Childhood abuse and borderline personality disorder features in Chinese undergraduates: the role of self-esteem and resilience.

BACKGROUND: Although childhood abuse is considered to be related to borderline personality disorder (BPD), few studies have elaborated on the mediating role of self-esteem and resilience in it. Thus, the present study aimed to explore the potential mediating role of resilience and self-esteem between childhood abuse and BPD. METHODS: This cross-sectional study was conducted with 4034 college students in Anhui Province, China. Participants were asked to complete Chinese versions of the following instruments: Childhood Trauma Questionnaire-Short Form (CTQ-SF), Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Connor-Davidson Resilience Scale (CD-RISC), and Rosenberg Self-Esteem Scale (RSES). Structural equation modeling (SEM) was used to test the mediation effects. RESULTS: Resilience and self-esteem were found to be mediators of all three types of childhood abuse (emotional abuse, physical abuse and sexual abuse) when the types were examined separately; however, when all three types of childhood abuse were entered into the model simultaneously, neither the indirect effects nor direct effects of physical abuse or sexual abuse were found to be significant, only the association between emotional abuse and BPD features was partially mediated by resilience and self-esteem. CONCLUSIONS: Self-esteem and resilience mediate the links between childhood abuse and BPD features, and emotional abuse is uniquely associated with BPD features.

History of Childhood Trauma and Association With Borderline and Dissociative Features.

ABSTRACT: Both borderline personality features and dissociative symptoms have been associated with different types of childhood trauma. The aim of this investigation was to analyze to what extent emotional, physical, and sexual child maltreatment predict borderline personality features and dissociative symptoms. For this purpose, we analyzed data from 86 consecutively admitted patients who completed the Borderline Symptom List, the Childhood Trauma Questionnaire, and the German version of the Dissociative Experiences Scale for differential diagnosis of a borderline personality disorder. Hierarchical regression analyses revealed that borderline features were mainly predicted by emotional abuse, whereas pathological dissociation was best predicted by sexual and physical abuse. This evidence supports the hypothesis that different kinds of maltreatment may lead to different psychopathological symptoms in adulthood and should be taken into account in the therapy.

Familial factors and the risk of borderline personality pathology: genetic and environmental transmission.

BACKGROUND: Parental characteristics and practices predict borderline personality disorder (BPD) symptoms in children. However, it is difficult to disentangle whether these effects are genetically or environmentally mediated. The present study examines the contributions of genetic and environmental influences by comparing the effects of familial risk factors (i.e. parental psychopathology and borderline traits, maladaptive parenting, marital discord) on child BPD traits in genetically related (biological) and non-related (adoptive) families. METHODS: Data are from 409 adoptive and 208 biological families who participated in the Siblings Interaction and Behavior Study (SIBS) and 580 twin families the Minnesota Twin Family Study (MTFS). Parent characteristics and practices included parental psychopathology (measured via structured clinical interviews), parental BPD traits, parenting behaviors, and marital discord. A series of multi-level regression models were estimated to examine the relationship of familial risk factors to child BPD traits and to test whether children's adoptive status moderated the association. RESULTS: Symptom counts of parents' conduct disorder, adult antisocial behavior, nicotine, alcohol, and illicit drug dependence, and paternal BPD traits substantially predicted child BPD traits only in biological offspring, implying genetic transmission. Maternal BPD traits and both maternal and paternal conflict, lack of regard, and lack of involvement predicted offspring BPD traits regardless of the adoptive status, implying environmental transmission. CONCLUSIONS: Parental externalizing psychopathology and father's BPD traits contribute genetic risk for offspring BPD traits, but mothers' BPD traits and parents' poor parenting constitute environmental risks for the development of these offspring traits.

Borderline personality disorder and eating disorders: a trans-diagnostic approach to unravelling diagnostic complexity.

OBJECTIVES: This opinion paper considers co-morbid borderline personality disorder (BPD) and eating disorders and proposes that a trans-diagnostic approach looking at presenting problems and treatment approaches may be of value. CONCLUSIONS: Trans-diagnostic elements can be identified across the two syndromes. Trans-diagnostic elements appear to include some shared aetiological factors as well as some shared syndromal components. The shared syndromal components include problems with affect, interpersonal problems, problems with self-concept and impulsivity. The pathoplastic effects of culture, attitudes to fatness and the neurobiology of starvation and/or restriction of intake are crucial to integrate into the understanding of co-morbidity of these two disorders. Trans-diagnostic approaches to treatment lead to trans-diagnostic improvements across the two disorders.

Development of a Psychiatric Disorder Linked to Cerebellar Lesions.

Cerebellar dysfunction plays a critical role in neurodevelopmental disorders with long-term behavioral and neuropsychiatric symptoms. A 43-year-old woman with a cerebellum arteriovenous malformation and history of behavioral dysregulation since childhood is described. After the rupture of the cerebellar malformation in adulthood, her behavior morphed into specific psychiatric symptoms and cognitive deficits occurred. The neuropsychological assessment evidenced impaired performance in attention, visuospatial, memory, and language domains. Moreover, psychiatric assessment indicated a borderline personality disorder. Brain MRI examination detected macroscopic abnormalities in the cerebellar posterior lobules VI, VIIa (Crus I), and IX, and in the posterior area of the vermis, regions usually involved in cognitive and emotional processing. The described patient suffered from cognitive and behavioral symptoms that are part of the cerebellar cognitive affective syndrome. This case supports the hypothesis of a cerebellar role in personality disorders emphasizing the importance of also examining the cerebellum in the presence of behavioral disturbances in children and adults.

Current Knowledge on Gene-Environment Interactions in Personality Disorders: an Update.

PURPOSE OF REVIEW: We review the existing literature on gene-environment interactions (G×E) and epigenetic changes primarily in borderline personality disorder (BPD) but also in antisocial, schizotypal, and avoidant personality disorders. RECENT FINDINGS: Research supports that susceptibility genes to BPD or its underlying traits may be expressed under certain environmental conditions such as physical or childhood sexual abuse. Epigenetic modifications of neurodevelopment- and stress-related genes are suggested to underlie the relationship between early life adversary and borderline personality disorder. Only limited studies have investigated the role of gene-environment interactions and epigenetic changes in the genesis of antisocial, schizotypal, and avoidant personality disorders. Considering the lack of pharmacological treatment for most personality disorders, the emerging evidence on the critical role of G×E and epigenetic changes in the genesis of personality disorders could help develop more biologically oriented therapeutic approaches. Future studies should explore the potential of this new therapeutic dimension.

Feasibility and effectiveness of cognitive remediation in the treatment of borderline personality disorder.

Several studies have demonstrated that borderline personality disorder (BPD) is associated with neuropsychological deficits and there is evidence that the neurocognitive profile of patients with BPD may be related to the outcome of this disorder. The aim of this study was to investigate the feasibility and the effectiveness of a cognitive remediation intervention in patients with BPD. Thirty patients with a DSM-IV-TR diagnosis of BPD were assessed on clinical, neuropsychological and functional outcome measures at baseline and after 16 weeks of a computer-assisted cognitive remediation (CACR) intervention or treatment as usual (TAU). Patients who received CACR showed a greater improvement in working memory and psychosocial functioning measures than patients treated with TAU. Symptom severity was not significantly affected by CACR treatment. The findings of this pilot study suggest the feasibility and potential effectiveness on specific cognitive domains, but modest clinical usefulness of a computerised modality of cognitive remediation in the treatment of BPD.

Borderline personality disorder: does its clinical features show specificity to differing developmental risk factors?

OBJECTIVES: To determine if differing developmental factors show specificity to differing manifestations of borderline personality disorder (BPD). METHODS: A clinical sample of 73 females diagnosed with BPD undertook a psychiatrist interview and completed self-report questionnaires, including the semi-structured Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV) assessing for BPD status. A set of negative and potentially traumatic developmental factors were included in the assessment. RESULTS: Childhood sexual abuse, affirmed by 49% of the sample, showed specificity in being linked with DIPD-defined affective instability. DIPD-defined identity disturbance also showed specificity in being associated only with reporting significant non-sexual developmental trauma. DIPD-defined anger and paranoia/dissociation showed minimal specificity and were associated with most antecedent developmental factors in adulthood. CONCLUSIONS: Differing manifestations of BPD are likely to be shaped by specific and non-specific developmental events. Clarification of such links has the potential to shape more specific therapeutic interventions.

Differences in the association between childhood trauma history and borderline personality disorder or attention deficit/hyperactivity disorder diagnoses in adulthood.

Common environmental etiological factors between borderline personality disorder (BPD) and attention deficit/hyperactivity disorder (ADHD) have not been fully studied. The main aim of this study was to investigate the relationship between childhood trauma histories, assessed by the Childhood Trauma Questionnaire-Short Form (CTQ-SF), with adult BPD, ADHD or BPD-ADHD diagnoses. Comorbid BPD-ADHD patients exhibited significantly higher clinical severity and higher scores in the Total Neglect Scale, compared to BPD and ADHD patients, and only a marginal difference was observed for Sexual Abuse when BPD and ADHD patients were compared. Physical Trauma Scales were associated with ADHD diagnosis, whereas Emotional Abuse and Sexual Abuse Scales were associated with BPD or BPD-ADHD diagnoses. The study findings support the association between experiencing traumatic events in childhood and a higher clinical severity of BPD in adulthood. Furthermore, physical trauma history in childhood could be associated with the persistence of ADHD in adulthood and emotional or sexual abuse with later development of BPD or comorbid BPD-ADHD. Whereas experiencing childhood traumas is associated with later development of more general psychopathology, our study supports that a specific type of traumatic event could increase the risk for the consolidation of a concrete psychiatric disorder in the trajectory from childhood to adulthood of vulnerable subjects.

Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms.

BACKGROUND: According to several studies, the onset of the Borderline Personality Disorder (BPD) depends on the combination between genetic and environmental factors (GxE), in particular between biological vulnerabilities and the exposure to traumatic experiences during childhood. We have searched for studies reporting possible alterations in several biological processes and brain morphological features in relation to childhood trauma experiences and to BPD. We have also looked for epigenetic mechanisms as they could be mediators of the effects of childhood trauma in BPD vulnerability. DISCUSSION: We prove the role of alterations in Hypothalamic-Pituitary-Adrenal (HPA) axis, in neurotrasmission, in the endogenous opioid system and in neuroplasticity in the childhood trauma-associated vulnerability to develop BPD; we also confirm the presence of morphological changes in several BPD brain areas and in particular in those involved in stress response. Not so many studies are available on epigenetic changes in BPD patients, although these mechanisms are widely investigated in relation to stress-related disorders. A better comprehension of the biological and epigenetic mechanisms, affected by childhood trauma and altered in BPD patients, could allow to identify "at high risk" subjects and to prevent or minimize the development of the disease later in life.

Pupillary and affective responses to maternal feedback and the development of borderline personality disorder symptoms.

Etiological models propose that a biological vulnerability to emotional reactivity plays an important role in the development of borderline personality disorder (BPD). However, the physiological and phenomenological components of emotional reactivity that predict the course of BPD symptoms in adolescence are poorly understood. This prospective study examines pupillary and affective responses to maternal feedback as predictors of BPD symptom development in adolescent girls over 18 months. Fifty-seven 16-year-old girls completed a laboratory task in which they heard recorded clips of their own mothers making critical or praising statements about them, as well as neutral statements that did not pertain to them. Changes in girls' pupil dilation and subjective affect were assessed throughout the task. The results demonstrated that greater pupillary response to maternal criticism predicted increases in BPD symptoms over time. In addition, greater pupillary and positive affective responses to maternal praise were associated with higher BPD symptoms at age 16 and faster decreases in BPD symptoms over time, but only among girls who heard clips that were rated by independent observers as less praising. The results suggest that emotional reactivity can serve as either a risk or a protective factor depending on context, with differential effects of reactivity to criticism versus praise.

Emotional Awareness Moderates the Relationship Between Childhood Abuse and Borderline Personality Disorder Symptom Factors.

OBJECTIVE: To examine pathways to borderline personality disorder (BPD), focusing on childhood abuse and emotional attention and clarity. METHOD: Among 293 community residents (mean age = 43.1; 53.9% female), measured associations between the BPD symptom factors of disturbed relatedness, affective dysregulation, and behavioral dysregulation and (a) childhood abuse (emotional, physical, and sexual); (b) emotional attention and clarity; and (c) negative affect, using structured interviews, the Schedule for Non-Adaptive and Adaptive Personality-2, the Trait Meta Mood Scale, and the Positive and Negative Affect Scale, respectively. RESULTS: All forms of childhood abuse were associated with BPD symptom factors. Emotional attention and clarity moderated the effects of childhood physical and emotional abuse on behavioral dysregulation and disturbed relatedness. All results held when controlling for negative affect. CONCLUSION: The relations between childhood abuse and BPD are robust. Emotional attention and clarity may help elucidate the links between childhood abuse and BPD.

The role of hypothalamus-pituitary-adrenal genes and childhood trauma in borderline personality disorder.

Current knowledge suggests that borderline personality disorder (BPD) results from the interaction between genetic and environmental factors. Research has mainly focused on monoaminergic genetic variants and their modulation by traumatic events, especially those occurring during childhood. However, to the best of our knowledge, there are no studies on the genetics of hypothalamus-pituitary-adrenal (HPA) axis, despite its vulnerability to early stress and its involvement in BPD pathogenesis. The aim of this study was to investigate the contribution of genetic variants in the HPA axis and to explore the modulating effect of childhood trauma in a large sample of BPD patients and controls. DNA was obtained from a sample of 481 subjects with BPD and 442 controls. Case-control differences in allelic frequencies of 47 polymorphisms in 10 HPA axis genes were analysed. Modulation of genetic associations by the presence of childhood trauma was also investigated by dividing the sample into three groups: BPD with trauma, BPD without trauma and controls. Two FKBP5 polymorphisms (rs4713902-C and rs9470079-A) showed significant associations with BPD. There were also associations between BPD and haplotype combinations of the genes FKBP5 and CRHR1. Two FKBP5 alleles (rs3798347-T and rs10947563-A) were more frequent in BPD subjects with history of physical abuse and emotional neglect and two CRHR2 variants (rs4722999-C and rs12701020-C) in BPD subjects with sexual and physical abuse. Our findings suggest a contribution of HPA axis genetic variants to BPD pathogenesis and reinforce the hypothesis of the modulating effect of childhood trauma in the development of this disorder.

A latent profile analysis of childhood trauma in women with bulimia nervosa: Associations with borderline personality disorder psychopathology.

OBJECTIVE: The aim of this study was to empirically examine naturally occurring groups of individuals with bulimia nervosa (BN) based on their childhood trauma (CT) histories and to compare these groups on a clinically relevant external validator, borderline personality disorder (BPD) psychopathology. METHOD: This study examined the relationship between CT and BPD psychopathology among 133 women with BN using latent profile analysis (LPA) to classify participants based on histories of CT. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P), the Diagnostic Interview for Borderlines-Revised (DIB-R), and the Childhood Trauma Questionnaire (CTQ). RESULTS: The LPA revealed four trauma profiles: low/no trauma, emotional trauma, sexual trauma, and polytrauma. Results indicated that the sexual and polytrauma profiles displayed significantly elevated scores on the DIB-R and that the low/no and emotional trauma profiles did not differ significantly on the DIB-R. Secondary analyses revealed elevated levels of a composite CT score among those with both BN and BPD psychopathology compared to those with BN only. DISCUSSION: These findings suggest that both childhood sexual abuse and the additive effects of childhood polytrauma may be linked to BPD psychopathology in BN. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:689-694).

Genetic and environmental overlap between borderline personality disorder traits and psychopathy: evidence for promotive effects of factor 2 and protective effects of factor 1.

BACKGROUND: Previous studies have reported strong genetic and environmental overlap between antisocial-externalizing (factor 2; F2) features of psychopathy and borderline personality disorder (BPD) tendencies. However, this line of research has yet to examine etiological associations of affective-interpersonal (factor 1, F1) features of psychopathy with BPD tendencies. METHOD: The current study investigated differential phenotypic and genetic overlap of psychopathy factors 1 and 2 with BPD tendencies in a sample of over 250 male and female community-recruited adult twin pairs. RESULTS: Consistent with previous research, biometric analyses revealed strong genetic and non-shared environmental correlations of F2 with BPD tendencies, suggesting that common genetic and non-shared environmental factors contribute to both phenotypes. In contrast, negative genetic and non-shared environmental correlations were observed between F1 and BPD tendencies, indicating that the genetic factors underlying F1 serve as protective factors against BPD. No gender differences emerged in the analyses. CONCLUSIONS: These findings provide further insight into associations of psychopathic features - F1 as well as F2 - and BPD tendencies. Implications for treatment and intervention are discussed, along with how psychopathic traits may differentially influence the manifestation of BPD tendencies.

Borderline personality disorder and bipolar disorder: what is the difference and why does it matter?

Borderline personality disorder (BPD) and bipolar disorder (types I and II) are frequently confused because of their symptomatic overlap. Although affective instability is a prominent feature of each, the pattern is entirely different. BPD is characterized by transient mood shifts that occur in response to interpersonal stressors, whereas bipolar disorder is associated with sustained mood changes. These disorders can be further distinguished by comparing their phenomenology, etiology, family history, biological studies, outcome, and response to medication. Their distinction is of great clinical importance because misdiagnosis can deprive the patient of potentially effective treatment, whether it is psychotherapy for BPD or medication for bipolar disorder. On the basis of a comprehensive literature review, guidelines for differential diagnosis are suggested, and priorities for further research are recommended.

Risk Factors for Borderline Personality Disorder in Treatment Seeking Patients with a Substance Use Disorder: An International Multicenter Study.

Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs.

The impact of childhood traumas, depressive and anxiety symptoms on the relationship between borderline personality features and symptoms of adult attention deficit hyperactivity disorder in Turkish university students.

BACKGROUND: Previous studies reported that there is a significant association between attention deficit hyperactivity disorder (ADHD) in childhood and borderline personality disorder (BPD) in adulthood. AIM: The aim of this study is to investigate the relationship of borderline personality features (BPF) and ADHD symptoms while controlling the effect of childhood traumas, symptoms of depression and anxiety in adulthood on this relationship in Turkish university students. METHODS: A total of 271 Turkish university students participated in this study. The students were assessed through the Turkish version of the Borderline Personality Inventory (BPI), the Adult ADHD Self-Report Scale (ASRS), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). RESULTS: Correlation analyses have revealed that severity of BPF is related with adult ADHD symptoms, emotional, physical abuse and depression scores. Hierarchical regression analysis has indicated that depressive symptoms, emotional and physical abuse and the severity of ADHD symptoms are the predictors for severity of BPF. CONCLUSIONS: Findings of the present study suggests that clinicians must carefully evaluate these variables and the relationship between them to understand BPF and ADHD symptoms in university students better. Together with depressive symptoms, emotional and physical abuse may play a mediator role on this relationship. Further studies are needed to evaluate causal relationship between these variables in both clinical and non-clinical populations.

[Difficulties in the assessment of trauma-related disorders]. / Begutachtung von Traumafolgestörungen.

Assessment of trauma disorders is becoming increasingly important. A major problem here is that trauma disorders are extremely heterogeneous. Moreover, they are often associated with comorbid disorders, such as borderline personality disorder. The valid diagnostic systems ICD-10 and DSM-5 poorly represent trauma disorders. The so-called complex post-traumatic stress disorder or DESNOS (disorders of extreme stress not otherwise specified) are listed .in either of the ICD-10 or DSM-5. The distinctiveness is not generally scientifically accepted. In addition, the assessment of trauma disorders is complicated because there are often multiple traumas of varying degrees of severity.

[Role of the body image in creativity--a group of objects as an attempt for contextualization]. / A teskép szerepe a kreativitásban-- Egy tárgycsoport kontextualizálási kisérlete.

The Psychiatric Institutes have supported the different forms of self-expression from the very beginning, sometimes realizing therapeutic goals as well. Under this point theatrical phenomenon was held too. Physicians often created such scenic actions themselves. The visual, pictorial expressions have begun to be shown parallel to the representation of such scenic world. That was the context to create a number of psychiatric art collections. By this kind of theatre based on esthetical judgment visual creations have been shown to the greater public promoting the representation of integral, intact and differing body image. The exotic, the bizarre, differing from the expected, the different was in the focus. It is always a question who is inside and who is outside, who can see and who can know the secret and who cannot. Starting from space - and from a psychic point of view - the perspective and the focus are also important attitudes. It is important from where we look at things, are we included in the studied area or are we watching it from outside? Are we the ones to study something or are we being watched? Only the stability of our identity enables us to play different roles. I find it important how the ability to accept one's own body limits, the formation of body image influences one's visual expression in the mirror of the surrounding society and how it appears in the creative process. Being traumatized may lead to dissociation, post-traumatic disorder or some other psychosomatic complaints. People who endure some trauma diverge from the real situation that makes them suffer if they feel that their state is hopeless, if they cannot see any way out. One possible way to come to grips with some trauma is to create, to frame, which can be either negative or positive. In the negative sense it leads to remembrance, trace-leaving, the process of grief, frustration, mutilation and sacrifice. On the other hand, in the positive sense one is able to build up something through all these. We can also look at this process from the male or female viewpoint. Through such approach and with such questions in mind, I analyze a group of graphic objects of the Psychiatric Art Collection of the Hungarian Academy of Sciences.