Gitta A. Jacob

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.

Measuring shame and guilt by self-report questionnaires : A validation study

Quantitative assessment of shame and guilt using self-report questionnaires can help to understand the role of these emotions in various mental disorders. However, shame and guilt measures have predominantly been tested among healthy subjects that usually show low levels of guilt and shame. Thus, little is known about the comparative validity of different shame and guilt questionnaires in a population of shame- and guilt-prone persons with mental illness as compared to healthy subjects. This study used the Test of Self-Conscious Affect (TOSCA-3), the Personal Feelings Questionnaire (PFQ-2) and the Experiential Shame Scale (ESS) among 60 women with borderline personality disorder (BPD) and 60 healthy women. Intercorrelations of shame-proneness, guilt-proneness and state shame as well as their correlations with self-efficacy, empowerment, state and trait-anxiety, experiential avoidance, depression, and general psychopathology were assessed. In both groups, shame-proneness was moderately related to guilt-proneness, both as assessed by the TOSCA-3 and the PFQ-2. For the TOSCA-3, among healthy subjects shame-proneness was significantly correlated with other constructs while guilt-proneness was not. This difference turned largely insignificant among women with BPD. For the PFQ-2, shame- and guilt-proneness showed similar correlational patterns with other constructs in both groups. The guilt-proneness scale of the TOSCA-3 showed poor internal consistency. State shame (ESS) was strongly related to state anxiety in both groups, and its correlations with other constructs were similar to state anxiety. The discriminant validity of the TOSCA-3 to distinguish between shame- and guilt-proneness may be diminished in clinical samples. The measure of state shame (ESS) showed a large overlap with state anxiety.

Impulsivity in borderline personality disorder: impairment in self-report measures, but not behavioral inhibition.

Background: Impulsivity is a core feature of borderline personality disorder (BPD). However, previous clinical and experimental studies investigating impulsivity in BPD rendered mixed results. In this study, impulsivity was assessed by self-report scales and behavioral inhibition tasks to compare different data levels. Sampling and Methods: Fifteen women with BPD and 15 matched healthy control subjects (HC) completed the Barratt Impulsiveness Scale, Eysenck’s Impulsivity Questionnaire and the UPPS (Urgency, Lack of Perseverance, Lack of Premeditation and Sensation Seeking) scale, and participated in a Stroop task, an antisaccade task and a stop signal task. Results: Patients with BPD scored significantly higher on self-report measures as compared to HC, but not in behavioral tests. In BPD patients, but not in HC, behavioral inhibition errors were correlated with more intense emotional state. Conclusion: We found a discrepancy between self-report and behavioral data. Further studies need to assess additional possible mechanisms underlying increased impulsivity, their relation to emotional instability, and their neurobiological underpinnings.

Impulsivity in borderline personality disorder: a matter of disturbed impulse control or a facet of emotional dysregulation?

Impulsivity is regarded as a clinical, diagnostic and pathophysiological hallmark of borderline personality disorder (BPD). Self-report measures of impulsivity consistently support the notion of higher impulsive traits in BPD patients as compared to healthy control subjects. Laboratory tests of impulsivity, i.e. neuropsychological tests of impulse control render weak and inconsistent results both across different cognitive components of impulse control and within the same cognitive component of impulse control. One important factor worsening impulsive behaviors and impulse control deficits in BPD is comorbid attention-deficit/hyperactivity disorder (ADHD). In addition, emotional dysregulation interacts with impulse control especially for BPD salient emotions. In sum, although basic mechanisms of impulse control seem not to be disturbed in BPD, clinically well observed impulsive behaviors may be explained by comorbid ADHD or may be the consequence of dysregulation of BPD salient emotions.

Predictors of dropout from inpatient dialectical behavior therapy among women with borderline personality disorder.

Inpatient dialectical behavior therapy (DBT) is an effective treatment for borderline personality disorder (BPD), but often treatment is ended prematurely and predictors of dropout are poorly understood. We, therefore, studied predictors of dropout among 60 women with BPD during inpatient DBT. Non-completers had higher experiential avoidance and trait anxiety at baseline, but fewer life-time suicide attempts than completers. There was a trend for more anger-hostility and perceived stigma among non-completers. Experiential avoidance and anxiety may be associated with dropout in inpatient DBT. Low life-time suicidality and high anger could reflect a subtype at risk for discontinuation of inpatient treatment.

Emotional sensitivity, emotion regulation and impulsivity in borderline personality disorder: a critical review of fMRI studies.

Emotional sensitivity, emotion regulation and impulsivity are fundamental topics in research of borderline personality disorder (BPD). Studies using fMRI examining the neural correlates concerning these topics is growing and has just begun understanding the underlying neural correlates in BPD. However, there are strong similarities but also important differences in results of different studies. It is therefore important to know in more detail what these differences are and how we should interpret these. In present review a critical light is shed on the fMRI studies examining emotional sensitivity, emotion regulation and impulsivity in BPD patients. First an outline of the methodology and the results of the studies will be given. Thereafter important issues that remained unanswered and topics to improve future research are discussed. Future research should take into account the limited power of previous studies and focus more on BPD specificity with regard to time course responses, different regulation strategies, manipulation of self-regulation, medication use, a wider range of stimuli, gender effects and the inclusion of a clinical control group.

Emotional modulation of motor response inhibition in women with borderline personality disorder: an fMRI study

BACKGROUND Both emotion regulation and impulsivity are core aspects of borderline personality disorder (BPD) pathology. Although both problems may be combined specifically in BPD, few studies to date have investigated the emotional modulation of impulsivity in BPD. METHODS Women with BPD and matched healthy controls performed go/no-go tasks after induction of anger, joy or a neutral mood by vocally presented short stories. Dependent variables were the behavioural results and functional magnetic resonance imaging data. RESULTS We included 17 women with BPD and 18 controls in our study. No behavioural group differences were found. However, patients with BPD showed stronger activation of the left amygdala and weaker activation of the subgenual anterior cingulate during anger induction than controls. Inhibition in the go/no-go task after anger induction increased activity in the left inferior frontal cortex in controls, but not in women with BPD, who, in turn, showed increased activation in the subthalamic nucleus. LIMITATIONS Findings cannot be generalized to men, and 4 patients were taking antidepressant medication (selective serotonin reuptake inhibitors). In addition, no patient control group was investigated, thus we do not know whether findings are specific to BPD compared with other disorders. CONCLUSION Our findings are consistent with the view that a disturbed amygdala-prefrontal network in patients with BPD is compensated by a subcortical loop involving the subthalamic nucleus, leading to normal behavioural inhibition in these patients.

Emotional Reactions to Standardized Stimuli in Women With Borderline Personality Disorder: Stronger Negative Affect, But No Differences in Reactivity

Emotional dysregulation is hypothesized to be a core feature of borderline personality disorder (BPD). In this study, we investigated the course of emotions in response to standardized emotion inductions in BPD. A total of 26 female BPD patients, 28 matched healthy control subjects, and 15 female patients with major depressive disorder listened to short stories inducing an angry, joyful, or neutral mood. Before and immediately after each story as well as 3 and 6 minutes later, participants rated their current anger, joy, anxiety, shame, and sadness. All 3 groups showed the same increase and decrease of emotions. However, strong group differences in the general level of all negative emotions occurred. While sadness was stronger both in BPD and major depressive disorder as compared with healthy controls, all other negative emotions were significantly increased in BPD only independent of comorbid depression. Extreme negative affectivity may be a more appropriate description of BPD-related emotional problems than emotional hyperreactivity.

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.

Dialectic behavioural therapy has an impact on self-concept clarity and facets of self-esteem in women with borderline personality disorder

Identity disturbance and an unstable sense of self are core criteria of borderline personality disorder (BPD) and significantly contribute to the suffering of the patient. These impairments are hypothesized to be reflected in low self-esteem and low self-concept clarity. The objective of this study was to evaluate the impact of an inpatient dialectic behavioral therapy (DBT) programme on self-esteem and self-concept clarity. Forty women with BPD were included in the study. Twenty patients were treated with DBT for 12 weeks in an inpatient setting and 20 patients from the waiting list served as controls. Psychometric scales were used to measure different aspects of self-esteem, self-concept clarity and general psychopathology. Patients in the treatment group showed significant enhancement in self-concept clarity compared with those on the waiting list. Further, the scales of global self-esteem and, more specifically, the facets of self-esteem self-regard, social skills and social confidence were enhanced significantly in the intervention group. Additionally, the treatment had a significant impact on basic self-esteem in this group. On the other hand, the scale of earning self-esteem was not significantly abased in patients with BPD and did not show significant changes in the intervention group. Our data provide preliminary evidence that DBT has an impact on several facets of self-esteem and self-concept clarity, and thus on identity disturbance, in women with BPD.