Three-level containment model of hospitalized adolescents with borderline pathology: a holistic therapeutic perspective.

Borderline personality disorders account for 50% of adolescent hospitalization cases in psychiatry. The severity and psychopathological complexity of these symptoms indicate the need for inclusive models of understanding. Adopting a holistic approach allows for the consideration of not only the patient's environment, but also their position within that environment and their life history. In this article, a model based on the concept of therapeutic containment at three levels is presented. Global containment refers to the mindset and organization of the institution that provides care, which is itself a part of society at a specific time. Local containment focuses on understanding and therapeutic interventions within the immediate social environment of the individual. Lastly, individual containment encompasses the development of independent processes during the course of care. These three levels are integrated in the hospital treatment of borderline personality disorders, forming a trans-theoretical approach.

Four attachment-based categories of emotion regulation in adolescent psychic troubles.

Introduction: Emotion regulation is altered in many psychiatric disorders in adolescence, but the understanding of mechanisms that underlie this alteration is still poor. Methods: The PERCEPT study explores alexithymia, empathy, facial emotion recognition (FER) and defence mechanisms in a sample of adolescents in psychiatric care (n = 61, 74% of girls, mean age = 15.03 y.o.), in relation with participants' attachment styles. Results: Results revealed correlations between attachment dimensions and all of the emotion regulation variables, suggesting that attachment modalities have functional links with emotional regulation at its different levels: FER accuracy was inversely correlated with avoidant attachment, while affective empathy, difficulty in identifying feelings (alexithymia) and immature as well as neurotic defence mechanisms were positively correlated with anxious attachment. Moreover, attachment categories delineated distinct emotional perception profiles. In particular, preoccupied attachment included adolescents with the highest levels of facial emotion perception (sensitivity and accuracy) and of affective empathy, whereas detached attachment included adolescents with the lowest levels of these variables. Neurotic defence mechanisms and difficulty to identify feelings were correlated with preoccupied attachment; immature defence mechanisms and difficulty to describe feelings to others characterized fearful attachment. Discussion: These results suggest that attachment categories underlie emotion regulation processes in psychiatric disorders in adolescence. Theoretical and clinical implications are discussed.

Clinical Stakes of Sexual Abuse in Adolescent Psychiatry.

BACKGROUND: The extent and nature of sexual abuse (SA) and its consequences in psychiatry are still poorly described in adolescence. OBJECTIVE: This article describes the frequency of SA reported in an adolescent population hospitalized in psychiatry, and assesses its links with the severity of mental disorders and the medical issues of these adolescents. METHODS: The study includes 100 patients for whom SA has been mentioned, among all patients aged 13 to 17 years old hospitalized for about 4 years. The characteristics of sexual abuse were correlated with the medical severity of the patients, as well as the number, the duration of their hospitalization(s), and the time until disclosure. RESULTS: The results show the central place of SA in adolescent psychiatry, with a prevalence of 28.5% and a cumulative hospital stay which is five times longer than average. Correlations have been observed between the number of suicide attempts and the number of abuses reported. The medical severity of patients is significantly increased when the named aggressor is an adult. The number of hospitalizations is positively correlated with the number of reported abuses, as well as with the intrafamilial and adult status of the perpetrator. Finally, an early age of onset, repeated abuse, and the intrafamilial nature of the abuse are associated with a longer time to disclosure. CONCLUSIONS: The severity of adolescent psychiatric situation is statistically in favor of a history of SA, which should therefore be actively explored during care.

Experiences of French medical students during their clerkship in adolescent psychiatry: a qualitative study.

The epidemiology of adolescent psychiatric disorders and the relational complexity of their management make exposure to adolescent psychiatry essential during medical school. However, some clinical particularities can complicate the students' learning experiences. Our work aimed to explore the experience of being a medical student during clerkships in adolescent psychiatry. Following the Interpretative Phenomenological Analysis qualitative approach, 20 semi-structured face-to-face interviews were conducted with medical students at the end of their clerkship in adolescent psychiatry. Three super-ordered themes emerged to describe their experience: in-depth self-exploration calling on emotions, thoughts and experiences; changes in the view of adolescent mental health; better understanding of the role and meaning of adolescent psychiatric care and how to approach it. Identification between students and patients could result from time-related factors (the end of adolescent brain remodeling, long, demanding studies, and financial and material dependence). In addition, the predominant use of non-analytical clinical reasoning processes-less valued in the rest of the graduate curriculum-poses a challenge for students. Indeed, for a student to find his or her place in adolescent psychiatry requires the student to reinvent him or herself, because the codes are different (no gown, less well-defined tasks, etc.). Finally, the excess prevalence of mental disorders among medical students requires increased vigilance on the part of tutors. For all these reasons, close, attentive tutoring seems essential to support students, while these clerkships afford a real opportunity for students to broaden their interpersonal skills.

The impact of a telephone hotline on suicide attempts and self-injurious behaviors in patients with borderline personality disorder.

Background: Borderline personality disorder is often associated with self-injurious behaviors that cause personal suffering, family distress, and substantial medical costs. Mental health hotlines exist in many countries and have been shown to be effective in some contexts, but none have been specifically designed for borderline patients. The aim of the present study is to evaluate the impact of a 24/7 hotline dedicated to patients with borderline personality disorder on suicide attempts and self-injurious behaviors. Methods: We conducted a single-blind, multicenter (9 French centers) clinical trial with stratified randomization (by age, sex and center). Patients (N = 315) with a diagnosis of borderline personality disorder (according to the SIDP-IV) were randomized into two groups with or without access to the hotline in addition to treatment as usual. The number of suicide attempts and self-injurious behaviors in each group within 12 month were analyzed in the "per protocol" population (Student's t-tests, 5% significance threshold), adjusting for possible confounders in a multivariate analysis (using Poisson regression). The percentage of patients with suicide attempts and with self-injurious behaviors (and other percentages) were analyzed in the per protocol population (χ2-tests or exact Fischer tests, 5% significance threshold). Results: The mean number of suicide attempts was 3 times lower in the hotline group (0.41 vs. 1.18, p = 0.005) and the mean number of self-injurious behaviors was 9 times lower (0.90 vs. 9.5, p = 0.006). Multivariate analysis confirmed the effectiveness of the hotline in reducing suicide attempts and self-harm. Conclusion: This study supports the effectiveness of hotlines in reducing self-aggressive behavior in patients with borderline personality disorder. Such support is easy to use, cheap and flexible, and therefore easy to implement on a large scale.

Anorexia nervosa, fertility and medically assisted reproduction.

Anorexia nervosa is a psychiatric disorder that mainly affects women (sex ratio 1/10) and for which the prognosis remains poor (10% of deaths and high risk of chronicity). This disorder is associated with a risk of infertility explained by different physiopathological pathways. Thus, the clinical and subclinical forms of this disease may be over-represented in populations of women using medically assisted reproduction technologies. This raises the question of a narcissistic investment of the pregnancy, with a desire for pregnancy for what it brings to the woman. However, this recourse to mechanized care to access motherhood leads to questions for these women for whom access to femininity and sexuality may have been hindered. Furthermore, suffering from eating disorders might have a significant impact upon pregnancy, birth, and the offspring's well-being with psychiatric, obstetric, pediatric, child psychiatric and developmental morbidities. Thus, several specific aspects must be considered by medical professionals when women with anorexia nervosa either intend to undergo fertility treatment or become pregnant. It is important to promote the training of nursing and medical staff to the specific clinic of anorexia nervosa and the development and implementation of multidisciplinary teams to ensure follow-up of these women from the beginning of their treatment until the sixth month postpartum.

Adversity, attachment and emotion recognition in BPD adolescents: the distinct roles of disengaged and controlling environment.

BACKGROUND: Literature data about emotion perception in patients with borderline personality disorders (BPD) revealed some discrepancies between some patients that are vigilant and accurate to detect their emotional environment and others that are impaired at identifying emotions of others. Even if some links between childhood adversity and facial affect recognition have been established, there is a need to understand the heterogeneous psychobiological mechanisms underlying this association. The aim is to distinguish in a BPD sample, the links between facial emotion recognition (FER) and adversity types (maltreatment and parental bonding), by evaluating two dimensions of disengaged and controlling environment. METHOD: The study includes BPD adolescents (n = 45) and healthy controls (HC, n = 44): two scores of disengaged environment (parental low care; emotional and physical neglect) and controlling environment (high level of parenting control; emotional, physical and sexual abuse) were established and correlated to FER, as well as to attachment dimensions. Multiple linear regression analyzes were conducted to evaluate the effect of disengaged and controlling dimensions, on FER scores of sensitivity and accuracy, including anxious and avoidant attachment as covariables. RESULTS: Analyzes revealed that a disengaged environment was positively correlated to sensitivity in BPD patients, and the correlation was negative in the HC group. Controlling environment was negatively associated to accuracy of emotion in BPD. Avoidant and anxious attachment did not influence these associations. CONCLUSIONS: These results suggest that distinct adverse experiences account for the heterogeneity observed in emotion regulation in BPD patients.

Long-term follow-up of a randomized controlled trial comparing systemic family therapy (FT-S) added to treatment as usual (TAU) with TAU alone in adolescents with anorexia nervosa.

BACKGROUND: Randomized controlled trials showed the efficacy of family therapy for anorexia nervosa during adolescence, but studies examining its long-term beneficial effect are still needed. This article presents the results of a 54-month post-randomization follow-up of a previously reported randomized controlled trial that compared two post-hospitalization outpatient treatment programs: Treatment As Usual alone versus Systemic Family Therapy added to Treatment As Usual. METHODS: A consecutive series of 60 female adolescents with anorexia nervosa (DSM-IV) were randomized (30 per group). During the first 18 months, in the Treatment As Usual group, subjects received a multidisciplinary treatment. In the other group, Systemic Family Therapy sessions targeting intra-familial dynamics were added to Treatment As Usual. At 54 months, the primary outcome was defined using the Morgan and Russell global Outcome Categories (Good or Intermediate versus Poor). Secondary outcomes were the Global Outcome Assessment Schedule score, body mass index, amenorrhea, number of hospitalizations, eating disorder symptoms, psychopathological features, and family functioning. Analyses were carried out using an Intention-To-Treat with the Last Observation Carried Forward procedure. Data of 59/60 subjects were available. RESULTS: At 54 months, significant effects in favor of adding Systemic Family Therapy to Treatment As Usual were shown for the Global Outcome Categories (60% of Good/Intermediate versus 31% in the control group, p = .026), mean body mass index (p = .048), resumption of menses (70.0% vs. 40% p = .020), and mental state score (p = .010). Family cohesion scores were lower in the Systemic Family Therapy group (p = .040). CONCLUSIONS: Adding Systemic Family Therapy focusing on intra-familial dynamics to a multidimensional outpatient treatment program appeared to lead to a better long-term outcome in young women who suffered from severe anorexia nervosa during adolescence.

Facteurs D'adversité Chez des Adolescents Issus de Milieu Aisé Hospitalisés en Psychiatrie.

Malgré l'enjeu majeur de santé publique qu'elles représentent, les maltraitances infantiles, et particulièrement les négligences, restent sous-estimées en psychiatrie, tant dans leur prévalence que leur impact sur la santé. De plus, le phénomène de maltraitance reste habituellement associé à un fort déterminisme socio-culturel et est très peu évalué dans les catégories sociales aisées. Cette étude mesure la prévalence et l'impact sur l'état médical des facteurs d'adversité précoce - maltraitances (abus et négligences) et événements de vie (divorce, séparations précoces, antécédents familiaux de maladie psychiatrique) - dans une population d'adolescents hospitalisés en psychiatrie et issus de milieux aisés, afin d'en évaluer l'ampleur et l'impact. Les résultats montrent l'ampleur et le cumul des facteurs d'adversité, incluant des fréquences élevées de maltraitances (64.8%), d'événements de vie difficile (dont 29.7% de séparations précoces et 36.4% de troubles psychiatriques familiaux). Ils soutiennent ainsi l'idée d'une sous-estimation importante de ces phénomènes en population générale et en psychiatrie, et ce, notamment dans les catégories sociales aisées. Les maltraitances sont associées à la gravité médicale (niveau de fonctionnement global, nombre et durée d'hospitalisation). Les abus sont particulièrement corrélés au nombre d'hospitalisations, alors que les négligences semblent également impacter leur durée et le niveau de gravité médicale de l'adolescent. Cette étude invite à une évaluation systématique des phénomènes d'adversité en pédopsychiatrie, quel que soit le contexte environnemental du patient, et à renforcer les prises en charge familiales ainsi que la prévention des abus et négligences.

Interpersonal Relatedness and Non-suicidal Self-Injurious Behaviors in Female Adolescents With Borderline Personality Disorder.

Background: Psychopathological models of adolescent borderline personality disorder (BPD) suggest that non-suicidal self-injuring (NSSI)-a particularly frequent symptom in girls-may constitute a way of coping with distress resulting from interpersonal concerns they typically experience as a developmental psychopathological feature. Objectives: Our objective was to investigate the relationship in BPD female adolescents between NSSI and the Sidney Blatt two-polarities model of personality development, which focuses on the psychological processes of interpersonal relatedness and self-definition. Methods: The study was conducted within the European Research Network on Borderline Personality Disorder in Adolescence, using the Depressive Experience Questionnaire (DEQ). Results: BPD patients (n = 59; mean age = 16.6 ± 1.3) scored significantly higher than healthy controls on the two DEQ sub-factors assessing the more immature forms of Interpersonal Relatedness (Neediness) and Self-definition (Self-criticism) and significantly lower on the more mature form of Self-definition (Efficacy). BPD adolescents with NSSI showed significantly higher scores on both mature and immature forms of Interpersonal Relatedness (Neediness and Connectedness) compared to BPD adolescents without NSSI. A logistic regression analysis showed that the subfactor Neediness of the DEQ was the only significant predictor of the presence of NSSI among BPD adolescents. Conclusions: The preliminary results of this study suggests that NSSI in adolescents with BPD is developmentally linked to high developmental concerns in the domain of interpersonal relatedness, which may be taken into consideration in clinical practice. More studies are necessary to better understand the relationships between NSSI and developmental psychopathology in borderline adolescents.

Paradoxes in Borderline Emotional Dysregulation in Adolescence: Influence of Parenting, Stressful Life Events, and Attachment.

Introduction: Borderline personality disorder (BPD) in adolescents is characterized by emotional dysregulation, insecure attachment, a history of stressful life events (SLEs) as well as dysfunctional parent-child interactions. The respective contribution of each of these factors on BPD affective symptoms is not yet clear. The purpose of this study is to assess the distinct impact of parental adversity and SLEs on BPD affective symptoms and the role of attachment and alexithymia in such emotional processes. Method: This study explored parental dysfunction and SLEs as predictors of affective symptoms of BPD and of attachment insecurity in BPD adolescents (n = 85) and healthy controls (n = 84) aged 13-19 years from the European Research Network on BPD. The links between adversity and BPD symptoms were also investigated by emotional dysregulation assessment, as measured by alexithymia and hopelessness. Results: Dysfunctional parental interactions were linked to affective symptoms, hopelessness, and anxious attachment in healthy controls but not in BPD. Cumulative SLEs were positively correlated with affective symptoms and avoidant attachment in the control group but negatively correlated with both these variables in BPD. Multivariate regression analysis revealed that, in BPD, affective symptoms were independent of dysfunctional parenting but depended on attachment, whereas in controls, a maternal affectionless control style directly predicted affective symptoms. Moreover, increasing numbers of SLEs reduced affective symptoms in BPD, independently of parental interactions or attachment, and were associated with growing use of operative thinking. Discussion: BPD patients showed paradoxical emotional reactions: there was no increase of hopelessness and affective symptoms with an increased parental dysfunction, but a decrease in affective symptoms and hopelessness with cumulative SLE. Two pathways arose, one involving attachment as an emotional dysregulation process for parent-child interactions and a second one for SLE, with a more direct pathway to affective symptoms, independent of attachment but dependent on early interactions, and involving alexithymia. In summary, adversity factors have distinct effects in BPD, and attachment is partly accountable for affective symptoms independently of adversity. Our results suggest that in highly insecure conditions, cumulative adversity may produce paradoxical effects, including a lesser expression of affective symptoms and hopelessness.

The ACAMTO study-impact of add-on osteopathic treatment on adolescent patients with anorexia nervosa: study protocol for a randomized controlled trial.

BACKGROUND: Anorexia nervosa (AN) mainly affects women (sex ratio 1/10) and most often starts during adolescence. The prognosis of AN remains poor (10% of deaths and high risk of chronicity). Body dissatisfaction, disturbances in recognition and identification of body sensations are some of the key symptoms of AN. However, there is a contrast between this consensual observation of body image disorders in AN, and the relative deficit of specifically targeted body treatments. Our proposal for a body approach specifically dedicated to AN is based on the understanding that posture, breathing, muscle tension and body perception are closely linked to our psychological and emotional state and are therefore disturbed in patients with AN. The purpose of this monocentric randomized controlled trial is to evaluate if a targeted osteopathic protocol treatment for AN in addition to treatment as usual (TAU) is significantly more effective than TAU alone. METHODS: In total, 72 patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups: one receiving the specific osteopathic treatment targeted for AN in addition to the TAU (group A) and the other one, receiving TAU only (group B). The patients in group A will receive 5 30-min osteopathic treatment sessions. Soft specific palpatory techniques on the diaphragm, digestive system and cervical region will be performed. The TAU is defined by the multidisciplinary approach recommended by the French health high authority. The primary outcome is the evaluation of interoceptive sensibility and secondary outcomes include clinical and psychopathology-related symptoms with assessment of somatic dysfunctions' evolution. A qualitative study will also be carried out, applying the Interpretative Phenomenological Analysis method. Patients will be included for a maximum of 14 weeks between the inclusion time and the last evaluation. DISCUSSION: If the results of the study are positive (statistically significant efficacy of this osteopathic treatment protocol), the study will provide arguments in favor of osteopathic sessions as a possible non-invasive additional treatment option in the multidisciplinary care approach for patients with AN. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04666415 , Release Date: December 11, 2020; N° ID-RCB: 2019-A02613-54.

Borderline personality disorder and adolescent suicide attempt: the mediating role of emotional dysregulation.

BACKGROUND: Emotional dysregulation seems to be a core feature of Borderline Personality Disorders (BPD). In addition, recent research in the adolescent population has shown that suicidal behaviours have been associated with maladaptive strategies of emotion regulation. METHODS: This study examined the relative contributions of emotional dysregulation to suicide attempt history in a clinical sample of borderline adolescents. Data were analyzed from 85 participants of the Collaborative European Research Network on Borderline Personality Disorder. Participants completed measures of BPD traits and symptoms, suicide behaviours, emotional dysregulation, attachment styles and lifetime depressive disorders. RESULTS: In an SEM model, lifetime depressive disorders and insecure attachment styles have a significant direct effect on lifetime suicide attempt, but only lifetime depressive disorders have an indirect effect through emotion dysregulation. The results suggest that emotional dysregulation has a mediating role in suicide attempts among BPD adolescents. CONCLUSIONS: These findings call for the development of interventions targeting the role of emotion dysregulation in effectively predicting and preventing suicidality in borderline adolescents.

High-risk sexual behaviours, from the neurotica to complex trauma: Psychopathologies of repetition.

In adolescent psychiatry, when patients present high-risk sexual behaviours, analysing the symptoms usually leads back to a traumatic sexual event in childhood. These clinical situations include a first stage in which the trauma is constituted and a second adolescent stage in which the mnemic trace can lead to the traumatic experience being reproduced within a destructured psychic apparatus that is seeking restructuration through actions. These two psychopathological stages are examined in the light of the connection between Freud's two paradigms of the neurotica and the theory of fantasy, focusing therapeutically either on the primacy of sexual abuse or on the psychic representation of a traumatic sexuality, respectively. Here, the elaboration of these behaviours relates either to the individual traumatic history or the transgenerational history, or to both histories, intermingled or even undifferentiated. The repetition processes and the temporary loss of reality-testing in these clinical situations are analysed there, including by the yardstick of the psychopathology of complex trauma, as well as by that of containment in the familial and therapeutic environment, from which the subject will benefit in the context of the revelation processes.

Eating disorders and sexuality: A quantitative study in a French medically assisted procreation course.

OBJECTIVE: Among medically assisted procreation (MAP) patients, the prevalence of eating disorders (ED), clinical or subclinical, current or past, is considerable. In addition to metabolic repercussions, the literature suggests that these patients present with more sexual dysfunction, leading to anxiety. This quantitative research on a population of women consulting a MAP department for unexplained or ovulatory infertility proposed to study the sexuality of this population by comparing the sexuality of patients suffering from or having suffered from an ED to the sexuality of the non-ED group. METHOD: Patients (n = 61) filled out the Eating Disorder Examination Questionnaire (EDE-Q), the Brief Index of Sexual Functioning for Women (BISF-W), the ED Whole Life Research Questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the Kansas Marital Satisfaction Scale (KMSS). RESULTS: We found a prevalence of 54% of ED, current or past. Even though these patients reported the same prevalence of sexual intercourse, they had significantly more physical problems (e.g., anorgasmia, vaginismus, headache) affecting their sexuality (p = .01) than the non-ED group, after adjusting for depression. Approximately 10% of the study population reported no intravaginal intercourse during the last month. DISCUSSION: This study provides evidence for the existence of more sexual dysfunction in patients who have a fertility disorder and have ED or a history of ED. Future research should evaluate the results of psychological or sexological care that may be more suitable for the infertility of these patients.

Specific Pathways From Adverse Experiences to BPD in Adolescence: A Criteria-Based Approach of Trauma.

Within the European Research Network on BPD (EURNET-BPD; n = 85 BPD adolescents, n = 84 healthy controls, aged 13-19), this study explored the combination of three types of adversity-maltreatment, stressful life events (early separation from parents, parental suicide attempt, parental chronic disease) and parental bonding-as predictors of BPD, on a criteria-based approach. Results indicated that cumulative traumatic experiences largely characterize borderline adolescent's history; and, in the multivariate regression models, all adversity experiences were likely to contribute to BPD symptoms. The role of emotional abuse, parental suicide attempt, and a decrease in paternal level of care were particularly prominent. Moreover, adversities combinations were different for each criterion, suggesting that specific sets of traumatic experiences are leading to BPD. These findings argue for a further criteria-based exploration of trauma in borderline patients, as well as a more accurate and efficient prevention.

The Challenges of Potential Destructiveness in Designing a Therapeutic Framework for Adolescents with Anorexia Nervosa.

The authors begin by presenting the epistemological foundations that enabled them to design a therapeutic mediation framework aimed at enhancing the treatment of hospitalized anorexic patients. This unique framework utilizes bodily exploration through sound and music vibration. The authors were inspired by a method of dynamic structuring of the body image through clay modeling, created by Gisela Pankow, and by the bodily aspects of the subject's relationship with the object in transitional phenomena and in playing, as elaborated by Donald W. Winnicott. A detailed account of a clinical experience with a young female patient highlights the way in which the framework helped reveal destructive fantasies linked to scenes of psychic conflict.1.

Decreased Immune Response in Alexithymic Women: A One-Year Longitudinal Study.

Although previous cross-sectional studies suggested significantly dysregulated immune response in alexithymia, there is a lack of longitudinal studies. We sought to determine the reliability of the reported relationship between alexithymia and decreased immune response in a longitudinal study. Thirty-eight healthy women who had participated in a cross-sectional study were recontacted 1-year later. Of this sample, 26 were finally included: 13 females who had been found to be alexithymic, and 13 females who were classified as non-alexithymic under the 20-item Toronto Alexithymia Scale during the first phase of the study. A year later, they were still healthy women without any psychiatric disorders, their ages now ranging from 19 to 28 years old. Lymphocyte subset counts (CD4, CD8), in vitro production of interleukin 1ß (IL-1ß), IL-2, IL-4, and IL-10 by phytohemagglutinin stimulated peripheral blood lymphocytes, as well as serum cortisol levels, were compared between women with and without alexithymia. One-year later, alexithymic women still had significantly lowered in vitro production of IL-2 and IL-4, with lowered IL-2/IL-10 ratio and a reduced percentage of CD4. This is the first ever published study assessing cytokine production during a follow-up of alexithymics. Although our results should be interpreted with caution due the small sample size, they suggest a sustained reduction in both major type 1 and type 2 cytokines while the former seems to be more affected. The potential long-term health impact, if any, is still to be determined.

Prevalence of lifetime eating disorders in infertile women seeking pregnancy with pulsatile gonadotropin-releasing hormone therapy.

OBJECTIVES: Relationships between weight and fertility are well known. The aim of this study is to assess the prevalence of lifetime eating disorder (ED) in a sample of infertile women seeking a specific infertility treatment, pulsatile gonadotropin-releasing hormone (pGnRH) treatment, and to compare it to the prevalence of lifetime ED in a sample of infertile women seeking other types of assisted reproductive technology (ART) treatments. DESIGN: Non-randomized, observational study including infertile female patients. Two-group design including consecutive women treated with GnRH pump (pGnRH) or with other types of ART. SETTING: Multi-centric infertility centers, France METHODS: Twenty one consecutive women treated with pGnRH treatment were compared to 21 consecutive women receiving other types of infertility treatment. Diagnosis of ED was based on DSM-IV and the Composite International Diagnostic Interview (CIDI). RESULTS: Twenty patients (95.2%) from the sample of women treated with pulsatile GnRH treatment and 5 patients (23.8%) from the patients receiving other types of infertility treatment met the criteria of lifetime ED diagnosis (p < 0.000). CONCLUSION: This study highlights the fact that the prevalence of ED is considerably higher in women receiving GnRH pulsatile treatment, when compared to women receiving other kinds of infertility treatment. In our study population ED were under-diagnosed, particularly in women receiving pulsatile GnRH treatment. Fertility clinicians should use reliable diagnostic tools to identify promptly ED in women presenting with hypothalamic amenorrhea and difficulties in conceiving. Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Validation of the French version of the McLean screening instrument for borderline personality disorder (MSI-BPD) in an adolescent sample.

BACKGROUND: The study examines the psychometric properties of the French version of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) created by M. Zanarini to screen borderline personality disorder in clinical and non-clinical populations. METHOD: In this multicentric longitudinal study from the European Network on Borderline Personality Disorder, a sample of 84 adolescent patients from five psychiatric centres and 85 matched controls without psychiatric comorbidity completed the MSI-BPD, French version, and were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV), in order to assess the presence or absence of borderline personality disorder. RESULTS: The MSI-BPD showed excellent internal consistency (α = 0.87 [0.84;0.90]). Compared to the semi-structured reference interview (SIDP-IV), the MSI-BPD showed substantial congruent validity (AUC = 0.93, CI 95%: 0.90-0.97). The optimal cut-off point in the present study was 5 or more, as it had relatively high sensitivity (0.87) and specificity (0.85). In our sample, the cut-off point (7 or more) proposed by the original developers of the MSI-BPD showed high specificity (0.95) but low sensitivity (0.63). CONCLUSIONS: The French version of the MSI-BPD is now available, and its psychometric properties are satisfactory. The French version of the MSI-PBD can be used as a screening tool for borderline personality disorder, for clinical purposes or in research studies.