Characteristics of hallucinations in borderline personality disorder. Similarities and differences with schizophrenia and bipolar disorder / Características de las alucinaciones en el trastorno límite de la personalidad. Similitudes y diferencias con la esquizofrenia y el trastorno bipolar.

Psychosis can be considered a dimension that in its most severe extreme can be expressed with alterations in sensory perception, mainly hallucinations. Their presence is a fact that is frequently observed in severe psychiatric pathologies such as schizophrenia (EZQ) and bipolar disorder (BD) where they can be markers of severity. However, sensory-perceptual disturbances are not pathognomonic of these disorders, nor do they signal any of these illnesses as an isolated event. Such symptomatology can be described in a variety of situations both within and outside psychopathology. In this sense, proposing a direct line between hallucinations and diseases such as CZS or TB disregards their occurrence in other pathologies, as is the case of Borderline Personality Disorder (BPD). It is feasible that we may find the expression of pseudo hallucinations or hallucinations in patients with this disorder and their presence may have etiological, clinical and therapeutic connotations that should be reviewed and taken into account in our clinical practice.

La psicosis puede ser considerada una dimensión que en su extremo de mayor gravedad puede expresarse con alteraciones en la sensopercepción, principalmente alucinaciones. Su presencia es un hecho que se constata con frecuencia en patologías psiquiátricas severas como la esquizofrenia (EZQ) y el trastorno bipolar (TB) donde pueden ser marcadores de gravedad. No obstante, las alteraciones sensoperceptivas no son patognomónicas de estos trastornos ni señalan ninguna de estas enfermedades como un hecho aislado. Dicha sintomatología puede ser descripta en diversas situaciones dentro y fuera de la psicopatología. En este sentido, proponer una línea directa entre las alucinaciones con enfermedades tales como la EZQ o el TB desestima su ocurrencia en otras patologías, como es el caso del Trastorno límite de la personalidad (TLP). Es factible que constatemos la expresión de alucinaciones en pacientes con este trastorno y su presencia puede tener connotaciones etiológicas, clínicas y terapéuticas que deben ser revisadas para tener en cuenta en nuestra práctica clínica.

Automatic detection of facial expressions during the Cyberball paradigm in Borderline Personality Disorder: a pilot study.

Borderline Personality Disorder (BPD) symptoms include inappropriate control of anger and severe emotional dysregulation after rejection in daily life. Nevertheless, when using the Cyberball paradigm, a tossing game to simulate social exclusion, the seven basic emotions (happiness, sadness, anger, surprise, fear, disgust, and contempt) have not been exhaustively tracked out. It was hypothesized that these patients would show anger, contempt, and disgust during the condition of exclusion versus the condition of inclusion. When facial emotions are automatically detected by Artificial Intelligence, "blending", -or a mixture of at least two emotions- and "masking", -or showing happiness while expressing negative emotions- may be most easily traced expecting higher percentages during exclusion rather than inclusion. Therefore, face videos of fourteen patients diagnosed with BPD (26 ± 6 years old), recorded while playing the tossing game, were analyzed by the FaceReader software. The comparison of conditions highlighted an interaction for anger: it increased during inclusion and decreased during exclusion. During exclusion, the masking of surprise; i.e., displaying happiness while feeling surprised, was significantly more expressed. Furthermore, disgust and contempt were inversely correlated with greater difficulties in emotion regulation and symptomatology, respectively. Therefore, the automatic detection of emotional expressions during both conditions could be useful in rendering diagnostic guidelines in clinical scenarios.

Trastornos del espectro autista, trastornos por déficit de atención hiperactividad y desregulación emocional: enmascaramiento y abordaje / Autistic spectrum disorders, attention deficit disorders, hyperactivity and emotional dysregulation: masking and approach

Resumen Los Trastornos del Espectro Autista (TEA) y los Tras tornos por Déficit de Atención Hiperactividad (TDAH) son Trastornos del Neurodesarrollo (TN) que coexisten frecuentemente y que tienen factores etiológicos, bio lógicos, clínicos en común. La comorbilidad de ambos TN se asocia a un retraso en el diagnóstico del TEA o un diagnóstico que nunca llegan a recibir y es frecuente el desarrollo de alteraciones perceptivas, emocionales, cognitivas y conductuales relacionadas con la Desregu lación Emocional (DE). Cuando ambos TN no son diag nosticados en infancia, frecuentemente reciben diag nósticos equivocados en edades más tardías, siendo el más frecuente el Trastorno Límite de Personalidad (TLP). Se analiza la presentación clínica de la asociación del TEA y el TDAH, la asociación con DE, diferenciación del TLP y evaluación e intervención. La comorbilidad TEA, TDAH, DE, es un trastorno más severo, asociado a poli farmacología y a ingresos hospi talarios.

Abstract Autism Spectrum Disorders (ASD) and Attention Defi cit Hyperactivity Disorders (ADHD) are Neurodevelop mental Disorders (ND) that frequently coexist together and have etiological, biological, and clinical factors in common. The comorbidity of both neurodevelopmental disorders is associated with a delay or lack of ASD di agnosis and the development of perceptual, emotional, cognitive and behavioral alterations related to Emotional Dysregulation (ED) is common. When both TN are not diagnosed in childhood, they frequently receive wrong diagnoses at later ages, the most frequent being Border line Personality Disorder (BPD). The clinical presentation of the association of ASD and ADHD, the association with ED, differentiation of BPD, and evaluation and intervention are here analyzed. The comorbidity ASD, ADHD, ED is a more severe disorder associated to polypharmacology and hospital admissions.

Human olfactory neural progenitor cells reveal differences in IL-6, IL-8, thrombospondin-1, and MCP-1 in major depression disorder and borderline personality disorder.

Background: Discovering biological markers is essential for understanding and treating mental disorders. Despite the limitations of current non-invasive methods, neural progenitor cells from the olfactory epithelium (hNPCs-OE) have been emphasized as potential biomarker sources. This study measured soluble factors in these cells in Major Depressive Disorder (MDD), Borderline Personality Disorder (BPD), and healthy controls (HC). Methods: We assessed thirty-five participants divided into MDD (n=14), BPD (n=14), and HC (n=7). MDD was assessed using the Hamilton Depression Rating Scale. BPD was evaluated using the DSM-5 criteria and the Structured Clinical Interview for Personality Disorders. We isolated hNPCs-OE, collected intracellular proteins and conditioned medium, and quantified markers and soluble factors, including Interleukin-6, interleukin-8, and others. Analysis was conducted using one-way ANOVA or Kruskal-Wallis test and linear regression. Results: We found that hNPCs-OE of MDD and BPD decreased Sox2 and laminin receptor-67 kDa levels. MASH-1 decreased in BPD, while tubulin beta-III decreased in MDD compared to controls and BPD. Also, we found significant differences in IL-6, IL-8, MCP-1, and thrombospondin-1 levels between controls and MDD, or BPD, but not between MDD and BPD. Conclusions: Altered protein markers are evident in the nhNPCs-OE in MDD and BPD patients. These cells also secrete higher concentrations of inflammatory cytokines than HC cells. The results suggest the potential utility of hNPCs-OE as an in vitro model for researching biological protein markers in psychiatric disorders. However, more extensive validation studies are needed to confirm their effectiveness and specificity in neuropsychiatric disorders.

[Autistic spectrum disorders, attention deficit disorders, hyperactivity and emotional dysregulation: masking and approach]. / Trastornos del espectro autista, trastornos por déficit de atención hiperactividad y desregulación emocional: enmascaramiento y abordaje.

Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorders (ADHD) are Neurodevelopmental Disorders (ND) that frequently coexist together and have etiological, biological, and clinical factors in common. The comorbidity of both neurodevelopmental disorders is associated with a delay or lack of ASD diagnosis and the development of perceptual, emotional, cognitive and behavioral alterations related to Emotional Dysregulation (ED) is common. When both TN are not diagnosed in childhood, they frequently receive wrong diagnoses at later ages, the most frequent being Borderline Personality Disorder (BPD). The clinical presentation of the association of ASD and ADHD, the association with ED, differentiation of BPD, and evaluation and intervention are here analyzed. The comorbidity ASD, ADHD, ED is a more severe disorder associated to polypharmacology and hospital admissions.

Los Trastornos del Espectro Autista (TEA) y los Trastornos por Déficit de Atención Hiperactividad (TDAH) son Trastornos del Neurodesarrollo (TN) que coexisten frecuentemente y que tienen factores etiológicos, biológicos, clínicos en común. La comorbilidad de ambos TN se asocia a un retraso en el diagnóstico del TEA o un diagnóstico que nunca llegan a recibir y es frecuente el desarrollo de alteraciones perceptivas, emocionales, cognitivas y conductuales relacionadas con la Desregulación Emocional (DE). Cuando ambos TN no son diagnosticados en infancia, frecuentemente reciben diagnósticos equivocados en edades más tardías, siendo el más frecuente el Trastorno Límite de Personalidad (TLP). Se analiza la presentación clínica de la asociación del TEA y el TDAH, la asociación con DE, diferenciación del TLP y evaluación e intervención. La comorbilidad TEA, TDAH, DE, es un trastorno más severo, asociado a poli farmacología y a ingresos hospitalarios.

Efficacy of Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder: A Systematic Review of Randomized Controlled Trials.

Objective: Borderline personality disorder (BPD) is a serious public health problem. Dialectical Behavior Therapy (DBT) is a program that has provided encouraging results for its treatment. However, scientific evidence about its efficacy is scarce. Therefore, we aimed to describe the scientific production on the components of the DBT program and its therapeutic efficacy in the treatment of people with BPD. Method : A systematic review with relevant keywords was conducted based on studies available in Scopus, Web of Science, and PubMed until June 2023, including studies in English, research on therapeutic intervention, studies with a randomized controlled trial (RCT) design that included people with the diagnosis of BPD. Results: We found 18 RCTs, most of which supported the effectiveness of DBT for BPD. There were a total of 1,755 participants in these studies, most of whom were women. These studies looked for treating self-injurious behaviors, suicidal thoughts or ideations, number of visits to emergency services, and frequency of hospital admissions. Most studies revealed that both short-term DBT and standard DBT improved suicidality in BPD patients with small or moderate effect sizes, lasting up to 24 months after the treatment period. Furthermore, these studies showed that DBT can significantly improve general psychopathology and depressive symptoms in patients with BPD. Improvement of compliance, impulsivity, mood instability, as well as reduction in hospitalization rate are other findings observed in the trials following DBT. Conclusion: Although DBT shows efficacy in the treatment of BPD, heterogeneity in the methodologies employed is highlighted. Therefore, it is necessary to design studies from a homogeneous theoretical and methodological framework.

Trastornos somatomorfos y rasgos de personalidad en pacientes hospitalizados por lumbalgia crónica en El Salvador / Somatoform Disorders and Personality Traits in Hospitalized Patients with Chronic Back Pain in El Salvador

Introducción. El trastorno somatomorfo se caracteriza por la presentación de múltiples síntomas físicos que no pueden ser atribuidos a otra enfermedad física, mental o al uso de sustancias, teniendo como comorbilidad más prevalente a los trastornos de personalidad. Objetivo. Determinar la frecuencia de trastorno somatomorfo, sus características principales y diferentes rasgos de personalidad entre pacientes con lumbalgia crónica. Metodología. Estudio descriptivo transversal realizado con pacientes ingresados en el servicio de neurocirugía del Hospital General del Instituto Salvadoreño del Seguro Social. La recolección de datos se realizó a través de la escala Screening for Somatoform Symptoms 2 y la escala InternationalPersonality Disorder Examination. Las variables cualitativas fueron analizadas a través de frecuencias absolutas. Las variables cuantitativas fueron analizadas a través de medidas de tendencia central y de dispersión. Los análisis estadísticos fueron realizados en el programa Statistical Package for the Social Sicience, versión 26. Resultados. Se incluyeron 60 pacientes, 40 de ellos mujeres, 31 entre los 41 y 60 años. Veintiocho pacientes presentaron ocho o más síntomas, excluyéndose dolor lumbar. Cuarenta y cinco pacientes reportaron sintomatología por más de un año. Cincuenta y tres pacientes presentaron trastorno somatomorfo. Los trastornos de personalidad más frecuentes fueron obsesivo-compulsivos (31), límites (21) y paranoides (21). Conclusión. Los pacientes con dolor lumbar crónico que requieren ingreso hospitalario presentan una alta frecuencia de trastornos somatomorfos, con dolor en piernas o brazos como síntoma principal; además, estos pacientes se caracterizan por presentar en su mayoría rasgos de personalidad obsesivo-compulsivos.

Introduction. The somatoform symptoms disorder is characterized by multiple psychical symptoms that can't be attributed to another physical or mental health diagnosis or drug abuse, having personality disorders as the most common comorbidity. Objective. To determine the frequency of somatoform disorders, it's most important characteristics and different personality traits among patients with chronic back pain. Methodology. Cross-sectional descriptive study carried out with patients admitted to the neurosurgery department of the General Hospital of the Salvadoran Social Security Institute. Data collection was carried out using the Screening for Somatoform Symptoms 2 scale and the International Personality Disorder Examination scale. The qualitative variables were analyzed through absolute frequencies. The quantitative variables were analyzed through measures of central tendency and dispersion. The statistical analyzes were carried out using the Statistical Package for the Social Sciences version 26. Results. The study included 60 patients, 40 of them women, 31 between 41 and 60 years old. Twenty-eight patients presented eight or more symptoms, excluding low back pain. Forty-five patients reported symptoms for more than one year. Fifty-three patients presented somatoform disorder. The most frequent personality disorders were obsessive-compulsive (31), borderline (21) and paranoid (21). Conclusion. Patients with chronic lower back pain who require hospital admission have a high frequency of somatoform disorders, with the main symptom being pain in the legs or arms; furthermore, these patients are characterized by mostly presenting obsessive-compulsive personality traits

Brazilian adaptation of the McLean Screening Instrument for Borderline Personality Disorder

Abstract Objective Borderline personality disorder (BPD) is a serious and extremely prevalent mental disorder. Early diagnosis is vital for treatment. However, there are no specific screening instruments validated for Brazilian Portuguese. This study aimed to adapt the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) to the Brazilian context. The MSI-BPD is a self-report instrument based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), that enables fast and reliable assessment of BPD, with measures of sensitivity (SN) and specificity (SP) similar to the diagnostic interview for the DSM-5 (Structured Clinical Interview for DSM-V Axis II Disorders [SCID-II]), taken as the gold standard. Methods Two independent translations, a synthesis version, back-translation, and analysis by experts were employed to create the final version of the instrument in Brazilian Portuguese. The translated instrument was administered to 1,702 adults aged 18-59 years to verify evidence of validity relating to content, internal structure, relationship with other variables, and reliability. Results The exploratory and confirmatory factor analyses show that the one-factor structure is adequate. The scale showed satisfactory internal consistency (Kuder-Richardson coefficient [KR-20] of Cronbach's alpha = 0.691) and good test-retest reliability (intraclass correlation coefficient [ICC] = 0.802). Logistic regression analysis using the Personality Inventory for the DSM-5-Brief Form (PID-5-BF) (DSM-5) as reference established an ideal cut-off point of eight symptoms, with adequate SN (0.79) and SP (0.75), similar to the original instrument. The area under the curve (AUC) was 0.830 (95% confidence interval: 0.802-0.858), with a positive predictive value of 89.2%. Conclusion The Brazilian version of the MSI-BPD has adequate psychometric properties for use as a BPD screening tool by clinicians.

Study Features and Response Compliance in Ecological Momentary Assessment Research in Borderline Personality Disorder: Systematic Review and Meta-analysis.

BACKGROUND: Borderline personality disorder (BPD) is characterized by frequent and intense moment-to-moment changes in affect, behavior, identity, and interpersonal relationships, which typically result in significant and negative deterioration of the person's overall functioning and well-being. Measuring and characterizing the rapidly changing patterns of instability in BPD dysfunction as they occur in a person's daily life can be challenging. Ecological momentary assessment (EMA) is a method that can capture highly dynamic processes in psychopathology research and, thus, is well suited to study intense variability patterns across areas of dysfunction in BPD. EMA studies are characterized by frequent repeated assessments that are delivered to participants in real-life, real-time settings using handheld devices capable of registering responses to short self-report questions in daily life. Compliance in EMA research is defined as the proportion of prompts answered by the participant, considering all planned prompts sent. Low compliance with prompt schedules can compromise the relative advantages of using this method. Despite the growing EMA literature on BPD in recent years, findings regarding study design features that affect compliance with EMA protocols have not been compiled, aggregated, and estimated. OBJECTIVE: This systematic meta-analytic review aimed to investigate the relationship between study design features and participant compliance in EMA research of BPD. METHODS: A systematic review was conducted on November 12, 2021, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analyses of Observational Studies in Epidemiology) guidelines to search for articles featuring EMA studies of BPD that reported compliance rates and included sufficient data to extract relevant design features. For studies with complete data, random-effect models were used to estimate the overall compliance rate and explore its association with design features. RESULTS: In total, 28 peer-reviewed EMA studies comprising 2052 participants were included in the study. Design features (sampling strategy, average prompting frequency, number of items, response window, sampling device, financial incentive, and dropout rate) showed a large variability across studies, and many studies did not report design features. The meta-analytic synthesis was restricted to 64% (18/28) of articles and revealed a pooled compliance rate of 79% across studies. We did not find any significant relationship between design features and compliance rates. CONCLUSIONS: Our results show wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying setups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible nonspecific factors of study design that may have an impact on compliance. Given the promise of EMA research in BPD, we also discuss the importance of unifying standards for EMA reporting so that data stemming from this rich literature can be aggregated and interpreted jointly.

Rasgos antisociales y neuroticismo como predictores de conducta suicida en trastorno límite de la personalidad: un estudio retrospectivo

Introducción: El espectro de la conducta suicida (CS) es nuclear en la clínica y el tratamiento del trastorno límite de personalidad (TLP). Los rasgos patológicos del TLP intervienen como factores de riesgo de CS en confluencia con otras variables clínicas y sociodemográficas asociadas con el TLP. El objetivo del presente trabajo consiste en evaluar los rasgos de personalidad específicos del TLP que se relacionan con la CS. Métodos: Se realiza un estudio transversal, observacional y retrospectivo, de una muestra de 134 pacientes con diagnóstico de TLP según los criterios del DSM-5. Se utilizan los cuestionarios de Millon-II, Zuckerman-Kuhlman y Barrat para valorar distintos parámetros de la personalidad. Se realizan comparaciones por variables mediante las pruebas de la x2 y de la t de Student. La asociación entre variables se analiza mediante regresión logística multivariada. Resultados: Se objetivan diferencias estadísticamente significativas entre la CS y relacionadas y la dimensión neuroticismo-ansiedad en el test de Zuckerman-Kuhlman. Asimismo se relaciona de manera significativa con la subescala fóbica y antisocial del Millon-II. La impulsividad medida con las pruebas de Zuckerman-Kuhlman y Barrat no aparece relacionada con la CS. Conclusiones: Los resultados presentados plantean el papel de los rasgos fóbicos, antisociales y del neuroticismo como posibles rasgos de personalidad del TLP relacionados con la CS. Incluso se propone una importancia mayor que el de la impulsividad dentro de la relación del TLP con la CS. De cara al futuro, estudios longitudinales permitirían aumentar la evidencia científica de los hallazgos presentados. © 2021 Asociación Colombiana de Psiquiatría. Publicado por Elsevier Espafña, S.L.U. Todos los derechos reservados.

Introduction: The spectrum of suicidal behaviour (SB) is nuclear in the clinic andmanagement of borderline personality disorder (BPD). The pathological personality traits of BPD intervene as risk factors for SB in confluence with other clinical and sociodemographic variables associated with BPD. The objective of this work is to evaluate the specific personality traits of BPD that are related to SB. Methods: A cross-sectional, observational and retrospective study was carried out on a sample of 134 patients diagnosed with BPD according to DSM-5 criteria. The Millon-II, Zuckerman-Kuhlman and Barrat questionnaires were used to assess different personality parameters. Variable comparisons were made using the test and the Student's t-test. The association between variables was analysed using multivariate logistic regression. Results: Statistically significant differences were observed between SB and related factors and the neuroticism-anxiety dimension in the Zuckerman-Kuhlman test. It is also significantly related to the phobic and antisocial subscale of the Millon-II. Impulsivity measured with the Zuckerman-Kuhlman and Barrat tests does not appear to be related to SB. Conclusions: The results presented raise the role of phobic, antisocial and neuroticism traits as possible personality traits of BPD related to SB, suggesting an even greater importance within the relationship between BPD and SB than that of impulsivity. Looking to the future, longitudinal studies would increase the scientific evidence for the specified findings. © 2021 Asociacio´n Colombiana de Psiquiatria. Published by Elsevier España, S.L.U. All rights reserved.

Estruturas de interação no tratamento psicodinâmico de uma paciente com Transtorno de Personalidade Borderline / Estructuras de interacción en el tratamiento psicodinámico de un paciente con Trastorno Límite de la Personalidad / Interaction Structures in the Psychodynamic Therapy of a Patient with Borderline Personality Disorder

Estruturas de interação são padrões repetitivos que ocorrem entre terapeuta e paciente, mesmo que am-bos não sejam conscientes disso. Na pesquisa empíri-ca, elas ajudam a compreender como se estabelece o processo de mudança em psicoterapia. Nesse sentido, esta investigação utilizou 68 sessões de psicoterapia psicanalítica de um caso de uma jovem paciente com Transtorno de Personalidade Borderline (tpb) com o objetivo de identificar as estruturas de interação e sua correlação com o tempo de tratamento. Os dados fo-ram gravados em vídeo e posteriormente codificados através do Psychotherapy Process Q-Set (pqs), por duplas de juízes treinados na metodologia Q-Sort. A partir desses dados, foi realizada a análise fatorial do tipo Q de componentes principais que indicou quatro estruturas de interação, sendo fator 1: Colaborativo; fa-tor 2: Resistência; fator 3: Aliança/Ruptura e fator 4: Apoio/Encorajamento. As estruturas indicaram que a interação se voltou para o trabalho de manutenção da interação colaborativa, através de uma posição empá-tica do terapeuta, direcionado para o reconhecimento dos estados internos do paciente. Apesar do trabalho colaborativo, a resistência também surgiu como um padrão repetitivo. O terapeuta se tornou diretivo com intervenções estruturadas e questionando o paciente, desta forma contribuindo para o desenvolvimento da capacidade de mentalização. Implicações sobre o pro-cesso psicoterápico e indicações para estudos futuros são apresentados com o intuito de contribuir na com-preensão sobre o tratamento de pacientes com tpb em psicoterapia psicodinâmica.

Las estructuras de interacción son patrones repetitivos que ocurren entre el terapeuta y el paciente, incluso si ambos no son conscientes de esto. En la investigación empírica ayudan a comprender cómo se establece el proceso de cambio en psicoterapia. En tal sentido, esta investigación utilizó 68 sesiones de psicoterapia psicoanalítica del caso de un paciente joven con Tras-torno Límite de la Personalidad (tlp) para identificar las estructuras de interacción y su correlación con el momento del tratamiento. Los datos fueron grabados en video y posteriormente codificados utilizando el Q-Set Proceso de Psicoterapia (pqs), por pares de jueces en-trenados en la metodología Q-Sort. Con base en estos datos, se realizó un análisis factorial del tipo Q de componentes principales, el cual indicó cuatro estructuras de interacción, siendo factor 1: Colaborativo; factor 2: Resistencia; factor 3: Alianza/Disrupción y factor 4: Apoyo/Estímulo. Las estructuras indicaron que la interacción se tornó al trabajo de mantener la interacción colaborativa, a través de una posición empática del terapeuta, dirigida al reconocimiento de los estados internos del paciente. A pesar del trabajo colaborativo, la resistencia también surgió como un patrón repetitivo. El terapeuta se volvió directivo con intervenciones estructuradas cuestionando al paciente, contribuyendo así al desarrollo de la capacidad mentalizadora. Se presentan implicaciones en el proceso psicoterapéutico e indicaciones para futuros estudios con el objetivo de contribuir a la comprensión del tratamiento de pacientes con tlp en psicoterapia psicodinámica.

Interaction structures are repetitive patterns of interaction between therapist and patient, even if they are not conscious of it. In empirical research, they help to un-derstand how the process of change in psychotherapy is established. In this sense, the current research used 68 sessions of psychoanalytic psychotherapy in a young patient with Borderline Personality Disorder (bpd) to identify the interaction structures and their correlation with different moments of treatment. The sessions were recorded on video and later encoded through the Psy-chotherapy Process Q-Set (PQS) by pairs of judges trained in Q-Sort methodology. A factor analysis of the Q-type of main components was performed based on these data, which indicated four interaction structures. Factor 1: Collaborative; factor 2: Resistance; factor 3: Alliance/Rupture; and factor 4: Support/Encornment. The structures indicated the interaction became a work of maintenance of the collaborative interaction through an empathic position of the therapist, focused on recognizing the patient's internal states. Despite the collaborative work, resistance also appeared as a repetitive pattern. The therapist became more directive with more structured interventions questioning the patient, thus, contributing to the development of the capacity of mentalization. Implications for the psychotherapeutic process and in-dications for future studies are presented to contribute to the comprehension of the treatment of patients with bpd in psychodynamic psychotherapy.

Components of event-related potentials and borderline personality disorder: a meta-analysis.

Background: Borderline personality disorder (BPD) is characterized by symptoms associated with difficulties in emotion regulation, altered self-image, impulsivity, and instability in personal relationships. A relationship has been found between BPD symptoms and altered neuropsychological processes. Studies of event-related potentials (ERP) measured with electroencephalogram (EEG) have found neural correlates related to BPD symptoms. Of note is the P300 component, considered a potential mental health biomarker for trauma-associated disorders. However, no meta-analysis has been found to demonstrate this relationship.Objectives: To evaluate the relationship between the P300 component and BPD symptoms. To evaluate the relationship of other ERP components with BPD symptoms.Methods: The method and procedure were adjusted to the PRISMA checklist. The search was performed in three databases: WOS, Scopus and PubMed. A Random Effects Model was used to perform the analysis of the studies. In addition, a meta-regression was performed with % women, Gini and GDP. Finally, a descriptive analysis of the main results found between P300, other ERP components (LPP, P100 and ERN/Ne) and BPD symptoms was performed.Results: From a review of 485 articles, a meta-analysis was performed with six articles that met the inclusion criteria. A moderate, positive relationship was found between the P300 component and BPD symptoms (REM = .489; p < .001). It was not possible to perform meta-analyses for other ERP components (LPP, P100 and ERN/Ne) due to the low number of articles found.Conclusion: The idea that P300 could be considered for use as a biomarker to identify altered neural correlates in BPD is reinforced. In addition, a moderating effect of inequality (Gini) was detected.

The P300 component of event-related potentials could be considered for use as a possible biomarker to identify altered neural correlates in Borderline Personality Disorder.There is support for the proposition that an altered P300 would be present in disorders related to exposure to traumatic events.P300 could be used to evaluate the therapeutic processes associated with the clinical symptoms of Borderline Personality Disorder.

Oxidative stress and inflammatory process in borderline personality disorder (BPD): a narrative review

Borderline personality disorder (BPD) is a severe psychiatric condition that affects up to 2.7% of the population and is highly linked to functional impairment and suicide. Despite its severity, there is a lack of knowledge about its pathophysiology. Studies show genetic influence and childhood violence as factors that may contribute to the development of BPD; however, the involvement of neuroinflammation in BPD remains poorly investigated. This article aimed to explore the pathophysiology of BPD according to the levels of brain-derived neurotrophic factor (BDNF), inflammatory cytokines, and oxidative stress substances that exacerbate neuronal damage. Few articles have been published on this theme. They show that patients with BPD have a lower level of BDNF and a higher level of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in peripheral blood, associated with increased plasma levels of oxidative stress markers, such as malondialdehyde and 8-hydroxy-2-deoxyguanosine. Therefore, more research on the topic is needed, mainly with a pre-clinical and clinical focus.

Trastorno límite de la personalidad (TLP), experiencias adversas tempranas y sesgos cognitivos: una revisión sistemática

Introducción: La investigación actual y los artículos rastreados sobre adversidad temprana y sesgos cognitivos en pacientes con trastorno límite de la personalidad (TLP) evidencian la relación entre estas variables y la gravedad de los síntomas clínicos de este trastorno. Objetivo: Revisar sistemáticamente la evidencia de la relación entre adversidad temprana, sesgos cognitivos y agudización de los síntomas del TLP. El vacío investigativo tiene que ver con el tipo específico de adversidad temprana y su relación con el tipo específico de sesgos cognitivos y el curso del TLP de pacientes con este diagnóstico. Metodología: Se realizó una revisión sistemática de la literatura y para reportar la evidencia se utilizó la versión 2020 de la declaración Prisma. Las bases de datos consultadas fueron Scopus, Pubmed, Web of Science y PsycInfo. En la búsqueda también se incluyeron bases de datos de literatura gris como Google Académico, Open Gray y WorldCat. Resultados: En total se incluyeron en el estudio 13 artículos que satisficieron criterios de originalidad, temática estudiada (adversidad temprana, funcionamiento cognitivo y sintomatología límite) y población indicada (pacientes con diagnóstico de TLP). Conclusiones: Si bien existe evidencia de que la adversidad temprana en general es un factor de riesgo para el TLP, se necesita más investigación para comprender los tipos específicos de adversidad que pueden estar más fuertemente relacionados con el desarrollo del TLP. Si bien algunos estudios han identificado sesgos cognitivos en individuos con TLP, poco se conoce sobre el modo en que estos sesgos se desarrollan y cambian con el tiempo, o según la etapa de exposición del paciente a la adversidad temprana.

Introduction: Current research and articles on early adversity and cognitive biases in patients with borderline personality disorder (BPD) demonstrate the relationship between these variables and the severity of the clinical symptoms of this disorder. Objective: The aim was to systematically review the evidence of the relationship between early adversity, cognitive biases, and exacerbation of symptoms of borderline personality disorder. The research gap concerns the particular type of early adversity and its relationship with the specific type of cognitive biases and the course of BPD in patients with this diagnosis. Methodology: We conducted a systematic literature review, and the Prisma statement version 2020 was used to report the evidence. The databases consulted were Scopus, Pubmed, Web of Science, and PsycInfo. Gray literature databases, such as Google Scholar, Open Gray, and WorldCat, were also included in the search. Results: We included 13 articles in the study that met the criteria for originality, studied theme (early adversity, cognitive functioning, and borderline symptomatology), and target population (patients diagnosed with a personality disorder). Conclusions: We found that while there is evidence that early adversity, in general, is a risk factor for BPD, further research is needed to understand the specific types of adversity that may be more strongly related to the development of BPD. In addition, although some studies have identified cognitive biases in individuals with BPD, little is known about how these biases develop and change over time or according to the stage of the patient's exposure to early adversity.

Autolesiones no suicidas y trastorno límite de la personalidad en adolescentes: scoping review

Objetivo: Mapear la evidencia científica respecto de las autolesiones no suicidas y trastorno límite de la personalidad en adolescentes de muestras comunitarias o clínicas en el contexto internacional. Introducción: Las autolesiones no suicidas corresponden a un importante campo de investigación en el espectro de suicidio, no obstante, son diversas las perspectivas para su conceptualización. La literatura señala ampliamente la comorbilidad entre las autolesiones no suicidas y el trastorno límite de la personalidad. Métodos: Scoping review basada en la metodología propuesta por el Joanna Briggs Institute. Se utilizaron las bases de datos Ovid, Science Direct, Proquest, Biblioteca Virtual de Salud y Web of Science. La búsqueda fue realizada en fuentes publicadas del 2011 hasta noviembre de 2021 en idiomas español, inglés y portugués. Resultados: La muestra final estuvo conformada por 12 artículos extraídos que cumplieron con los criterios de inclusión. Se encontraron cuatro categorías: curso longitudinal de las autolesiones no suicidas y trastornos límite de la personalidad en adolescentes, marcadores neuronales-fisiológicos de las autolesiones no suicidas y trastornos límite de la personalidad en adolescentes y riesgos psicosociales asociados a las autolesiones no suicidas y trastornos límite de la personalidad. Conclusiones: Se requieren más estudios interdisciplinares en el campo de las autolesiones no suicidas y trastornos límite de la personalidad en adolescentes. Se evidencia la necesidad de estudiar el curso longitudinal, marcadores neuronales-fisiológicos y riesgos psicosociales para mejorar la especificad de las intervenciones en muestras clínicas.

Objective: To map the scientific evidence regarding non-suicidal self-harm and borderline personality disorder in adolescents from community or clinical samples in the international context. Introduction: Non-suicidal self-harm corresponds to an important field of research in the suicide spectrum; however, there are diverse perspectives for its conceptualization. The literature widely points out the comorbidity between non-suicidal self-harm and borderline personality disorder. Methods: Scoping review based on the methodology proposed by the Joanna Briggs Institute. The Ovid, Science Direct, Proquest, Virtual Health Library and Web of Science databases were used. The search was carried out in sources published from 2011 to November 2021 in Spanish, English and Portuguese languages. Results: The final sample consisted of 12 extracted articles that met the inclusion criteria. Four categories were found: longitudinal course of non-suicidal self-harm and borderline personality disorders in adolescents, neuronal-physiological markers of non-suicidal self-harm and borderline personality disorders in adolescents, and psychosocial risks associated with non-suicidal self-harm and borderline disorders. of personality. Conclusions: More interdisciplinary studies are required in the field of non-suicidal self-harm and borderline personality disorders in adolescents. The need to study the longitudinal course, neuronal-physiological markers and psychosocial risks is evident to improve the specificity of interventions in clinical samples.

Diferencias clínicas del trastorno bipolar y el trastorno límite de la personalidad: a propósito de un caso / Clinical Differences between Bipolar Disorder and Borderline Personality Disorder: A Case Report

RESUMEN La diferencia clínica entre el trastorno bipolar y el trastorno límite de la personalidad siempre ha sido un reto diagnóstico, sobre todo con el trastorno bipolar tipo II, y con los cuadros subumbrales, lo cual abre un sesgo diagnóstico con las consiguientes repercusiones de un tratamiento no adecuado. Ambas afecciones reciben en gran proporción un diagnóstico previo equivocado. En este artículo se hace énfasis en las principales diferencias clínicas entre ambas enfermedades. Se presenta el caso de una paciente con una larga historia de síntomas psiquiátricos que se inició en la infancia, con muchas dificultades en su funcionamiento, que cumplían criterios de ambos trastornos, lo cual apunta a comorbilidad; en el seguimiento respondió favorablemente a los psicofármacos, y su diagnóstico se inclinó hacia el espectro bipolar, por la notable mejoría. Sin embargo, no debe dejarse de lado la comorbilidad por su alta presentación.

ABSTRACT The clinical difference between bipolar disorder and borderline personality disorder has always been a diagnostic challenge, especially with type II bipolar disorder and subthreshold symptoms, opening a diagnostic bias with the consequent repercussions of inappropriate treatment. Both pathologies are often misdiagnosed initially. The objective of this article is to emphasise the main clinical differences between the two pathologies. We present the case of a patient with a long history of psychiatric symptoms that started in childhood, with considerable functional impairment, who met the criteria for both disorders, pointing to comorbidity. During follow-up, she responded favourably to psychotropic drugs, pushing the diagnosis towards the bipolar spectrum, due to the notable improvement. However, comorbidity should not be neglected due to its high presentation.

Brazilian adaptation of the McLean Screening Instrument for Borderline Personality Disorder.

INTRODUCTION: Borderline personality disorder (BPD) is a serious and extremely prevalent mental disorder. Early diagnosis is vital for treatment. However, there are no specific validated screening instruments for Brazilian Portuguese. This study aimed to adapt the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) to the Brazilian context. The MSI-BPD is a self-report instrument based on the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) that allows a fast and reliable assessment of BPD, with measures of sensitivity and specificity similar to the diagnostic interview for the DSM-5 (SCID-II), taken as the gold standard. METHOD: Simultaneous translation, synthesis version, back-translation, and analysis by experts were performed to create the final version of the instrument in Brazilian Portuguese. The translated instrument was responded by 1,702 adults aged 18-59 years to verify validity evidence on content, internal structure, relationship with other variables, and reliability. RESULTS: The exploratory and confirmatory factor analyses show the unifactorial structure's adequacy. The scale showed satisfactory internal consistency (KR-20 of the Cronbach's alpha = 0.691) and good test-retest reliability (ICC = 0.802). Logistic regression analysis using PID-5-BF (DSM-5) as reference established an ideal cut-off point of 8 symptoms, with adequate sensitivity (0.79) and specificity (0.75), similar to the original instrument. The area under the curve (AUC) was 0.830 (95% confidence interval, 0.802-0.858), with a positive predictive value of 89.2%. CONCLUSION: The Brazilian version of MSI-BPD has adequate psychometric properties to be used as a screening tool for BPD by the clinician.

Parental Reports of Physically Self-Destructive Behavior in the Offspring of Patients With Borderline Personality Disorder and Other Personality Disorders.

The main aim of this article is to compare the prevalence of four forms of physically self-destructive behavior in the offspring of parents with borderline personality disorder (BPD) and compare them to the offspring of parents with other personality disorders (OPD). At the 4- and 6-year waves in a prospective study of the long-term course of BPD, participants were asked to report on the self-destructive behaviors of their children using the Childhood Self-Destructiveness Scale. A total of 68 parents were interviewed regarding 131 children, 104 of whom were offspring of parents with BPD (n = 55) and 27 were offspring of parents with OPD (n = 13). BPD parents reported significantly more self-injury and substance abuse in their children than OPD parents. The results from this study suggest that both direct and indirect forms of self-destructive behavior are both more common and quite specific for the children of parents with BPD.

Potential epigenetic mechanisms in psychotherapy: a pilot study on DNA methylation and mentalization change in borderline personality disorder.

Genetic and early environmental factors are interwoven in the etiology of Borderline Personality Disorder (BPD). Epigenetic mechanisms offer the molecular machinery to adapt to environmental conditions. There are gaps in the knowledge about how epigenetic mechanisms are involved in the effects of early affective environment, development of BPD, and psychotherapy response. We reviewed the available evidence of the effects of psychotherapy on changes in DNA methylation and conducted a pilot study in a sample of 11 female adolescents diagnosed with BPD, exploring for changes in peripheral DNA methylation of FKBP5 gene, which encodes for a stress response protein, in relation to psychotherapy, on symptomatology and underlying psychological processes. For this purpose, measures of early trauma, borderline and depressive symptoms, psychotherapy outcome, mentalization, and emotional regulation were studied. A reduction in the average FKBP5 methylation levels was observed over time. Additionally, the decrease in FKBP5 methylation observed occurred only in those individuals who had early trauma and responded to psychotherapy. The results suggest an effect of psychotherapy on epigenetic mechanisms associated with the stress response. The finding that epigenetic changes were only observed in patients with early trauma suggests a specific molecular mechanism of recovery. The results should be taken with caution given the small sample size. Also, further research is needed to adjust for confounding factors and include endocrinological markers and therapeutic process variables.

Reações contratransferenciais de psicoterapeutas frente a uma paciente borderline em psicoterapia: um estudo qualitativo / Countertransferential reactions of psychotherapists towards a borderline patient in psychotherapy: a qualitative study

A contratransferência (CT) é um elemento do relacionamento terapêutico que possui valor clínico, especialmente com pacientes com personalidade borderline (PB). Este estudo, qualitativo e exploratório, visou identificar os sentimentos despertados em psicoterapeutas frente a um caso de paciente com PB, buscando compreendê-los em relação às características da paciente ou da sua narrativa, bem como explorar de que forma a CT seria idealmente manejada. Oito psicoterapeutas assistiram ao vídeo de uma sessão real com paciente com PB e, após, responderam a uma entrevista. As transcrições das entrevistas foram analisadas com o método Consensual Qualitative Research (CQR). Os dados organizaram-se em relação às facetas da CT, características da paciente que mobilizam afetos, e manejo da CT. Os resultados sugerem que pacientes com PB tendem a suscitar sentimentos intensos, vinculados a sua história e seu funcionamento em situação observacional, apontando para a viabilidade do método para o estudo empírico da CT. Resultados de estudos como esse podem ser utilizados como guia para jovens terapeutas compreenderem o mundo interno dos seus pacientes. A validação empírica de hipóteses clínicas fortalece a teorização e enriquece a prática psicanalítica.(AU)

Countertransference (CT) is an element of the therapeutic relationship that has clinical value, especially with borderline personality patients (BP). This qualitative and exploratory study aimed to identify the feelings aroused in psychotherapists in the case of a BP patient, seeking to understand them in relation to the patient's characteristics or her narrative, as well as exploring how the CT would be ideally managed. Eight psychotherapists watched the video of a real session with a BP patient and responded to an interview. The interview transcripts were analyzed using the Consensual Qualitative Research (CQR) method. The data were organized in relation to the facets of the CT, characteristics of the patient that mobilize affections, and management of the CT. The results suggest that patients with BP tend to elicit intense feelings, linked to their history and functioning, in an observational situation, pointing to the feasibility of the method for the empirical study of CT. Results from studies like this one can be used as a guide for young therapists to understand the inner world of their patients. Empirical validation of clinical hypotheses strengthens theorization and enriches psychoanalytic practice.(AU)

La contratransferencia (CT) es un elemento de la relación terapéutica que tiene valor clínico, especialmente en pacientes con personalidad límite (BP). Este estudio cualitativo y exploratorio tuvo como objetivo identificar los sentimientos que despiertan los psicoterapeutas en el caso de un paciente con BP, buscando comprenderlos en relación con las características de la paciente o su narrativa, así como explorar cómo se manejaría idealmente la CT. Ocho psicoterapeutas vieron el video de una sesión real y luego respondieron a una entrevista. Las transcripciones de las entrevistas se analizaron utilizando el método de Investigación Cualitativa Consensual (CQR). Los datos se organizaron en relación a las facetas del CT, características del paciente que movilizan afectos y manejo de la CT. Los resultados sugieren que los pacientes con BP tienden a provocar sentimientos intensos, ligados a su historia y funcionamiento, en una situación de observación, lo que apunta a la viabilidad del método para el estudio empírico de la CT. Los resultados de estudios como este pueden usarse como una guía para que los terapeutas jóvenes comprendan el mundo interior de sus pacientes. La validación empírica de hipótesis clínicas fortalece la teorización y enriquece la práctica psicoanalítica.(AU)