The interaction between monoamine oxidase A (MAOA) and childhood maltreatment as a predictor of personality pathology in females: Emotional reactivity as a potential mediating mechanism.

Research consistently demonstrates that common polymorphic variation in monoamine oxidase A (MAOA) moderates the influence of childhood maltreatment on later antisocial behavior, with growing evidence that the "risk" allele (high vs. low activity) differs for females. However, little is known about how this Gene × Environment interaction functions to increase risk, or if this risk pathway is specific to antisocial behavior. Using a prospectively assessed, longitudinal sample of females (n = 2,004), we examined whether changes in emotional reactivity (ER) during adolescence mediated associations between this Gene × Environment and antisocial personality disorder in early adulthood. In addition, we assessed whether this putative risk pathway also conferred risk for borderline personality disorder, a related disorder characterized by high ER. While direct associations between early maltreatment and later personality pathology did not vary by genotype, there was a significant difference in the indirect path via ER during adolescence. Consistent with hypotheses, females with high-activity MAOA genotype who experienced early maltreatment had greater increases in ER during adolescence, and higher levels of ER predicted both antisocial personality disorder and borderline personality disorder symptom severity. Taken together, findings suggest that the interaction between MAOA and early maltreatment places women at risk for a broader range of personality pathology via effects on ER.

Agreement between momentary and retrospective reports of cannabis use and alcohol use: Comparison of ecological momentary assessment and timeline followback indices.

OBJECTIVE: This study compares three methods of cannabis and of alcohol use assessment in a sample of regular cannabis users: (a) ecological momentary assessment (EMA) repeated momentary surveys aggregated to the daily level, (b) EMA morning reports (MR) where participants reported on their total use from the previous day, and (c) retrospective timeline followback (TLFB) interviews covering the same period of time as the EMA portion of the study. We assessed the overall correspondence between these methods in terms of cannabis and alcohol use occasions and also investigated predictors of agreement between methods. METHOD: Forty-nine individuals aged 18-50 (Mage = 24.49, 49% female, 84% White) who reported regular cannabis use completed a 14-day EMA study. At the end of the EMA period, participants returned to the laboratory to complete a TLFB (administered via computer) corresponding to the same dates of the EMA period. RESULTS: Daily aggregated EMA and TLFB reports showed a low to modest agreement for both alcohol and cannabis use. Overall, agreement between EMA and MR was better than agreement between EMA and TLFB, likely because less retrospection is required when only reporting on behavior from the previous day. Quantity and frequency of use differentially predicted agreement across reporting methods when assessing alcohol compared to cannabis. When reporting cannabis use, but not alcohol use, individuals who used more demonstrated higher agreement between EMA and TLFB. CONCLUSIONS: Results suggest that retrospective reporting methods assessing alcohol and cannabis should not be considered a direct "substitute" for momentary or daily assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Using ecological momentary assessment and a portable device to quantify standard tetrahydrocannabinol units for cannabis flower smoking.

AIMS: To evaluate the feasibility and validity of a new method of quantifying cannabis flower use, integrating the amount of cannabis flower smoked, and the potency of the cannabis flower. DESIGN: Ecological momentary assessment (EMA) for 14 days. SETTING: Participants' daily lives in Columbia, Missouri, USA. PARTICIPANTS: A total of 50 community participants, who were regular cannabis flower smokers (48% female). MEASUREMENTS: Momentary subjective intoxication ratings following cannabis flower smoking; momentary quantity of cannabis flower smoked; potency of cannabis flower smoked in terms of percentage of tetrahydrocannabinol (THC) concentration assessed with a portable device, the Purpl Pro; and time since finished smoking. FINDINGS: Participants completed our field testing of their cannabis flower (96.2%) and were compliant with our 2-week EMA protocol (73% for random prompts and 91% for morning reports). Momentary subjective intoxication ratings trended down as a function of time since smoking (r = -0.10, P = 0.004, 95% CI, [-0.17, -0.03]). Multi-level model (MLM) results indicated the momentary standard THC units (mg THC) were positively associated with momentary subjective intoxication ratings (b = 0.01, P = 0.03, 95% CI, [0.01, 0.012]). CONCLUSIONS: There is evidence to support the feasibility and initial validity of a new method of quantifying cannabis flower use into standard tetrahydrocannabinol units. Researchers investigating the effects of cannabis flower use on a range of outcomes (e.g. neurobehavioral effects, emotional sequelae, and driving impairment) as well as in clinical treatment trials might adopt this method to provide estimates of cannabis flower use.

Co-use of medication and alcohol: The influence on subjective effects of intoxication and affect.

Co-use of alcohol and medication can have serious negative health effects (e.g., overdose risk, liver damage). Research has primarily focused on older adults or the pharmacokinetics of specific medication-alcohol combinations. Little work has focused on the subjective experience of persons who take alcohol-interactive (AI) medications and also drink alcohol, particularly in psychiatric samples at high risk for problematic alcohol use and high rates of prescription medication use, such as individuals with borderline personality disorder (BPD). Data from a larger ecological momentary assessment study of alcohol use in 52 persons diagnosed with BPD (83% women; Mage = 26 years) were used to examine the influence of alcohol intoxication (i.e., estimated blood alcohol concentration [eBAC]) and medication co-use on momentary subjective experience while drinking. Participants reported AI medication use at baseline and completed multiple ecological momentary assessment reports per day over 21 days, which included reports of alcohol use, subjective effects of alcohol (e.g., pleasure, feeling worse), and negative and positive affect. AI medications significantly moderated the association between eBAC and pleasurable effects of alcohol, such that at higher levels of eBAC, those taking AI medications experienced blunted subjective pleasure compared with those not taking AI medications. AI medications did not moderate the associations between eBAC and subjective relief, feeling worse, positive affect, or negative affect. Attenuated pleasure during drinking could lead to increased drinking in an attempt to achieve a desirable state among individuals who co-use psychiatric medications and alcohol, and therefore may represent a useful target for prevention and intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Relations between lab indices of emotion dysregulation and negative affect reactivity in daily life in two independent studies.

BACKGROUND: We investigated the extent to which physiological/biological measures of emotion dysregulation collected in the lab, resting respiratory sinus arrhythmia (RSA) in Study 1 and amygdala activation in response to negative stimuli in Study 2, combined with daily measures of interpersonal stressors predicted negative emotional states in outpatients better than the stressors alone. METHODS: Participants were adult outpatients with emotional distress disorders (N=30 individuals in Study 1, and N=26 women in Study 2). After completing a laboratory session that collected physiological/biological measures of emotion dysregulation, participants then completed 1-3 weeks of ambulatory assessment during which they reported on interpersonal stressors and negative affective states several times per day. RESULTS: Laboratory measures of emotion dysregulation were largely unrelated to either momentary or mean levels of daily-life hostility, sadness, and fear in both studies. However, resting RSA significantly moderated the association between day-level interpersonal stressors and momentary fear such that low resting RSA strengthened this association. Similarly, amygdala activation tended to moderate this relationship in the predicted direction. LIMITATIONS: Both samples were relatively small and focused on only a limited set of diagnoses associated with emotion dysregulation. Only two possible physiological/biological markers of emotion dysregulation were examined. CONCLUSIONS: The current studies support the collection of physiological/biological data on emotion dysregulation when indexing daily-life emotion dysregulation as the degree of emotional reactivity to stressors in daily life among outpatients with emotional distress disorders.

The environmental, interpersonal, and affective context of nonsuicidal self-injury urges in daily life.

Urges for nonsuicidal self-injury (NSSI) are important precursors to NSSI acts and may serve as a point of intervention. A close understanding of the phenomenology of NSSI urges and the contexts in which they occur is therefore warranted. We used ambulatory assessment to examine the environmental, interpersonal, and affective contexts of NSSI urges. We recruited 56 participants with borderline personality disorder who reported on urges and contexts for 21 days with six random daily prompts, resulting in 5,750 completed assessments. Twenty-two participants reported 160 NSSI urges. We provide extensive descriptive results characterizing the interaction partners, activities, and events participants reported in association with NSSI urges. Results from a logistic multilevel model using the full sample (testing associations between all contexts and urges simultaneously) revealed that urges were more likely to occur at higher levels of negative affect, when rejection was experienced, and later in the day. Urges were not associated with disagreements or feeling let down, being at home versus away, being alone versus in company, socializing versus doing another activity, and it being a weekday versus weekend. Additional growth curve analysis for negative affect using the subsample of 22 participants who reported urges showed that, over the course of urge days compared with nonurge days, negative affect increased before urges, peaked during the urge, and then decreased, approximating a quadratic curve. We conclude that urges occurred primarily in the context of negative affect and rejection, which is consistent with theories on intra- and interpersonal functions of NSSI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A daily-life study of interpersonal stressors and alcohol use in individuals with borderline personality disorder and community controls.

BACKGROUND: Interpersonal stressors (ISs) are major factors in relapse in alcohol use disorder (AUD) and are theorized to play a role in drinking behaviors. Past work has examined this association using ecological momentary assessment (EMA), but the unique effects of rejections and disagreements on alcohol use are unknown. Research suggests the two ISs functionally differ and may display distinct associations with drinking. Further, these associations may differ in people with borderline personality disorder (BPD), a population reporting frequent IS and co-occurring AUD. METHODS: 113 drinkers (community: n = 59; BPD: n = 54) reported alcohol use and ISs using EMA for 21 days. Using generalized estimating equations, we expected that rejection and disagreement would predict increased likelihood of drinking each day. We examined both cumulative (throughout each day) and immediate momentary effects of ISs predicting subsequent drinking on that same day. Further, we predicted that these associations would be stronger in individuals with BPD. RESULTS: Greater rejections throughout the day were associated with a reduced likelihood of drinking that day (OR = 0.56, 95 % CI:[0.32, 0.97], p < .040). In contrast, disagreements immediately prior to drinking were associated with an increased likelihood of drinking that day (OR = 0.60, 95 % CI:[1.02, 2.50], p = .039). However, the effect of disagreement on drinking was moderated by BPD diagnosis (OR = 2.56, 95 % CI:[1.13, 5.80], p = .025), such that the effect was only present for individuals with BPD. CONCLUSIONS: Assessing ISs as an aggregate predictor may mask potentially opposite effects on alcohol use. Additionally, disagreements may be a risk factor for subsequent alcohol use in BPD.

Borderline personality disorder and substance use disorders: an updated review.

For decades, clinicians and researchers have recognized that borderline personality disorder (BPD) and substance use disorders (SUDs) are often diagnosed within the same person (e.g., (Gunderson JG. Borderline personality disorder: A clinical guide. Washington, D.C.: American Psychiatric Press, 2001; Leichsenring et al., Lancet 377:74-84, 2011; Paris J. Borderline personality disorder: A multidimensional approach. American Psychiatric Pub, 1994; Trull et al., Clin Psychol Rev 20:235-53, 2000)). Previously, we documented the extent of this co-occurrence and offered a number of methodological and theoretical explanations for the co-occurrence (Trull et al., Clin Psychol Rev 20:235-53, 2000). Here, we provide an updated review of the literature on the co-occurrence between borderline personality disorder (BPD) and substance use disorders (SUDs) from 70 studies published from 2000 to 2017, and we compare the co-occurrence of these disorders to that documented by a previous review of 36 studies over 15 years ago (Trull et al., Clin Psychol Rev 20:235-53, 2000).