Disgust and implicit self-concept in women with borderline personality disorder and posttraumatic stress disorder

Disgust may be a key emotion and target for psychotherapeutic interventions in borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) at explicit and implicit-automatic levels. However, automatically activated disgust reactions in individuals with these disorders have not been studied. Disgust and its correlation with childhood abuse were assessed in women with BPD, but without PTSD; women with PTSD, but without BPD; women with BPD and PTSD; and healthy women. Disgust sensitivity, anxiety and depression were measured by self-report. Implicit disgust-prone (relative to anxiety-prone) self-concept was assessed using the Implicit Association Test. Women with BPD and/or PTSD reported more disgust sensitivity than controls. The implicit self-concept among patients was more disgust-prone (relative to anxiety-prone) than in controls. Women with BPD, with PTSD, or BPD and PTSD did not differ significantly in self-reported disgust levels or implicit disgust-related self-concept. Among women with BPD and/or PTSD, current psychiatric comorbidity (major depression, anxiety disorder, eating disorder, or substance-related disorder) did not affect disgust-related variables. More severe physical abuse in childhood was associated with a more anxiety-prone (less disgust-prone) implicit self-concept. Independent of psychiatric comorbidity, disgust appears to be elevated at implicit and explicit levels in trauma-related disorders. Psychotherapeutic approaches to address disgust should take implicit processes into account.     

Implicit and explicit self-concept of neuroticism in borderline personality disorder

Purpose: In the past, research on personality in borderline personality disorder (BPD) used primarily questionnaires suggesting heightened neuroticism in BPD. Self-report instruments inform about the conscious or explicit self-concept. BPD patients are known to show negative distortion with exaggeration of negative affect in the self-report. Neuroticism represents a risk factor for mental disorders. Indirect measures are available that tap into the implicit self-concept of neuroticism. The implicit self-concept refers to individual differences in associative representations of the self. The present study examined for the first time the implicit in addition to the explicit self-concept of neuroticism in BPD.

Materials and methods: Female BPD patients (N?=?35) and healthy women (N?=?39) completed an implicit association test and the NEO-FFI personality inventory.

Results: BPD patients showed higher implicit and explicit neuroticism compared to controls. The group difference for explicit neuroticism was four times larger than that for implicit neuroticism. Presence of comorbid depressive disorder was positively correlated with implicit neuroticism. The IAT neuroticism showed excellent split-half reliability for BPD patients.

Conclusions: The present data suggest that BPD patients with comorbid clinical depression but not those without clinical depression differ from healthy individuals in their implicit self-concept of neuroticism. In the associative network, BPD patients with comorbid clinical depression exhibit stronger associations of the self with neuroticism-related characteristics, such as nervousness, fearfulness, and uncertainty than healthy individuals. Regardless of depression, BPD patients show increased explicit neuroticism. Our findings provide evidence that the IAT neuroticism can be applied reliably to BPD patients.     

The impact of posttraumatic stress disorder on dysfunctional implicit and explicit emotions among women with borderline personality disorder

A comorbid posttraumatic stress disorder (PTSD) aggravates symptoms, course of illness and social functioning of persons with borderline personality disorder (BPD). However, it is largely unclear how this effect is mediated. In 60 women with BPD of whom 23 had a comorbid current PTSD we investigated whether dysfunctional explicit and implicit emotions were associated with a comorbid PTSD. Shame and guilt proneness, anxiety, anger-hostility, and general psychopathology were assessed by self-report measures. Implicit anxiety-related self-concept was measured using the Implicit Association Test. Self-reported guilt proneness and general psychopathology, but not shame proneness or trait anxiety, were significantly higher in women with BPD and PTSD than in women with BPD alone. A comorbid PTSD was associated with a more anxiety-prone (relative to shame-prone) implicit self-concept as assessed by the Implicit Association Test. Self-reported guilt proneness and implicit anxiety may mediate the negative impact of comorbid PTSD on women with BPD.     

Self-stigma in women with borderline personality disorder and women with social phobia

Little is known about how women with borderline personality disorder (BPD) and women with social phobia react to mental illness stigma. The goal of this study was to assess empirically self-stigma and its correlates in these groups. Self-stigma and related constructs were measured by self-report questionnaires among 60 women with BPD and 30 women with social phobia. Self-stigma was inversely related to self-esteem, self-efficacy, and quality of life and predicted low self-esteem after controlling for depression and shame-proneness. Stereotype awareness was not significantly correlated with self-esteem or quality of life. While there was no difference in stereotype awareness between women with BPD and women with social phobia, women with BPD showed higher self-stigma than women with social phobia. Self-stigma is associated with low self-esteem and other indices of poor psychological well-being. In comparison to women with social phobia, women with BPD suffer from more self-stigma. This may reflect intense labeling processes as being mentally ill due to repeated hospitalizations, frequent interpersonal difficulties, and visible scars.     

Affect regulation in women with borderline personality disorder traits

Affect dysregulation is considered a defining feature of borderline personality disorder (BPD). In spite of this, there is a dearth of empirical research that examines affect regulation among persons with BPD. The present study examined the relationship between specific dimensions of affect regulation and borderline traits in a sample of 39 patients. Participants were administered the Personality Diagnostic Questionnaire-Revised to assess the degree of borderline traits and the Affect Intensity Measure and Affect Control Scale to assess dimensions of affect regulation, selected based on the biosocial theory of BPD. Results from hierarchical regression analyses indicated that level of affect intensity and affect control were significantly associated with number of BPD traits, even after controlling for level of depression. Findings for affect control remained significant even after controlling for affect intensity. These results, consistent with biosocial theory of BPD, suggest that persons with BPD experience emotions more intensely and have greater difficulty in controlling their affective responses.     

Increased diurnal salivary cortisol in women with borderline personality disorder

Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image. In previous studies, we have used portable mini-computers to assess the severity of recurrent states of aversive emotional distress and dissociation during ambulatory conditions. Here, we used this approach for the assessment of the hypothalamic–pituitary–adrenal (HPA) axis in patients with BPD. We studied 23 unmedicated female patients with BPD and 24 matched healthy controls. Salivary cortisol was collected from all participants during ambulatory conditions in response to reminders provided by portable mini-computers on 3 consecutive days every 2 h for 14 h after awakening. In addition, cortisol in response to awakening was determined in four 15 min intervals on days 1 and 2. After the last collection of cortisol on the second day, 0.5 mg dexamethasone was administered in order to achieve cortisol suppression on day 3 (low-dose dexamethasone suppression test, DST). Patients with BPD displayed significantly higher salivary cortisol levels than healthy controls as demonstrated by higher total cortisol in response to awakening and higher total daily cortisol levels. There were significantly more non-suppressors of cortisol in the low-dose DST in the patient group when compared to the control group. The ambulatory assessment of saliva cortisol is a suitable approach to study basic parameters of the HPA-axis in patients with BPD. Increased adrenal activity and lowered feedback sensitivity of the HPA-axis may characterise BPD. Further studies have to reveal reasons of heightened adrenal activity in these patients.     

Basal cortisol and DHEA levels in women with borderline personality disorder

Previous research suggests that in borderline personality disorder (BPD) normal stress regulation, with a main role for cortisol, is disturbed. However, most studies were confounded by their lack of attention to co-morbidity. Relevant patient characteristics such as depression, childhood abuse, posttraumatic stress disorder (PTSD) and copying styles were not systematically examined. Moreover, none of the studies incorporated dehydroepiandrosterone (DHEA), a hormone that can antagonize the effects of cortisol. Hence, the present pilot study investigates the basic levels of cortisol and DHEA and the ratio (CDR) between the two hormones in BPD patients. Twenty-two women with BPD and 22 healthy female controls provided two diurnal (8 a.m./8 p.m.) salivary samples. Overall cortisol levels were not significantly increased in the patient group as a whole but only in those patients diagnosed with co-morbid PTSD and a history of childhood abuse. The patients’ cortisol secretions decreased relatively less steep during the day than it did in the controls. Surprisingly, morning DHEA levels were significantly higher in the patients than in the controls. Moreover, the CDR showed a significantly larger and less favourable increase in the BPD group during the day. In the patients lower levels of DHEA in the evening proved significantly related to a stronger tendency to avoid active problem solving and a lowered inclination to seek social support. The current findings underline the relevance of cortisol and DHEA assessments and the need for further scrutiny of their interplay to foster our understanding of the biological basis of stress regulation in BPD.     

Schemas and borderline personality disorder symptoms in incarcerated women

There is increasing interest regarding the role of maladaptive cognition in Borderline Personality Disorder (BPD). The current study examined the relationship between early maladaptive schema (EMS) domains and BPD symptoms as well as whether schema domains account for the relationship between childhood maltreatment and BPD severity. Incarcerated women (N = 105) were assessed for BPD symptoms via semi-structured diagnostic interview. Disconnection/Rejection and Impaired Limits were associated with BPD pathology although these domains shared variance with depression and antisocial personality disorder pathology, respectively. In addition, the relationship between childhood abuse and BPD severity was non-significant after controlling for schema domains. Related findings and the implications for cognitive treatment of BPD are discussed.     

Neurochemical alterations in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder

Background. Borderline personality disorder (BPD) is associated with structural and functional brain changes. Recent models and findings refer to alterations of glutamate and total N-acetylaspartate (tNAA) in this condition. Methods. Absolute quantities of tNAA, creatine, glutamate, glutamine, myoinositol and total choline were measured using 3 Tesla magnetic resonance spectroscopy of the left anterior cingulate cortex and the left cerebellum in 14 unmedicated women with BPD and comorbid attention-deficit hyperactivity disorder (ADHD) and 18 healthy women. Both groups were matched with respect to age, education and premorbid intelligence. Results. In the anterior cingulate, we found significantly higher tNAA and glutamate concentrations and a trend for lower glutamine levels in women with BPD and comorbid ADHD as compared to healthy women. There were no significant group differences in cerebellar metabolite concentrations. Conclusions. Glutamatergic changes in the anterior cingulate may be associated with BPD and comorbid ADHD. Increased anterior cingulate tNAA may indicate disturbed energy metabolism or impaired frontal maturation.     

Basal cortisol and DHEA levels in women with borderline personality disorder

Previous research suggests that in borderline personality disorder (BPD) normal stress regulation, with a main role for cortisol, is disturbed. However, most studies were confounded by their lack of attention to co-morbidity. Relevant patient characteristics such as depression, childhood abuse, posttraumatic stress disorder (PTSD) and copying styles were not systematically examined. Moreover, none of the studies incorporated dehydroepiandrosterone (DHEA), a hormone that can antagonize the effects of cortisol. Hence, the present pilot study investigates the basic levels of cortisol and DHEA and the ratio (CDR) between the two hormones in BPD patients. Twenty-two women with BPD and 22 healthy female controls provided two diurnal (8 a.m./8 p.m.) salivary samples. Overall cortisol levels were not significantly increased in the patient group as a whole but only in those patients diagnosed with co-morbid PTSD and a history of childhood abuse. The patients’ cortisol secretions decreased relatively less steep during the day than it did in the controls. Surprisingly, morning DHEA levels were significantly higher in the patients than in the controls. Moreover, the CDR showed a significantly larger and less favourable increase in the BPD group during the day. In the patients lower levels of DHEA in the evening proved significantly related to a stronger tendency to avoid active problem solving and a lowered inclination to seek social support. The current findings underline the relevance of cortisol and DHEA assessments and the need for further scrutiny of their interplay to foster our understanding of the biological basis of stress regulation in BPD.     

Corpus callosum abnormalities in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder

OBJECTIVE: Decreased brain volumes in prefrontal, limbic and parietal areas have been found in women with borderline personality disorder (BPD). Recent models suggest impaired structural and functional connectivity in this condition. To investigate this, we studied the thickness of the corpus callosum, the largest connecting fibre bundle in the human brain. METHODS: We acquired magnetic resonance imaging scans from 20 healthy women and 20 women with BPD and comorbid attention-deficit hyperactivity disorder. A novel computational mesh-based method was applied to measure callosal thickness at high spatial resolution. RESULTS: Women with BPD had a thinner isthmus of the corpus callosum, compared with healthy women. In the patient group, a history of childhood sexual abuse was associated with a thinner posterior body of the corpus callosum. CONCLUSION: Interhemispheric structural connectivity involving parietal and temporal areas may be impaired in women with BPD and comorbid attention-deficit hyperactivity disorder.     

Shame in patients with narcissistic personality disorder

Shame has been described as a central emotion in narcissistic personality disorder (NPD). However, there is a dearth of empirical data on shame in NPD. Patients with NPD (N=28), non-clinical controls (N=34) and individuals with borderline personality disorder (BPD, N=31) completed self-report measures of state shame, shame-proneness, and guilt-proneness. Furthermore, the Implicit Association Test (IAT) was included as a measure of implicit shame, assessing implicit shame-self associations relative to anxiety-self associations. Participants with NPD reported higher levels of explicit shame than non-clinical controls, but lower levels than patients with BPD. Levels of guilt-proneness did not differ among the three study groups. The implicit shame-self associations (relative to anxiety-self associations) were significantly stronger among patients with NPD compared to nonclinical controls and BPD patients. Our findings indicate that shame is a prominent feature of NPD. Implications for diagnosis and treatment are discussed.     

Motives for nonsuicidal self-injury among women with borderline personality disorder

Patients with borderline personality disorder (BPD) are known to use nonsuicidal self-injury (NSSI) as a dysfunctional strategy to regulate intense emotions. The primary purpose of this study was to clarify the motives for NSSI along with their interrelations. We further investigated the variety of emotions preceding NSSI and possible effects of NSSI on these emotions. To this end, a structured self-rating questionnaire on NSSI was administered to 101 female BPD-patients exhibiting NSSI. Most patients reported multiple motives for NSSI. The motives were more likely to compound than to exclude one another. Negative reinforcement was almost always involved in NSSI, whereas positive reinforcement (e.g., "getting a kick") played an additional role among about half of the patients. NSSI was usually preceded by a large variety of negative feelings that were reported to clearly improve with NSSI. In conclusion, therapists should anticipate a multidimensional functional spectrum when exploring motives of NSSI.     

Multiple personality and borderline personality disorder

The authors offer their theory that multiple personality represents a "special instance" of borderline personality disorder, that the introjects are composed of a representation of the self, a representation of the object, and an affective bond.     

Smaller stress-sensitive hippocampal subfields in women with borderline personality disorder without posttraumatic stress disorder

Background

Animal and human studies have suggested that hippocampal subfields are differentially vulnerable to stress, but subfield volume has not been investigated in patients with borderline personality disorder (BPD). Based on the putative role of stressful life events as vulnerability factors for BPD, we hypothesized that patients with BPD would exhibit reduced volumes for the stress-sensitive dentate gyrus (DG) and the cornu ammonis (CA) 3 subfields volumes, and that these volumes would be associated with traumatic childhood experiences.

Methods

All participants underwent 3 T magnetic resonance imaging. Hippocampal subfield volumes were estimated using an automated and validated segmentation algorithm implemented in FreeSurfer. Age and total subcortical grey matter volume were covariates. We assessed traumatic childhood experiences using the Childhood Trauma Questionnaire (CTQ).

Results

A total of 18 women with BPD and 21 healthy control women were included in the study. Only 1 patient had comorbid posttraumatic stress disorder (PTSD). The volumes of the left (p = 0.005) and right (p = 0.011) DG-CA4 and left (p = 0.007) and right (p = 0.005) CA2–3 subfields were significantly reduced in patients compared with controls. We also found significant group differences for the left (p = 0.032) and right (p = 0.028) CA1, but not for other hippocampal subfields. No associations were found between CTQ scores and subfield volumes.

Limitations

The self-reported CTQ might be inferior to more comprehensive assessments of traumatic experiences. The sample size was moderate.

Conclusion

The volumes of stress-sensitive hippocampal subfields are reduced in women with BPD without PTSD. However, the degree to which childhood trauma is responsible for these changes is unclear.     

Reduced glucose metabolism in temporo-parietal cortices of women with borderline personality disorder

Individuals with borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) often experience dissociative symptoms. Evidence is increasing that stress-related hyperglutamatergic states may contribute to dissociative symptoms and neurodegeneration in temporo-parietal cortical areas. Seventeen young women with BPD who had been exposed to severe childhood physical/sexual abuse and presented with pronounced dissociative symptoms underwent (18)fluoro-2-deoxyglucose positron emission tomography (FDG-PET). Nine healthy, matched volunteers served as comparison subjects. Borderline subjects displayed reduced FDG uptake (as analyzed by SPM) in the right temporal pole/anterior fusiform gyrus and in the left precuneus and posterior cingulate cortex. Impaired memory performance among borderline subjects was significantly correlated with metabolic activity in ventromedial and lateral temporal cortices. Our results demonstrate regional hypometabolism in temporal and medial parietal cortical regions known to be involved in episodic memory consolidation and retrieval. Currently, the precuneus/posterior cingulate cortex is modeled as part of a network of tonically active brain regions that continuously gather information about the world around and within us. Decreased resting metabolic rate of these regions may reflect dissociative symptoms and possibly also identity disturbances and interpersonal difficulties of individuals with BPD.