Babette Renneberg

Rejection sensitivity and borderline personality disorder.

Rejection sensitivity (RS) is defined as a cognitive-affective processing disposition of anxious expectation, ready perception and overreaction to rejection cues. RS is widely investigated in social psychology, but research on RS in clinical samples is scarce. Focus of the present study was to examine the role of RS in patients with borderline personality disorder (BPD) compared to other clinical disorders. The Rejection Sensitivity Questionnaire (RSQ) was adapted for application in clinical and non-clinical samples and proved to be a methodologically sound measure. High correlations between the RSQ and borderline-specific cognitions (Questionnaire of Thoughts and Feelings) were observed. Compared to several clinical samples as well as healthy controls, BPD patients indicated the highest scores on both measures and differed significantly from all other groups, even from patients with social anxiety disorders.

Response inhibition in borderline personality disorder: performance in a Go/Nogo task.

Background: Borderline personality disorder is associated with subtle neuropsychological deficits. A potential impairment of response inhibition is of major interest, since it could be related to impulsivity as a clinical feature of borderline personality disorder. Sampling and Methods: Response inhibition was studied in an auditory Go/Nogo paradigm in a sample of 20 female inpatients with borderline personality disorder and 18 healthy controls. The main measures of interest were general task performance, errors and reaction times. Results: Patients with borderline personality disorder performed worse in the Nogo task but not in the Go task. In the Nogo task, when response inhibition was essential, patients made more errors of commission, revealing problems to inhibit a prepotent response. Additionally, the borderline group was characterized by significantly shorter reaction times in both tasks compared to the nonclinical control group. The results for errors of commission in the Nogo task remained significant even after controlling for reaction time. Conclusions: The present results suggest a double impairment on this response inhibition task. First, borderline personality disorder patients have inadequately fast reaction times and a speed-accuracy tradeoff. Second, they show a genuine deficit of response inhibition. These results are discussed in the context of the conflicting literature on response inhibition and executive control in borderline personality disorder.

Emotional Distress and Psychosocial Resources in Patients Recovering From Severe Burn Injury

Emotional distress as well as psychosocial resources in 55 patients with burn injuries was assessed during acute and follow-up treatment. Results showed significantly greater values of emotional distress among patients when compared with norms of the general population. As well as higher levels of general psychopathology, particularly prevalent were anxiety, depression, and posttraumatic symptoms. However, patients also reported high levels of resources such as general optimism, self-efficacy, and perceived social support. Within the sample, no significant correlation between severity of emotional distress and severity of burn injury was found. By psychological assessments a subgroup of highly distressed patients was identified. These patients were highly emotionally distressed while having objective injury severity comparable with the other patients in the sample. Reactions to burn accidents vary individually. The results demonstrate the importance of routine screenings of psychological symptoms. An early identification of patients at-risk allows for tailored psychotherapeutic interventions and can thus help to improve quality of life and general well-being of burn patients on a long-term basis.

Perception of Social Participation in Borderline Personality Disorder

Interpersonal dysfunction is a key feature of borderline personality disorder (BPD). Distorted perception of participation in social situations and altered emotional responses could contribute to these typical interpersonal problems in BPD. Thirty patients with BPD were compared with a healthy control group (n = 30) in their perceptions and subjective emotional reactions to situations of social inclusion and exclusion. Participants played Cyberball, a virtual ball-tossing paradigm, in which social inclusion and exclusion are experimentally induced. Control participants reacted with an increase in sadness, anger and overall negative affect when excluded. In BPD patients, social exclusion also induced anger, while general participating in the game seemed to reduce levels of sadness. Compared with healthy controls, BPD patients felt more readily excluded independent of the condition of inclusion or exclusion. In conclusion, patients with BPD displayed a negative bias toward perceived participation in social situations. Key PRACTITIONER MESSAGE: Patients with BPD have a biased perception for exclusion. Virtual ball-tossing games can be used to induce anger in patients with BPD. Participating in a virtual ball-tossing game may reduce levels of sadness in BPD in the short term.

Impaired decision making and feedback evaluation in borderline personality disorder

BACKGROUND Increased impulsivity is considered to be a core characteristic of borderline personality disorder (BPD) and has been shown to play a significant role in decision making and planning. Neuropsychological studies in BPD revealed impairments of executive functions, and it is assumed that these deficits are related to altered feedback processing. However, research on executive functions in BPD is still limited and the underlying deficits remain an open question. The present study, therefore, explored whether decision-making deficits are related to altered feedback evaluation in BPD. METHOD A total of 18 BPD patients and 18 matched healthy controls underwent a modified version of the Iowa Gambling Task while an electroencephalogram was recorded. Feedback processing was examined by measuring the feedback-related negativity (FRN) and the P300 as electrophysiological correlates of feedback evaluation. RESULTS Behavioural results revealed that BPD patients, relative to controls, made more risky choices and did not improve their performance. With regard to the FRN, amplitudes in BPD patients did not discriminate between positive and negative feedback information. Further, BPD patients showed reduced FRN amplitudes, which were associated with enhanced impulsivity and enhanced risk taking. In contrast, the P300 amplitudes following negative feedback were increased in BPD patients, relative to controls. CONCLUSIONS This study indicates that BPD patients are impaired in decision making, which might be related to a dysfunctional use of feedback information. Specifically, BPD patients did not learn to avoid disadvantageous selections, even though they attended to negative consequences.

Facial emotional expression in reaction to social exclusion in borderline personality disorder

BACKGROUND Disturbances in social interaction are a defining feature of patients with borderline personality disorder (BPD). In this study, facial emotional expressions, which are crucial for adaptive interactions in social contexts, were assessed in patients with BPD in response to social exclusion. METHOD We examined facial emotional reactions of 35 patients with BPD and 33 healthy controls when playing Cyberball, a virtual ball-tossing game that reliably induces social exclusion. Besides self-reported emotional responses, facial emotional expressions were analyzed by applying the Emotional Facial Action Coding System (EMFACS). RESULTS Patients with BPD showed a biased perception of participation. They more readily reported feeling excluded compared to controls even when they were included. In BPD, social exclusion led to an increase in self-reported other-focused negative emotions. Overall, EMFACS analyses revealed that BPD patients reacted with fewer positive expressions and with significantly more mixed emotional expressions (two emotional facial expressions at the same time) compared to the healthy control group when excluded. CONCLUSIONS Besides a negative bias for perceived social participation, ambiguous facial emotional expressions may play an important role in the disturbed relatedness in patients with BPD.

Positive change after severe burn injuries.

Aims of the study were to examine positive change in people with severe burn injuries and to examine the impact of related constructs, demographic and medical variables on Post Traumatic Growth (PTG). A total of 149 participants who had been treated for a severe burn injury completed the posttraumatic growth inventory as well as other self-report inventories assessing coping, social support, quality of life, and mental distress. Similar to other populations who experienced trauma and adversity, burn survivors also report PTG. The strongest predictors for PTG were active coping and social support. Gender and age differences were found in the current study. Implications for further research and interventions facilitating PTG are discussed.

Autobiographical memory in borderline personality disorder and depression

Responses to an autobiographical memory test (AMT, Williams & Broadbent, 1986) are examined in a sample of 30 female psychiatric inpatients with borderline personality disorder (BPD) in comparison to a group of 27 depressed inpatients and a nonclinical control group of 30 women. Concordant with the literature, depressed patients retrieved fewer specific memories than the control group, generated significantly more categoric memories than participants of both other groups, and needed more time for retrieval. Contrary to expectation, patients with BPD did not differ from normal control participants in specificity, nor latency of their retrieved memories. In both clinical groups, hedonic tone of retrieved memories was more often negative than in the control group. In this sample of inpatients with BPD, specificity of memories was not related to self-reported level of depression, dissociative symptoms, or frequency of self-mutilation.

Propensity scores as a basis for equating groups: basic principles and application in clinical treatment outcome research.

A propensity score is the probability that a participant is assigned to the treatment group based on a set of baseline covariates. Propensity scores provide an excellent basis for equating treatment groups on a large set of covariates when randomization is not possible. This article provides a nontechnical introduction to propensity scores for clinical researchers. If all important covariates are measured, then methods that equate on propensity scores can achieve balance on a large set of covariates that mimics that achieved by a randomized experiment. We present an illustration of the steps in the construction and checking of propensity scores in a study of the effectiveness of a health coach versus treatment as usual on the well-being of seriously ill individuals. We then consider alternative methods of equating groups on propensity scores and estimating treatment effects including matching, stratification, weighting, and analysis of covariance. We illustrate a sensitivity analysis that can probe for the potential effects of omitted covariates on the estimate of the causal effect. Finally, we briefly consider several practical and theoretical issues in the use of propensity scores in applied settings. Propensity score methods have advantages over alternative approaches to equating groups particularly when the treatment and control groups do not fully overlap, and there are nonlinear relationships between covariates and the outcome.

The Narcissistic Personality Inventory: A Useful Tool for Assessing Pathological Narcissism? Evidence From Patients With Narcissistic Personality Disorder

The Narcissistic Personality Inventory (NPI) has dominated research on narcissism in the field of social and personality psychology. Surprisingly, it is unclear whether the NPI is useful for identifying pathological narcissism in patients with Narcissistic Personality Disorder (NPD). The goal of this study was to close this research gap. We used an extreme-group approach by including NPD patients and healthy controls and comparing their narcissism scores. We further investigated whether explicit self-esteem (assessed with the Rosenberg Self-Esteem Scale) suppressed the relationship between group membership and NPI narcissism. According to our results, NPD patients do not score higher on the NPI in comparison to healthy controls. Analysis of indirect effects revealed that differences in NPI scores are suppressed by NPD patients’ low self-esteem. Our results indicate that the NPI is not a valid indicator of NPD, unless one controls for self-esteem. Implications for future research are discussed.