Allison Kalpakci

Mentalization in borderline personality disorder: From bench to bedside.

The current special issue focuses on the potential of mentalizing as a translational construct for the understanding and treatment of borderline personality disorder (BPD). Mentalizing, which provides the central construct around which mentalization-based therapy (MBT) and theory is organized, refers to the capacity to meaningfully reflect on the mind of others as well as the self. In this introductory article to the special issue, we begin by discussing the need for and nature of translational research. We contend that translational research in mental health and personality disorder, in particular, lags behind that of other medical disorders because of the challenges inherent in meeting translational criteria. We discuss these criteria and we demonstrate the potential of the construct of mentalizing to meet translational criteria in the context of BPD. This article thereby provides the context for the other 3 papers in this special issue which each represent a different point along the translational spectrum. In all, our aim is to provide a foundation for the further evaluation of the usefulness and potential of mentalizing as translational construct in the context of BPD.

Experiential avoidance mediates the link between maternal attachment style and theory of mind.

Theoretical and empirical models suggest a relation between attachment style and theory of mind (ToM) in childhood and adulthood; however, this link has not been evaluated to the same extent in adolescence. Additionally, these models typically fail to consider mechanisms by which attachment style affects ToM abilities. The present study sought to test a mediational model in which experiential avoidance mediates the relation between maternal attachment style and ToM. A sample of 282 adolescents (Mage=15.42years, SD=1.44, 62.8% female) was recruited from an inpatient psychiatric hospital. Findings revealed that maternal attachment style in females was related to ToM, through experiential avoidance. Specifically, those with a disorganized maternal attachment were most likely to engage in experiential avoidant cognitive and emotional strategies, which in turn related to lower levels of ToM ability. Implications and areas for future research are discussed.

A dimensional approach to assessing personality functioning: examining personality trait domains utilizing DSM-IV personality disorder criteria

BACKGROUND This study compared a dimensional, trait domain approach to characterizing personality pathology with the traditional polythetic approach with respect to their associations with interpersonal functioning and personality traits from the five factor model. METHODS Psychiatric inpatients (N=1476) were administered the Structured Clinical Interview for DSM-IV Axis II personality disorders. Dimensional representations of trait domains were derived from reorganizing DSM-IV criteria into personality trait domains from DSM-5 Alternative Model. Dimensional scores and personality disorder (PD) total criterion scores served as independent variables in predicting interpersonal profile clusters, as well as extraversion, agreeableness conscientiousness, neuroticism and openness from the five factor model traits. RESULTS Trait domain scores and PD criteria totals were significantly correlated with submissive interpersonal style yet none proved significant in regression analyses. Avoidant and borderline PD total criteria were negatively associated with a normative interpersonal style. Combined trait domain of detachment and avoidant PD total criteria predicted a hostile/withdrawn interpersonal style. The trait domain of detachment was negatively associated with five factor traits of extroversion, whereas borderline PD total criteria were negatively associated with conscientiousness. Avoidant and borderline PD total criteria were positively associated with neuroticism. CONCLUSIONS The cross-cutting dimensional approach provided useful information in predicting a hostile/withdrawn interpersonal style as well as extroversion. Importantly, PD criterion scores and dimensional trait scores combined to predict this interpersonal style providing support to the alternative model of personality diagnosis in DSM-5. Clinicians are encouraged to assess dimensions of personality traits as these are related to interpersonal problems frequently encountered in psychiatric settings. While potentially useful, the dimensional approach articulated here did not yield substantial prediction of behavior.

The specificity of emotion dysregulation in adolescents with borderline personality disorder: comparison with psychiatric and healthy controls

BackgroundResearch has supported the notion that emotion dysregulation is a core feature of BPD. However, given that this feature is typical of healthy adolescents as well as adolescents with other psychiatric disorders, the specificity of emotion dysregulation to BPD in this age group has not yet been determined. The overall aim of this study was to examine emotion dysregulation in adolescent inpatients with BPD compared with non-BPD inpatient adolescents and healthy non-clinical adolescents, taking into account both global emotion dysregulation deficits and more specific impairments.MethodThe sample included 185 adolescent inpatients with BPD (M = 15.23, SD = 1.52), 367 non-BPD psychiatric inpatient adolescents (M = 15.37, SD = 1.40), and 146 healthy adolescents (M = 15.23, SD = 1.22), all of whom were between the ages of 12 and 17. Borderline personality features were assessed, along with emotion dysregulation and psychiatric severity.ResultsAfter controlling for age, gender, and psychiatric severity, results revealed that adolescents with BPD had higher overall emotional dysregulation compared with non-BPD psychiatric controls and healthy controls. These differences were apparent in only two domains of emotion dysregulation including limited access to emotion regulation strategies perceived as effective and impulse control difficulties when experiencing negative emotions.ConclusionsFindings suggest BPD-specific elevations on emotion dysregulation generally, and subscales related to behavioral regulation specifically.

Evaluating smartphone-based user interface designs for a 2D psychological questionnaire

This study explored various user interface designs to transition a two dimensional (2D) questionnaire from its paper-and-pencil testing format to the mobile platform. The current administration of the test limits its usage beyond the lab environment. Creating a mobile version would facilitate ubiquitous administration of the test. Yet, the mobile design must be at least as good as its paper-based counterpart in terms of input accuracy and user interaction efforts. We developed four user interface designs, each of which featured a specific interaction approach. These approaches included displaying the 2D space of the questionnaire in its original form (M1), inputting one variable at a time on the 2D space (M2), dissolving the 2D space into two one-dimensional ordinal scales (M3), and orienting the input selections to the diagonal axes (M4). The designs were tested by a total of 34 participants, aged 18 to 52 years. The study results find the first three interaction approaches (M1-M3) effective but the fourth approach inefficient. Furthermore, the results indicate that the two-tap designs (M2 and M3) are equally as good as the one-tap design (M1).

Current maternal depression moderates the relation between critical expressed emotion in mothers and depressive symptoms in their adolescent daughters.

Prior studies have examined critical expressed emotion (EE-Crit) in mothers in the intergenerational transmission of depression. However, the potential moderating effect of maternal depression diagnostic status in relation to EE-Crit and youth depressive symptoms has yet to be determined. A total of N=121 biological mother/daughter dyads that differed in maternal depression diagnostic status were recruited for the present study: (1) currently depressed mothers (current depression, n=29); (2) formerly depressed mothers (past depression, n=39); and (3) mothers free from any psychiatric history (healthy controls, n=53). Mothers were administered structured clinical interviews and completed self-report measures of EE-Crit and psychopathology, and daughters self-reported depressive symptoms. Results indicated no significant group differences in EE-Crit; however, current maternal depression status moderated EE-Crit such that the magnitude of the relation between EE-Crit and adolescent depressive symptoms was significantly greater in daughters of currently depressed mothers. These findings highlight the importance of considering current maternal depression, rather than a history of maternal depression, in relation to EE-Crit and adolescent depressive symptoms, providing impetus for future investigations.

An evaluation of the construct of emotional sensitivity from the perspective of emotionally sensitive people

BackgroundEmotional sensitivity is a construct found in major developmental models of borderline personality disorder. However, the construct remains nebulous. The patient perspective is crucially important in helping to define and conceptualize any psychological construct – especially one that plays such a large role in the developmental theories of a given disorder. The aim of the current study was to explore the meaning of emotional sensitivity from the perspective of those who identify as being emotionally sensitive.MethodsParticipants were from a community sample of adults (Mage = 32.05, range: 21–59) who responded to an advertisement for a study of emotional sensitivity. Participants completed surveys related to personality pathology and a semi-structured interview about emotional sensitivity. Emotional sensitivity interviews were independently coded by two research assistants trained in qualitative analyses for content and process. Coders were blind to the personality pathology status of participants.ResultsRegardless of level of personality pathology, qualitative results of the emotional sensitivity interview largely suggest that emotional sensitivity is a heightened emotional reactivity to stimuli, including the emotions of other individuals, or a tendency to have emotional reactions to even low impact stimuli. However, emotional sensitivity was regarded predominantly as a negative trait (i.e. burden) only by those who have high levels of borderline personality pathology.ConclusionsThe implications of these results for the conceptualization and utility of emotional sensitivity in borderline personality disorder are discussed.

DSM Borderline Criterion Function Across Age-Groups: A Cross-Sectional Mixed-Method Study

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) Section II criteria for borderline personality disorder (BPD) lack developmental operationalization. The aim of the current study was to evaluate whether DSM criteria operate similarly across adolescents and adults to determine if developmental adjustment for DSM criteria was needed. Three age cohorts were recruited: adolescents (ages 12-17 years; n = 484), young adults (ages 18-25 years; n = 442), and adults (ages ≥26 years; n = 953). The Child Interview for DSM-IV BPD and the Structured Clinical Interview for DSM-IV Axis II disorders were administered to adolescents and adults, respectively. Item response theory methods were used to evaluate differential item (or criterion) functioning (DIF) of BPD criteria across adolescents and adults. Qualitative analyses were then used to evaluate the potential sources of DIF. Item response theory results demonstrated DIF across adolescents and adults for all DSM BPD criteria. Qualitative analyses suggested that the source of DIF was most likely due to rater/interviewer bias. Results furthermore suggested that behavioral criteria may represent the heterotypic features of BPD, while intra- and interpersonal criteria represent the homotypic features of the disorder. The article concludes with recommendations for developmentally informed guidelines for the assessment of BPD.

The relations between inadequate parent-child boundaries and borderline personality disorder in adolescence

Borderline Personality Disorder (BPD) is a severe mental illness that onsets in adolescence. Research has demonstrated the central role of parent-child relationships for the development and maintenance of BPD although more research is necessary to clarify the specific dynamics that relate to BPD during adolescence. Based on preliminary research establishing the importance of parent-child boundaries for adolescent BPD, this study sought to evaluate the relations between different forms of inadequate boundaries and BPD in adolescence using a multi-method approach. To that end, 301 adolescents (65.1% female; ages 12-17) inpatients were recruited; parents and adolescents completed questionnaire- and interview-based measures of BPD features in adolescent children and a questionnaire-based measure of parent-child boundaries. Relations were found between parental guilt induction and psychological control with childrens BPD features above and beyond relations with psychiatric severity and gender. Relations between parent reports of triangulation (when children are recruited to mediate parental marital conflict) and childrens BPD were contingent on the level of childrens perceptions of triangulation. Findings confirm previous research suggesting the relevance of inadequate parent-child boundaries to childrens BPD features and have important implications for understanding the dynamics in families with adolescents with BPD, representing a relevant treatment target.

The development and preliminary psychometric evaluation of an attachment Implicit Association Task

The importance of measuring attachment insecurity is underscored by a vast literature tying attachment insecurity to numerous psychological disorders. Self-report measures assess explicit attachment beliefs and experiences, while interview measures, like the Adult Attachment Interview, assess implicit internal working models about the self as worthy of care and others as reliable sources of care. The present study is a preliminary psychometric evaluation of a potentially cost-effective method of assessing implicit internal working models of attachment through the development of an Implicit Association Test (IAT). A racially diverse sample of 104 college females was administered Internet-based versions of three IATs (assessing views of the self, mother, and father) as well as self-report measures of attachment and interpersonal problems. Analyses were conducted to evaluate the (a) internal consistency of each task, (b) correlations among the tasks, (c) concurrent validity, and (d) convergent validity. Adequate internal consistency was noted and correlations among the three IATs were significant. No significant associations were observed between the explicit self-report measures of attachment and the IATs. Two primary areas for future research are discussed. First, future research should utilize an implicit attachment measure alongside an IAT. Second, future research should reevaluate the IAT stimuli used.