What aspects of mindfulness and emotion regulation underpin self-harm in individuals with borderline personality disorder?

BACKGROUND: Self-harm presents significant risk for individuals with borderline personality disorder (BPD). Both self-harm and BPD are associated with deficits in mindfulness and emotion dysregulation. Previous research suggests that thought suppression and emotional inexpressivity may underpin self-harm in people with BPD, suggesting potential links to self-harm functions common for those with BPD. More research is needed to strengthen our understanding of this relationship. AIMS: This study examines how BPD symptoms, mindfulness, emotion dysregulation and self-harm functions are related. METHODS: Australian community outpatients diagnosed with BPD (N = 110) completed measures of mindfulness, emotion dysregulation and self-harm functions. Serial mediation analyses were conducted to examine relationships between variables. RESULTS: BPD symptoms, chronic emptiness, mindfulness skills, describing and non-reacting, emotion dysregulation areas of emotion regulation strategies and poor emotional clarity were associated with recent self-harm. Various combinations of describing, strategies and clarity mediated the path between emptiness and self-harm functions more likely to be endorsed by individuals with a diagnosis of BPD. Describing was associated with all but anti-suicide function, while strategies was associated with all but anti-dissociation. CONCLUSION: The study highlights how individuals with BPD experiencing chronic emptiness may benefit from treatment targeting describing skills and adaptive emotion regulation strategies.

Evaluation of a brief intervention within a stepped care whole of service model for personality disorder.

BACKGROUND: Although there is growing evidence that stepped models of care are useful for providing appropriate, person centered care, there are very few studies applied to personality disorders. A brief, four session, psychological treatment intervention for personality disorder within a whole of service stepped care model was evaluated. The intervention stepped between acute emergency crisis mental health services and longer-term outpatient treatments. METHODS: Study 1 used service utilization data from 191 individuals referred to the brief intervention at a single community health site in a metropolitan health service. Proportions of individuals retained across the intervention and the referral pathways accessed following the intervention were examined. Study 2 examined 67 individuals referred to the brief intervention across 4 different sites in metropolitan health services. A range of measures of symptoms and quality of life were administered at the first and last session of the intervention. Effect sizes were calculated to examine mean changes across the course of the intervention. RESULTS: Study 1 found that 84.29% of individuals referred to the intervention attended at least 1 session, 60.21% attended 2 sessions or more and 41.89% attended 3 or more sessions. 13.61% of the sample required their care to be "stepped up" within the service, whereas 29.31% were referred to other treatment providers following referral to the intervention. Study 2 found a significant reduction in borderline personality disorder symptom severity and distress following the intervention, and an increase in quality of life. The largest reduction was found for suicidal ideation (d = 1.01). CONCLUSIONS: Brief psychological intervention was a useful step between acute services and longer-term treatments in this stepped model of care for personality disorder. Suicide risk and symptom severity reduced and quality of life improved, with only a small proportion of individuals requiring ongoing support from the health service following the intervention.

Vulnerable narcissism as a mediator of the relationship between perceived parental invalidation and eating disorder pathology.

PURPOSE: Parental invalidation and narcissism have been proposed to play an important role in understanding the etiology of eating disorders. The current research aimed to address two main gaps in the literature. The first aim was to determine the differential associations of grandiose and vulnerable narcissism with eating disorder pathology. The second aim was to find a common mediator between both maternal and paternal invalidation and eating disorder pathology. It was hypothesized that when controlling for vulnerable narcissism, grandiose narcissism would not predict eating disorder pathology. In addition, it was hypothesized that vulnerable narcissism would be a mediator of the relationship between parental invalidation and eating disorder pathology. METHODS: Participants were 352 women aged 18-30 years who were recruited from the general and tertiary student population, and as such constituted a community sample. Participants completed the Invalidating Childhood Environment Scale, Brief-Pathological Narcissism Inventory, Eating Disorder Examination Questionnaire, the Avoidance of Affect Subscale of the Distress Tolerance Scale, and the Emotional Expression as a Sign of Weakness Subscale of the Attitudes Towards Emotional Expression Scale in an online survey. RESULTS: Results showed that, when controlling for vulnerable narcissism, grandiose narcissism was no longer associated with eating disorder pathology. It was also found that parental invalidation had a positive indirect effect upon eating disorder pathology, via vulnerable narcissism. CONCLUSIONS: The findings indicate that vulnerable narcissism is more strongly associated with eating disorder pathology as opposed to grandiose narcissism and help to further elucidate the mechanisms via which parental invalidation might exert its negative effect on eating disorder pathology. LEVEL OF EVIDENCE: A cross-sectional survey (Level V).

Pathological Narcissism and Emotional Responses to Rejection: The Impact of Adult Attachment.

Background: Aspects of pathological narcissism, such as grandiosity, vulnerability and entitlement, tend be enacted in therapeutic settings, negatively influencing outcome and alliance between the clients and therapist. This research took an experimental approach to understanding the interplay between the emotional reactions of individuals with a pathological narcissistic presentation, and adult attachment style. We predicted that participants reporting narcissistic vulnerability would report greater insecurity in attachment (fearful and preoccupied styles), greater trait emotional reactivity, and also experience more intense and negative responses to simulated rejection Methods: 269 participants (75.84% female, median age = 21) completed baseline and rejection trials of a virtual ball-tossing game, following the assessment of grandiose and vulnerable pathological narcissism, entitlement, adult attachment, trait emotional reactivity (measured prior to the rejection) and in-situ affective response (measured both before and after the rejection). Change in affect from baseline was calculated to capture affective responses to the manipulation. Results: Vulnerable narcissism was positively associated with both fearful and preoccupied attachment, and negatively associated with secure and dismissive attachment, whilst grandiose narcissism was significantly related to preoccupied attachment only. Multiple hierarchical regression analyses showed vulnerable narcissism predicted both (1) more negative trait emotional reactivity and (2) a significant increase in negative affect following the rejection trial. Grandiose narcissism was associated with (1) higher positive trait emotional reactivity, and (2) significant reductions in positive affect following rejection. Conclusion: Results indicated that those high in pathological narcissistic vulnerability reported greater insecurity in attachment, negative trait emotional reactivity and experienced a more negative and intense emotional reaction to rejection. Grandiose narcissism was related to a more deactivated pattern of emotional reactivity, and less positive (rather than more negative) emotional reactions. Findings have important implications for therapy, particularly regarding communication of emotions for individuals high in vulnerable and grandiose narcissism.

Assessing the efficacy of a stepped-care group treatment programme for borderline personality disorder: study protocol for a pragmatic trial.

BACKGROUND: Borderline personality disorder (BPD) is a high prevalence and serious mental health disorder that has historically challenged the finite resources of health services. Despite empirical evidence supporting structured psychological therapy as the first line of treatment, there remains significant barriers in providing timely access to evidence-based treatment for this population. The primary aim of this study is to evaluate the effectiveness of providing a stepped-care structured psychological group treatment to individuals with BPD within local mental health services. The secondary aims of the study are to identify the variables that predict the need to step up or down in care and the effectiveness of treatment on psychosocial functioning. METHODS: Participants seeking treatment at two community mental health services will be invited to participate. Randomised controlled trial assignment will be to either (i) group skills treatment or (ii) treatment as usual. Group treatment will be offered via a stepped-care pathway with participants initially attending a 12-week group with the option of a subsequent 16-week group. The criteria for inclusion in continuing treatment includes meeting > 4 BPD diagnostic criteria or severity on GAF (< 65) at the completion of the 12-week group. Data will be collected at baseline and at five follow-up time points over a 12-month period. DISCUSSION: This pragmatic trial will provide valuable information regarding the effectiveness of a progressive stepped-care group treatment for individuals with BPD in the real-world setting of a community mental health service. It will further the current understanding of variables that predict treatment dose and duration. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000477224 . Registered on 3 April 2018.

Narcissistic traits in young people: understanding the role of parenting and maltreatment.

BACKGROUND: Elevated narcissism in young people often sets up a cascade of interpersonal and mental health challenges, reinforcing the need to understand its concomitants. Experiences of maltreatment and different parenting styles have been implicated but findings to date are inconclusive. By simultaneously considering multiple remembered parenting styles and maltreatment in a large sample, this study aims to elucidate possible prognostic factors associated with both grandiose and vulnerable narcissistic traits in youth. METHODS: Young people (N = 328, age range: 17-25 years) reported on the remembered interpersonal environment and current grandiose and vulnerable narcissism traits. Structural equation modelling was used to examine maternal and paternal parenting styles and examine the association between experiences of parenting and grandiose and vulnerable narcissism. RESULTS: Remembered overprotection from mothers and fathers was associated with both vulnerable and grandiose narcissistic traits. Remembered maternal overvaluation related to current grandiosity, and maternal leniency related to vulnerable narcissistic traits. For paternal parenting, the combination of overvaluation and leniency and overvaluation and care explained grandiose and vulnerable traits. There was no direct effect of remembered parental care or childhood maltreatment on current levels of narcissistic traits. CONCLUSIONS: Remembered childhood experiences of being overprotected, overvalued and experiencing leniency in parental discipline, were associated with higher traits of pathological narcissism in young people. Care and maltreatment were non-specific risk factors. Remembered childhood environments of being excessively pampered are associated with grandiose and vulnerable narcissistic traits, characterised by the young person expressing unrealistic self-views, entitlement beliefs and impaired autonomy. In treatment these traits may emerge in the patient-therapist relationship and working through their developmental origins may contribute to outcomes.

A 1-year follow-up study of capacity to love and work: What components of borderline personality disorder most impair interpersonal and vocational functioning?

BACKGROUND: For individuals with borderline personality disorder (BPD), both the reduction in symptoms and the improvement of vocational and interpersonal function (psychosocial function) are important for recovery. Research suggests that some components of BPD make it harder to achieve functional recovery; however, findings are varied and inconclusive. The present study assesses recovery over time in BPD, investigates which symptoms make it harder to function and explores the relationships between these symptoms. METHOD: One hundred ninety-nine consecutively recruited individuals in psychological treatment for personality disorder were studied over 12 months. Measures of BPD symptom severity at intake were used to predict improvements in social and vocational function at follow-up. Exploratory modelling was conducted to understand the relationships between symptoms and function. RESULTS: Following 12 months of treatment, symptoms and functioning improved. Those who experienced more severe emptiness, impulsivity and self-harm had worse outcomes. A relationship between chronic emptiness at intake and impaired vocational outcome (days out of work) at follow-up was found, mediated by severity of impulsivity and frequency of self-harm. CONCLUSION: Chronic emptiness is associated with dysfunctional behaviours such as impulsivity and self-harm, and poor psychosocial improvement. Interventions targeting chronic emptiness in those most vulnerable may improve functional outcomes. © 2018 John Wiley & Sons, Ltd.

Parental Invalidation and the Development of Narcissism.

Parenting behaviors and childhood experiences have played a central role in theoretical approaches to the etiology of narcissism. Research has suggested an association between parenting and narcissism; however, it has been limited in its examination of different narcissism subtypes and individual differences in parenting behaviors. This study investigates the influence of perceptions of parental invalidation, an important aspect of parenting behavior theoretically associated with narcissism. Correlational and hierarchical regression analyses were conducted using a sample of 442 Australian participants to examine the relationship between invalidating behavior from mothers and fathers, and grandiose and vulnerable narcissism. Results indicate that stronger recollections of invalidating behavior from either mothers or fathers are associated with higher levels of grandiose and vulnerable narcissism when controlling for age, gender, and the related parenting behaviors of rejection, coldness, and overprotection. The lowest levels of narcissism were found in individuals who reported low levels of invalidation in both parents. These findings support the idea that parental invalidation is associated with narcissism.