Neural processing of emotional overinvolvement in borderline personality disorder.

OBJECTIVE: Patients with borderline personality disorder (BPD) fare better clinically if their families are rated as being high in emotional overinvolvement, which is characterized by marked emotionality, anxious concern, and protective behavior. This is not true of patients with disorders such as schizophrenia or major depression. We used functional magnetic resonance imaging methods to explore the link between emotional overinvolvement (EOI) and better clinical outcome in BPD. Specifically, we tested the hypothesis that, unlike healthy controls or people with other psychiatric problems, people with BPD process EOI as an approach-related stimulus. METHOD: Participants with BPD (n = 13) and dysthymia (n = 10) (DSM-IV criteria for both) and healthy controls (n = 11) were imaged using a high field strength (3T) scanner while they listened to a standardized auditory stimulus consisting of either 4 neutral or 4 EOI comments. Participants also rated their mood before and after exposure to the comments. RESULTS: All participants reported increased negative mood after hearing EOI and rated the EOI comments as negative stimuli. However, after subtracting activation to neutral comments, participants with BPD showed higher activation in left prefrontal regions during EOI compared to the other groups. Increased left prefrontal activation during EOI was also correlated with clinical measures indicative of borderline pathology. Participants with dysthymia showed increased amygdala activation during EOI. This was not true for the healthy controls or participants with BPD. CONCLUSIONS: For people with BPD, EOI may be activating neural circuitry implicated in the processing of approach-related stimuli. Increased left prefrontal activation to EOI may be a vulnerability marker for BPD. These findings may also help explain why BPD patients do better clinically in high EOI family environments.

Cortico-limbic response to personally challenging emotional stimuli after complete recovery from depression.

People vulnerable to depression are at increased risk of relapse if they live in highly critical family environments. To explore this link, we used neuroimaging methods to examine cortico-limbic responding to personal criticisms in healthy participants and participants with known vulnerability to major depression. Healthy controls and fully recovered participants with a past history of major depression were scanned while they heard praising, critical, and neutral comments from their own mothers. Prior to scanning, the formerly depressed and the control participants were indistinguishable with respect to self-reported positive, negative, or anxious mood. They also reported similar mood changes after being praised or criticized. However, formerly depressed participants responded to criticism with greater activation in the amygdala and less activation in the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) than did controls. During praise and neutral commentary, amygdala activation was comparable in both groups, although lower levels of activation in the DLPFC and ACC still characterized formerly depressed participants. Vulnerability to depression may be associated with abnormalities in cortico-limbic activation that are independent of mood state and that remain even after full recovery. Criticism may be a risk factor for relapse because it activates the amygdala and perturbs the affective circuitry that underlies depression.

Cortico-limbic response to personally challenging emotional stimuli after complete recovery from depression.

People vulnerable to depression are at increased risk of relapse if they live in highly critical family environments. To explore this link, we used neuroimaging methods to examine cortico-limbic responding to personal criticisms in healthy participants and participants with known vulnerability to major depression. Healthy controls and fully recovered participants with a past history of major depression were scanned while they heard praising, critical, and neutral comments from their own mothers. Prior to scanning, the formerly depressed and the control participants were indistinguishable with respect to self-reported positive, negative, or anxious mood. They also reported similar mood changes after being praised or criticized. However, formerly depressed participants responded to criticism with greater activation in the amygdala and less activation in the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) than did controls. During praise and neutral commentary, amygdala activation was comparable in both groups, although lower levels of activation in the DLPFC and ACC still characterized formerly depressed participants. Vulnerability to depression may be associated with abnormalities in cortico-limbic activation that are independent of mood state and that remain even after full recovery. Criticism may be a risk factor for relapse because it activates the amygdala and perturbs the affective circuitry that underlies depression.

Repressive coping, emotional adjustment, and cognition in people who have lost loved ones to suicide.

Research indicates that a repressive coping style is psychologically protective against the stress of trauma, yet it is unclear whether this finding generalizes to suicide bereavement. Thus, we assessed cognitive ability and mental health among individuals who lost a loved one to suicide. The results indicate that repressive coping may be associated with greater emotional health during suicide bereavement. Interestingly, "repressors" also had lower scores on both cognitive tasks compared to "nonrepressors," but it is unclear whether their more recent loss accounts for this difference. These results are based on cross-sectional data, and should be interpreted with caution.

Measuring expressed emotion: an evaluation of the shortcuts.

The construct of expressed emotion (EE) is a highly reliable and valid predictor of poor clinical outcomes in patients with major psychopathology. Patients are at early risk for relapse if they live with family members who are classified as high in EE. Conventionally, EE is assessed with the Camberwell Family Interview (CFI), a semistructured interview that is conducted with the patient's key relatives. Unfortunately, training in the CFI is difficult to obtain. The CFI is also time-consuming to administer and labor intensive to rate. In this article, the authors discuss alternative ways of assessing EE. They also evaluate the predictive validity of these measures and make recommendations for researchers and clinicians interested in using these assessments.

Mental illness and suicidality after Hurricane Katrina.

OBJECTIVE: To estimate the impact of Hurricane Katrina on mental illness and suicidality by comparing results of a post-Katrina survey with those of an earlier survey. METHODS: The National Comorbidity Survey-Replication, conducted between February 2001 and February 2003, interviewed 826 adults in the Census Divisions later affected by Hurricane Katrina. The post-Katrina survey interviewed a new sample of 1043 adults who lived in the same area before the hurricane. Identical questions were asked about mental illness and suicidality. The post-Katrina survey also assessed several dimensions of personal growth that resulted from the trauma (for example, increased closeness to a loved one, increased religiosity). Outcome measures used were the K6 screening scale of serious mental illness and mild-moderate mental illness and questions about suicidal ideation, plans and attempts. FINDINGS: Respondents to the post-Katrina survey had a significantly higher estimated prevalence of serious mental illness than respondents to the earlier survey (11.3% after Katrina versus 6.1% before; chi(2)1= 10.9; P < 0.001) and mild-moderate mental illness (19.9% after Katrina versus 9.7% before; chi(2)1 = 22.5; P < 0.001). Among respondents estimated to have mental illness, though, the prevalence of suicidal ideation and plans was significantly lower in the post-Katrina survey (suicidal ideation 0.7% after Katrina versus 8.4% before; chi(2)1 = 13.1; P < 0.001; plans for suicide 0.4% after Katrina versus 3.6% before; chi(2)1 = 6.0; P = 0.014). This lower conditional prevalence of suicidality was strongly related to two dimensions of personal growth after the trauma (faith in one's own ability to rebuild one's life, and realization of inner strength), without which between-survey differences in suicidality were insignificant. CONCLUSION: Despite the estimated prevalence of mental illness doubling after Hurricane Katrina, the prevalence of suicidality was unexpectedly low. The role of post-traumatic personal growth in ameliorating the effects of trauma-related mental illness on suicidality warrants further investigation.

Autobiographical memory specificity in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse.

Some psychotherapists believe that adult survivors of childhood sexual abuse (CSA) are characterised by memory deficits for their childhood. Using the Autobiographical Memory Test (AMT), we asked nonabused control participants and participants who reported either continuous, recovered, or repressed memories of CSA to retrieve a specific personal memory in response to either positive or negative cue words from either childhood or adolescence/adulthood. The results indicated that participants who believed they harboured repressed memories of abuse tended to exhibit the greatest difficulty retrieving specific memories from their childhood. Neither posttraumatic stress disorder (PTSD) nor major depression was related to diminished memory specificity.

Reality monitoring in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse.

People who report either repressed or recovered memories of childhood sexual abuse (CSA) may have deficits in reality monitoring--the process whereby one discriminates memories of percepts from memories of images. Using signal detection methods, the authors found that adults reporting either repressed or recovered memories of CSA were less able to discriminate between words they had seen from words they had imagined seeing than were adults reporting either never having forgotten their CSA or adults reporting no history of CSA. Relative deficits in the ability to discriminate percepts from images (i.e., low d') were apparent on only some tests. The groups did not differ in their criterion--response bias--for affirming having seen versus imagined stimuli.

The relationship between obsessive-compulsive and posttraumatic stress symptoms in clinical and non-clinical samples.

Although case reports suggest the existence of a unique relationship between obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), results from large-scale epidemiological and clinical studies have been more equivocal. Furthermore, symptom overlap may artificially inflate the significance of the relationship between OCD and PTSD. Utilizing the Obsessive-Compulsive Inventory [OCI; Psychol. Assess. 10 (1998) 206] and the Posttraumatic Diagnostic Scale [PDS; Psychol. Assess. 9 (1997) 445], this study examined the relationship between OCD and PTSD symptoms in 128 patients diagnosed with OCD, 109 patients diagnosed with PTSD, 63 patients diagnosed with another anxiety disorder, and 40 college students. Experts in OCD and PTSD independently rated items on the OCI and PDS for the degree of overlap across the disorders. On the basis of these ratings, we created a scale from each measure that included only non-overlapping items. Results revealed that overall symptoms of OCD and PTSD were related in all samples. However, after controlling for depression and overlapping symptoms simultaneously, this relationship was no longer significant in the OCD and PTSD samples, although it remained significant in the anxious and college student comparison groups. These results support the presence of a relationship between symptoms of OCD and PTSD that may be largely accounted for by a combination of symptom overlap and depression.

No disgust recognition deficit in obsessive-compulsive disorder.

BACKGROUND: Patients with basal ganglia abnormalities misclassify facial expressions of disgust as expressions of anger when asked to identify the emotion depicted in photographs of individuals displaying different emotions. Sprengelmeyer, Young, Pundt et al. (1997) reported a similar disgust recognition deficit in patients with obsessive-compulsive disorder (OCD)--an anxiety disorder associated with basal ganglia abnormality. METHODS: In the present experiment, we attempted to replicate Sprengelmeyer, Young, Pundt et al.'s (1997) findings. RESULTS: We failed to replicate Sprengelmeyer, Young, Pundt et al.'s finding of disgust recognition deficits in OCD patients relative to healthy control subjects. One patient with especially severe OCD did, however, exhibit impairment by misclassifying disgust expressions as anger expressions. DISCUSSION: These data do not confirm the presence of disgust recognition deficits in individuals with OCD. In light of the deficits exhibited by one subject with severe OCD, disgust recognition deficits may be confined to an unidentified subset of people with OCD.