Carla Sharp

The rupture and repair of cooperation in borderline personality disorder.

To sustain or repair cooperation during a social exchange, adaptive creatures must understand social gestures and the consequences when shared expectations about fair exchange are violated by accident or intent. We recruited 55 individuals afflicted with borderline personality disorder (BPD) to play a multiround economic exchange game with healthy partners. Behaviorally, individuals with BPD showed a profound incapacity to maintain cooperation, and were impaired in their ability to repair broken cooperation on the basis of a quantitative measure of coaxing. Neurally, activity in the anterior insula, a region known to respond to norm violations across affective, interoceptive, economic, and social dimensions, strongly differentiated healthy participants from individuals with BPD. Healthy subjects showed a strong linear relation between anterior insula response and both magnitude of monetary offer received from their partner (input) and the amount of money repaid to their partner (output). In stark contrast, activity in the anterior insula of BPD participants was related only to the magnitude of repayment sent back to their partner (output), not to the magnitude of offers received (input). These neural and behavioral data suggest that norms used in perception of social gestures are pathologically perturbed or missing altogether among individuals with BPD. This game-theoretic approach to psychopathology may open doors to new ways of characterizing and studying a range of mental illnesses.

Social cognition and developmental psychopathology

PART I - DEVELOPMENTAL DISORDERS PART II - EXTERNALIZING DISORDERS PART III - INTERNALIZING DISORDERS PART IV - OTHER CONSIDERATIONS

New tricks for an old measure: The development of the Barratt Impulsiveness Scale-Brief (BIS-Brief)

The Barratt Impulsivity Scale (BIS), a 30-item self-report measure, is one of the most commonly used scales for the assessment of the personality construct of impulsiveness. It has recently marked 50 years of use in research and clinical settings. The current BIS-11 is held to measure 3 theoretical subtraits, namely, attentional, motor, and non-planning impulsiveness. We evaluated the factor structure of the BIS using full information item bifactor analysis for Likert-type items. We found no evidence supporting the 3-factor model. In fact, half of the items do not share any relation with other items and do not form any factor. In light of this, we introduce a unidimensional Barratt Impulsiveness Scale-Brief (BIS-Brief) that includes 8 of the original BIS-11 items. Next, we present evidence of construct validity comparing scores obtained with the BIS-Brief against the original BIS total scores using data from (a) a community sample of borderline personality patients and normal controls, (b) a forensic sample, and (c) an inpatient sample of young adults and adolescents. We demonstrated similar indices of construct validity that is observed for the BIS-11 total score with the BIS-Brief score. Use of the BIS-Brief in clinical assessment settings and large epidemiological studies of psychiatric disorders will reduce the burden on respondents without loss of information.

Borderline personality disorder in adolescents: evidence in support of the Childhood Interview for DSM-IV Borderline Personality Disorder in a sample of adolescent inpatients

Empirical evidence is increasing in support of the validity of the construct of borderline personality disorder (BPD) in adolescence. There is growing consensus that the early identification and treatment of emerging borderline traits may be an important focus. However, few diagnostic (questionnaire- or interview-based) measures specifically developed or adapted for adolescents and children exist. The Childhood Interview for DSM-IV Borderline Personality Disorder (CI-BPD) [Zanarini, 2003] is a promising interview-based measure of adolescent BPD. Currently, no studies have explicitly been designed to examine the psychometric properties of the CI-BPD. The aim of the current study was to examine various psychometric properties of the CI-BPD in an inpatient sample of adolescents (n = 245). A confirmatory factor analytic approach was used to examine the internal factor structure of the 9 CI-BPD items. In addition, internal consistency, interrater reliability, convergent validity (with clinician diagnosis and 2 questionnaire-based measures of BPD), and concurrent validity (with Axis I psychopathology and deliberate self-harm) were examined. Similar to several adult studies, the confirmatory factor analytic results supported a unidimensional factor structure for the CI-BPD, indicating that the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria on which the CI-BPD is based constitute a coherent combination of traits and symptoms even in adolescents. In addition, other validity criteria were excellent. Taken together, the current study provides strong evidence for the validity of the CI-BPD for use in adolescents.

The criTerion validiTy of The Borderline PersonaliTy feaTures scale for children in an adolescenT inPaTienT seTTing

The purpose of the current study was to examine the criterion validity of the Borderline Personality Features Scale for Children (BPFS-C) by assessing the performance of the self-report and a newly developed parent report version of the measure (BPFS-P) in detecting a borderline personality disorder (BPD) diagnosis in adolescent inpatients. This study also examined parent-child agreement and the internal consistency of the BPFS subscales. An inpatient sample of adolescents (n = 51) ranging from ages 12-18 completed the BPFS and were administered the Child Interview for DSM-IV Borderline Personality Disorder (CI-BPD) by trained clinical research staff. ROC analyses revealed that the BPFS-C has high accuracy (AUC = .931; Se = .856; Sp = .840) in discriminating adolescents with a diagnosis of BPD, as measured by the CI-BPD, while the BPFS-P has moderate accuracy (AUC = .795; Se = .733; Sp = .720). Parent-child agreement on total scores was significant (r = .687; p < .005). Cronbachs alphas suggested internal consistency for the four subscales of the BPFS. These findings support the criterion validity of this measure, particularly the self-report version, in adolescent inpatient settings.

Evaluating the Interpersonal Needs Questionnaire: Comparison of the Reliability, Factor Structure, and Predictive Validity across Five Versions

Five versions of the Interpersonal Needs Questionnaire (INQ), a self-report measure of perceived burdensomeness and thwarted belongingness, have been used in recent studies (including 10-, 12-, 15-, 18-, and 25-items). Findings regarding the associations between perceived burdensomeness, thwarted belongingness, and suicidal ideation using different versions have been mixed, potentially due to differences in measurement scales. This study evaluated factor structure, internal consistency, and concurrent predictive validity of these five versions in three samples. Samples 1 and 2 were comprised of 449 and 218 undergraduates, respectively; Sample 3 included 114 adolescent psychiatric inpatients. All versions demonstrated acceptable internal consistency. The 10-item version and 15-item version demonstrated the best, most consistent model fit in confirmatory factor analyses. Both perceived burdensomeness and thwarted belongingness consistently predicted concurrent suicidal ideation on the 10-item INQ only. Future research should consider using the 15-item or 10-item versions.

Imagining your child's mind: psychosocial adjustment and mothers' ability to predict their children's attributional response styles

One class of parent-child interaction that has recently received attention is maternal engagement with her child at a mental level. The current study operationalises this notion by asking the mothers of 354 7-11 year old children drawn from a larger community sample (n=659) to guess the responses of their children, who in turn, were asked to attribute thoughts to their peers in distressing peer-related scenarios. The following predictions were made: (1) mothers would be above chance in the accuracy by which they predicted their children’s overal attributional styles (2) increased maternal accuracy would be an important correlate of reduced psychopathology symptoms in children; and (3) poor maternal accuracy would associated with a maladaptive child attributional response style characterised by unrealistic and overly positive attributions. Results suggested that maternal accuracy was normally distributed with mothers accurately guessing the responses of their children for about half of the social scenarios. Mothers were furthermore shown to be above chance in the accuracy by which they predicted their childrens overall attributional styles. Maternal accuracy was found to be related to child psychosocial adjustment (reduced scores on child psychopathology measures), whilst poor maternal accuracy was associated with ineffective social-cognitive reasoning, as indexed by an unrealistic and overly positive child attributional style. Findings are discussed within the context of the burgeoning literature linking attachment, family talk about feelings and thoughts and parental mind-mindedness.

Theory of Mind and conduct problems in children : Deficits in reading the emotions of the eyes

A significant clinical feature of disorders of antisocial behaviour involves difficulties in social functioning. It has been suggested that deficits in “theory of mind” (ToM) reasoning—the ability to decode others’ emotions and thoughts—may underlie social difficulties in these populations. Success in demonstrating ToM impairment associated with antisocial behaviour and psychopathy in adults and children have been limited. In the current study, parent-reported conduct problems were concurrently measured with performance on an advanced test of ToM developed for children, the Child Eyes Test (Journal of Developmental and Learning Disorders, 5, 47–78). Preadolescent and young adolescent children (n=79) drawn from a community sample were required to identify emotions from photographic stimuli depicting the eye region of the face only. Findings suggested a generalised impairment in ToM in children with conduct problems, as indicated by a significant relationship between poor Eyes Test performance and conduct problems, even when IQ, sex and age were controlled for. The findings are discussed in the context of the amygdala theory of psychopathy, and the neural systems suggested to mediate performance on the Eyes Test.

The measurement of reflective function in adolescents with and without borderline traits

Reflective function refers to the capacity to reflect on the mind of self and others in the context of the attachment relationship. Reflective function (and its conceptual neighbor, mentalizing) has been shown to be an important correlate of a variety of disorders, including borderline personality disorder (BPD). The current study examined the construct validity of the Reflective Function Questionnaire for Youths (RFQY) in an inpatient sample of adolescents. Adequate internal consistency was established for the RFQY. Significant positive associations with an interview-based measure of reflective function and an experimental-based assessment of mentalization were found for the RFQY. Strong negative relations with BPD features were found and adolescent patients who scored above clinical cut-off for BPD symptoms demonstrated significantly poorer reflective function compared to patients without the disorder. These findings provide preliminary support for the notion that reflective function can be validly and reliably assessed in adolescent populations.

Perceptions about e-cigarette safety may lead to e-smoking during pregnancy

Electronic cigarettes (e-cigarettes) are nicotine-delivery devices that are increasingly used, especially by young people. Because e-cigarettes lack many of the substances found in regular tobacco, they are often perceived as a safer smoking alternative, especially in high-risk situations such as pregnancy. However, studies suggest that it is exposure to nicotine that is most detrimental to prenatal development. The authors studied perceptions of tobacco and e-cigarette health risks using a multiple-choice survey. To study the perceived safety of e-cigarettes versus tobacco cigarettes, 184 modified Global Health Youth Surveys (WHO, http://www.who.int/tobacco/surveillance/gyts/en/ ) were completed electronically or on paper. Age range, smoking status, and perceptions about tobacco cigarettes and e-cigarettes were studied. The results verified that younger people use e-cigarettes more than older people. Tobacco cigarettes were perceived as more harmful than e-cigarettes to health in general, including lung cancer and pregnancy. Although more research is necessary, the authors postulate that the perception that e-cigarettes are safer during pregnancy may induce pregnant women to use these devices more freely. Given that nicotine is known to cause fetal harm, pregnant mothers who smoke e-cigarettes could cause even greater harm to the fetus because e-cigarettes are perceived as being safer than tobacco cigarettes. Until more data about the effects of nicotine during pregnancy are available, the authors advocate for labeling of e-cigarettes as potentially harmful, at least during pregnancy.