, limited evidence exists on the effectiveness of clinical interventions for young people who engage in self-harm. Recent reviews have failed to demonstrate any effect on reducing repetition of self-harm among adolescents receiving a range of treatment approaches. Family factors are particularly important risk factors associated with fatal and non-fatal self-harm among children and adolescents. Family therapy focuses on the relationships, roles and communication patterns between family members, but there have been relatively few studies of specifically family-focused interventions with this population. The Self-Harm Intervention: Family Therapy (SHIFT) Trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (grant no. 07/33/01) following a commissioned call for this research. METHODS/DESIGN: SHIFT is a pragmatic, phase III, multicentre, individually randomised, controlled trial comparing Family Therapy (FT) with treatment as usual (TAU) for adolescents aged 11 to 17 who have engaged in at least two episodes of self-harm. Both therapeutic interventions were delivered within the National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) in England. Participants and therapists were, of necessity, aware of treatment allocation, but the researchers were blind to the allocations to allow unbiased collection of follow-up data. Primary outcome data (repetition of self-harm leading to hospital attendance 18 months post-randomisation) were collected from the Health and Social Care Information Centre (HSCIC), augmented by directed searches of medical records at Acute Trusts. Secondary outcome data (including suicidal intent, depression, hopelessness and health economics) were collected at 12 and 18 months post-randomisation via researcher-participant interviews and by post at 3 and 6 months. DISCUSSION: SHIFT will provide a well-powered evaluation of the clinical and cost effectiveness of Family Therapy for young people who have self-harmed on more than one occasion. The study will be reported in 2016, and the results will inform clinical practice thereafter. TRIAL REGISTRATION: ISRCTN59793150 . 26 January 2009.

Nonsuicidal self-injury and affect regulation: recent findings from experimental and ecological momentary assessment studies and future directions.

CONTEXT: Although research indicates that nonsuicidal self-injury (NSSI) may be used as a form of emotion regulation, studies have largely relied on the use of retrospective self-report data, which limits inferences about directionality of effects. Recently, researchers have started to employ lab-based experimental (e.g., guided imagery, acute pain) and moment sampling approaches to the study of NSSI. METHODS: In the present study, we conducted a review of this recent literature, using several electronic databases (e.g., PsychINFO, ERIC, CINAHL). RESULTS: We identified 18 studies that met our inclusion criteria. Findings indicated that the administration of pain was associated with decreases in negative affect among both self-injurers and noninjurers, although these declines were more pronounced for self-injurers in some studies. CONCLUSIONS: We discuss findings within the context of two central theories (i.e., opponent-process theory and distraction theory) and offer several recommendations for future research in this area.

Multifinality in the development of personality disorders: a Biology x Sex x Environment interaction model of antisocial and borderline traits.

Although antisocial personality disorder (ASPD) is more common among males and borderline PD (BPD) is more common among females, some authors have suggested that the two disorders reflect multifinal outcomes of a single etiology. This assertion is based on several overlapping symptoms and features, including trait impulsivity, emotional lability, high rates of depression and suicide, and a high likelihood of childhood abuse and/or neglect. Furthermore, rates of ASPD are elevated in the first degree relatives of those with BPD, and concurrent comorbidity rates for the two disorders are high. In this article, we present a common model of antisocial and borderline personality development. We begin by reviewing issues and problems with diagnosing and studying PDs in children and adolescents. Next, we discuss dopaminergic and serotonergic mechanisms of trait impulsivity as predisposing vulnerabilities to ASPD and BPD. Finally, we extend shared risk models for ASPD and BPD by specifying genetic loci that may confer differential vulnerability to impulsive aggression and mood dysregulation among males and impulsive self-injury and mood dysregulation among females. Although the precise mechanisms of these sex-moderated genetic vulnerabilities remain poorly understood, they appear to interact with environmental risk factors including adverse rearing environments to potentiate the development of ASPD and BPD.

Evaluation of an evolutionary model of self-preservation and self-destruction.

According to deCatanzaro's mathematical model of self-preservation and self-destruction, staying alive actually may reduce inclusive fitness for an individual who is low in reproductive potential and, at the same time, poses such a burden to close kin that it costs them opportunities for reproduction. Predictions generated from this model were tested using 175 university students as subjects and variables constructed from a 164-item questionnaire. The criterion variables were separate measures of depression, hopelessness, and suicide ideation and behavior. The predictor variables derived from the model were separate measures of reproductive potential of the individual, the individual's perceived benefit or cost to kin, and reproductive potential of the individual's kin. As predicted, there were negative and significant bivariate correlations between each of the model-generated predictor variables and one or more of the criterion variables. Multiple regression analyses showed that benefit to kin was the best predictor of both depression and hopelessness. Discriminant analysis showed that reproductive potential of kin significantly differentiated suicide attempters from nonattempters. Overall, our results support and extend deCatanzaro's model and empirical findings.