Multiple cluster axis II comorbidity and functional outcome in severe patients with borderline personality disorder.

BACKGROUND: Current literature suggests that personality disorder comorbidity negatively contributes to both the severity and prognosis of other disorders; however, little literature has been devoted to its influence on borderline personality disorder (BPD). The objective of the present work is to study comorbidity with other personality disorders in a severe clinical sample of patients with BPD, and its relationship with global functionality. METHODS: A sample of 65 patients with severe borderline personality disorder was included in the study. Clinical and functionality measures were applied in order to study comorbidity of BPD with other disorders and its relationship with functionality. Associations with other comorbid PDs were analyzed with t-tests and linear correlations. RESULTS: Most patients (87%) presented comorbidity with other PDs. Almost half of the sample (42%) presented more than two PDs, and cluster A (paranoid) and C (obsessive and avoidant) PD were more frequent than cluster B (histrionic and antisocial). Only the presence of avoidant PD predicted a worse functional outcome in the long term (U Mann Withney p<0.01). CONCLUSIONS: Severely impaired BPD patients present greater comorbidity with cluster A and C PDs. Comorbid avoidant personality disorder might negatively predict for prognosis.

Comorbilidad con el eje II y funcionalidad en pacientes graves con trastorno límite de la personalidad / Multiple cluster axis II comorbidity and functional outcome in severe patients with borderline personality disorder

Introducción. La literatura actual sugiere que la comorbilidad en los trastornos de la personalidad (TP) afecta a la gravedad y al pronóstico de otros trastornos. Sin embargo, existe poca literatura respecto al trastorno límite de la personalidad (TLP) en concreto. El objetivo de este trabajo es estudiar la comorbilidad con otros trastornos de personalidad en una muestra de pacientes graves con TLP, y la relación de esta comorbilidad con su funcionamiento global. Metodología. Se incluyó en el estudio una muestra de 65 pacientes con TLP grave. Se administraron cuestionarios clínicos y de funcionalidad para estudiar la comorbilidad del TLP con otros trastornos y su relación con la funcionalidad. Se analizaron las asociaciones con otros TP comórbidos a través de correlaciones lineares y de test T. Resultados. La mayoría de los pacientes (87%) presentaron comorbilidad con otros TP. Casi la mitad de la muestra (42%) presentó más de dos TP, y los incluidos en los clústeres A (paranoide) y C (obsesivo y evitativo) fueron más frecuentes que el clúster B (histriónico y antisocial). Sólo la presencia del TP evitativo predecía una peor funcionalidad a largo plazo (U Mann Withney p<0.01). Conclusiones. Los pacientes con TLP grave presentan una mayor comorbilidad con los TP de los clústers A y C. El trastorno de personalidad por evitación puede predecir el pronóstico del trastorno de manera negativa

Background. Current literature suggests that personality disorder comorbidity negatively contributes to both the severity and prognosis of other disorders; however, little literature has been devoted to its influence on borderline personality disorder (BPD). The objective of the present work is to study comorbidity with other personality disorders in a severe clinical sample of patients with BPD, and its relationship with global functionality. Methods. A sample of 65 patients with severe borderline personality disorder was included in the study. Clinical and functionality measures were applied in order to study comorbidity of BPD with other disorders and its relationship with functionality. Associations with other comorbid PDs were analyzed with t-tests and linear correlations. Results. Most patients (87%) presented comorbidity with other PDs. Almost half of the sample (42%) presented more than two PDs, and cluster A (paranoid) and C (obsessive and avoidant) PD were more frequent than cluster B (histrionic and antisocial). Only the presence of avoidant PD predicted a worse functional outcome in the long term (U Mann Withney p<0.01). Conclusions. Severely impaired BPD patients present greater comorbidity with cluster A and C PDs. Comorbid avoidant personality disorder might negatively predict for prognosis

Brain structural anomalies in borderline and avoidant personality disorder patients and their associations with disorder-specific symptoms.

BACKGROUND: Borderline personality disorder (BPD) and avoidant personality disorder (AvPD) are characterized by hyper-reactivity to negatively-perceived interpersonal cues, yet they differ in degree of affective instability. Recent work has begun to elucidate the neural (structural and functional) and cognitive-behavioral underpinnings of BPD, although some initial studies of brain structure have reached divergent conclusions. AvPD, however, has been almost unexamined in the cognitive neuroscience literature. METHODS: In the present study we investigated group differences among 29 BPD patients, 27 AvPD patients, and 29 healthy controls (HC) in structural brain volumes using voxel-based morphometry (VBM) in five anatomically-defined regions of interest: amygdala, hippocampus, medial prefrontal cortex (MPFC), dorsolateral prefrontal cortex (DLPFC), and anterior cingulate cortex (ACC). We also examined the relationship between individual differences in brain structure and self-reported anxiety and affective instability in each group. RESULTS: We observed reductions in MPFC and ACC volume in BPD relative to HC, with no significant difference among patient groups. No group differences in amygdala volume were found. However, BPD and AvPD patients each showed a positive relationship between right amygdala volume and state-related anxiety. By contrast, in HC there was an inverse relationship between MPFC volume and state and trait-related anxiety as well as between bilateral DLPFC volume and affective instability. LIMITATIONS: Current sample sizes did not permit examination of gender effects upon structure-symptom correlations. CONCLUSIONS: These results shed light on potentially protective, or compensatory, aspects of brain structure in these populations-namely, relatively reduced amygdala volume or relatively enhanced MPFC and DLPFC volume.

Elevated amygdala activity during reappraisal anticipation predicts anxiety in avoidant personality disorder.

BACKGROUND: Avoidant personality disorder is characterized by pervasive anxiety, fear of criticism, disapproval, and rejection, particularly in anticipation of exposure to social situations. An important but underexplored question concerns whether anxiety in avoidant patients is associated with an impaired ability to engage emotion regulatory strategies in anticipation of and during appraisal of negative social stimuli. METHODS: We examined the use of an adaptive emotion regulation strategy, cognitive reappraisal, in avoidant patients. In addition to assessing individual differences in state and trait anxiety levels, self-reported affect as well as measures of neural activity were compared between 17 avoidant patients and 21 healthy control participants both in anticipation of and during performance of a reappraisal task. RESULTS: Avoidant patients showed greater state and trait-related anxiety relative to healthy participants. In addition, relative to healthy participants, avoidant patients showed pronounced amygdala hyper-reactivity during reappraisal anticipation, and this hyper-reactivity effect was positively associated with increasing self-reported anxiety levels. LIMITATIONS: Our finding of exaggerated amygdala activity during reappraisal anticipation could reflect anxiety about the impending need to reappraise, anxiety about the certainty of an upcoming negative image, or anxiety relating to anticipated scrutiny of task responses by the experimenters. While we believe that all of these possibilities are consistent with the phenomenology of avoidant personality disorder, future research may clarify this ambiguity. CONCLUSIONS: These results suggest that amygdala reactivity in anticipation of receiving negative social information may represent a key component of the neural mechanisms underlying the heightened anxiety present in avoidant patients.

Schizotypal personality disorder: a current review.

The study of schizotypal personality disorder (SPD) is important clinically, as it is understudied, challenging to treat, often under-recognized or misdiagnosed, and associated with significant functional impairment. SPD also represents an intermediate schizophrenia-spectrum phenotype, and therefore, can provide a better understanding of the genetics, pathogenesis, and treatment of related psychotic illnesses. In this review we discuss recent findings of SPD related to epidemiology and functional impairment, heritability and genetics, working memory and cognitive impairments, social-affective disturbances, and neurobiology. Additionally, we examine the challenges associated with treating patients with SPD, as well as clinical recommendations. Finally, we address future directions and areas in need of further exploration.