Harald-J. Freyberger

Influence of Punishment, Emotional Rejection, Child Abuse, and Broken Home on Aggression in Adolescence: An Examination of Aggressive Adolescents in Germany

The results of this study provide evidence for the importance of psychosocial risks in childhood for aggressive behavior in adolescence. This study demonstrated that aggressive adolescents differed from a nonaggressive control group in an increased exposure to prior psychotraumatic events, such as sexual abuse (tendency), physical abuse, and broken homes. However, in predicting later aggressive behavior, long-term and chronically effective negative living conditions seem of greater importance. Parenting behavior which includes harsh punishment and emotional rejection as well as separation of the parents early in life are particularly important factors. Whereas aggressive girls do not differ from the nonaggressive control group in terms of self-reported mental health, the aggressive boys reported more attention deficits, depression, anxiety, delinquency, and social problems.

Dissociation and emotion regulation in borderline personality disorder

BACKGROUND Although some evidence suggests that borderline personality disorder (BPD) is primarily a disorder of the emotion regulation system, findings remain inconsistent. One potential explanation for this is the moderating role of dissociation. METHOD In this study, 33 female subjects with BPD and 26 healthy controls (HC; matched by education level and nicotine intake) were presented idiographic aversive, standard unpleasant and neutral scripts. Modulation of startle reflex and electrodermal responses (skin conductance level; SCL) were measured during imagery of emotional and neutral scripts. Additionally, self-reports of emotional experience (valence and arousal) and present-state dissociation were assessed. RESULTS Patients with BPD showed elevated levels of dissociative experiences during testing. Present-state dissociation mediated group differences in SCL and startle response between the HC and BPD groups. CONCLUSIONS These results suggest that careful attention must be paid to the moderating effect of dissociative symptoms on the psychophysiological responses of BPD patients. Furthermore, the findings have important implications for the assessment and treatment of BPD, including the need to carefully assess BPD patients for dissociative symptoms and to incorporate the treatment of dissociation.

Gender differences in unipolar depression: a general population survey of adults between age 18 to 64 of German nationality

BACKGROUND Several studies from different epidemiological backgrounds have shown that unipolar depression is more prevalent in females than in males. This study examines gender differences in depression in a sample of 4075 probands recruited representatively from the general population in the northern German epidemiological catchment area of Lübeck. METHODS Probands were interviewed with M-CIDI by lay interviewers. RESULTS Being married only seems to increase the female depression risk when having children, while higher education reduced female excess; both male and female risk for depression raised sharply in separated, divorced and widowed probands. Not being employed was associated with an increased risk in male depression whereas in females risk was nearly unchanged. The gender ratio increased with the minimum number of depressive symptoms. Female excess was not reduced by a higher degree of subjective impairment or melancholic features. Females also predominated in longer episode durations. Female excess in the total group emerged beginning from adolescence with a tendency for a male excess in the prepubescent ages. No birth cohort effect was observed. LIMITATIONS The cross-sectional design of this study precluded causal analysis of reported associations and some retrospective assessments are error-prone because of recall bias. CONCLUSIONS We support previous findings of variations in gender differences in depression, however observed social parameter influences underline the need for a more detailed analysis of subgroups and underlying psychological mechanisms.

The relation between suicidal feelings and mental disorders in the elderly : results from the Berlin Aging Study (BASE)

BACKGROUND The purpose of this study was to demonstrate the influence of several risk factors (particularly physical and mental disorders, loneliness and housing conditions) on the wish to die in the elderly. METHOD Using data from a population-based sample of 516 senior citizens (70 to 103 years of age) in Berlin (Germany), we compared 54 persons with death wishes with 462 persons without death wishes on several psychosocial risk factors, physical health and psychiatric diagnoses. A logistic regression analysis was also conducted. RESULTS . The data indicate that the wish to die is strongly associated with the presence of a mental disorder, especially major depression, while higher age, female gender, subjective assessment of physical health and negative living conditions were all only moderately related to death wishes. CONCLUSIONS Our results emphasize the need for very careful diagnosis of death wishes in the very old and question the view that it is a normal and understandable phenomenon in older age.

The importance of psychosocial factors, gender, and severity of depression in distinguishing between adjustment and depressive disorders

BACKGROUND This study evaluated the severity of depressive symptomatology as it relates to: (a) sociodemographic factors and (b) the occurrence and type of acute and chronic psychosocial triggers or life events before admission. METHODS In total, 718 psychiatric inpatients were assessed with the AMDP-system by the treating psychiatrist within the first 2 days after admission. RESULTS In the females, sociodemographic factors (being married, children in the household, higher education and the quality of interactions) but not psychosocial stressors or life events were found to be related to severity of depression on admission. Females showed more severe depressive syndromes than males, however, depression severity in males was independent of sociodemographic factors, life events or psychosocial triggers. LIMITATIONS Clinical assessment was based on retrospective history taking. The sample consisted of inpatients only, the results require replication using larger and more diverse samples. CONCLUSION Gender differences and life conditions such as familial distress are related to severity of depression. The present criteria for the differentiation between depressive disorders and adjustment disorders are not independent and should be substituted by a multiaxial assessment.

The Relation of a Family History of Alcoholism, Obstetric Complications and Family Environment to Behavioral Problems among 154 Adolescents in Germany: Results from the Children of Alcoholics Study in Pomerania

Background: Behavioral problems in adolescence have been shown to be associated with the presence of a positive family history of alcoholism (FH+), obstetric complications (OCs), and negative parenting practices. Method: This study tested the relation of these factors to aggression/delinquency and attention problems in an untreated population sample of 154 adolescents in Pomerania. Furthermore, we evaluated the predictive strength of a FH+, OCs and negative parenting styles in a prospective subsample of 127 adolescents using a hierarchical regression analysis. Results: Group comparisons between offspring with higher vs. lower values on aggression/delinquency revealed that only rejection by the parents was significantly more often reported by teenagers with higher measures on these behavioral problems. Offspring with higher values on attention problems had more OCs reported by the mother and also had more feelings of parental rejection compared to controls. The results of the hierarchical regression analysis showed that parental rejection was the only significant predictor for both aggression/delinquency, and attention problems measured 1 year after the initial assessment. Conclusion: We conclude that parental rejection is a major risk factor for both aggression/delinquency and attention problems. Reflecting the fact that these behavioral problems have been reported to be strongly associated with later substance misuse, the improvement of parenting practices should be considered in prevention and intervention programs.

The Family Environment in Early Life and Aggressive Behavior in Adolescents and Young Adults

Aggressive behavior in adolescents is of great interest to mental health professions, as it causes disruptions in the family, school, and peer relations, and predicts higher risks for criminality, substance misuse, and personality disorders in adulthood (Coie et al., 1982; Elliott, 1994).

The Use of a Symptom Checklist (SCL-90-R) as an Easy Method to Estimate the Relapse Risk after Alcoholism Detoxification

We tested the use of some subscales of the psychiatric symptom checklist SCL-90-R in predicting relapse within a 1-year follow-up period after a combined detoxification- and abstinence-focused day patient psychotherapy program in 20 men and 13 women with alcohol dependence. Scores of the SCL-90-R subscales interpersonal sensitivity (p = 0.008), anxiety (p = 0.022), phobic anxiety (p = 0.019) and Global Severity Index (GSI; p = 0.040) on admission were higher in the subgroup with relapse within the first year after therapy. A decrease in depression (p = 0.004), anxiety (p = 0.006) and GSI (p = 0.006) scores during therapy was associated with a longer abstinence duration (shorter vs. longer than 24 weeks). Therefore we propose to further investigate the capacity of the SCL-90-R to identify subgroups at higher risk for relapse after detoxification and abstinence therapy in patients with alcohol dependence.

Trauma, Temperaments- und Charaktermerkmale bei Patienten mit Borderline-Persönlichkeitsstörung und komplexer posttraumatischer Belastungsstörung

Hintergrund: Traumata finden sich besonders häufig bei Patienten mit Borderline-Persönlichkeitsstörung (BPS). Es wurde daher vermutet, dass diese Patienten auch die Kriterien für eine komplexe posttraumatische Belastungsstörung (PTBS) erfüllen. Diese Annahme wurde in der vorliegenden Studie untersucht. Zudem wurde gefragt, wie häufig solche Störungen bei Patienten mit BPS vorkommen und inwieweit sich Patienten mit BPS und komplexer PTBS von Patienten mit BPS aber ohne komplexe PTBS in der Art des Traumas, dem Alter bei Traumatisierung, der Temperaments- und der Charakterkonfiguration unterscheiden. Patienten und Methode: Es wurden 51 stationäre BPS-Patienten (Alter: 26,5 ± 7,57 Jahre) der Universitätsklinik Greifswald bezüglich Temperament und Charakter, traumatischer Lebenserfahrungen und Vorliegen einer komplexen PTBS untersucht. Ergebnisse: Insgesamt berichteten 41 der Patienten (80,4%) von traumatischen Erlebnissen, 31,4% wiesen eine komplexe PTBS auf. Im Vergleich zu BPS-Patienten ohne komplexe PTBS, gaben BPS-Patienten mit komplexer PTBS signifikant mehr Typ-II-Traumata in ihrer Entwicklungsgeschichte an. Bezüglich der vier erfassten Temperamentsdimensionen Neugierverhalten, Schadensvermeidung, Belohnungsabhängigkeit und Beharrlichkeit und der drei Charakterdimensionen Selbstlenkungsfähigkeit, Kooperativität und Selbsttranszendenz fanden wir eine signifikant höhere Schadensvermeidung bei BPSPatienten mit komplexer PTBS im Vergleich zu BPS-Patienten ohne. Schlussfolgerungen: Die Ergebnisse zeigen, dass disponierende Bedingungen wie erhöhte Verhaltenshemmung (Schadensvermeidung) und chronische traumatische Lebenserfahrungen mit einer komplexen PTBS assoziiert sind. Im Hinblick auf die spätere Behandlung und eine adäquate Differentialdiagnostik bestätigen unsere Befunde die Notwendigkeit, für Patienten mit komplexen Traumatisierungen modifizierte Therapiemanuale zu entwickeln, die der Schwere der Störung aber auch der Bedeutung des Traumas Rechnung tragen.

Structural alterations in white-matter tracts connecting (para-)limbic and prefrontal brain regions in borderline personality disorder.

BACKGROUND A dysfunctional network of prefrontal and (para-)limbic brain region has been suggested to underlie emotional dysregulation in borderline personality disorder (BPD). Abnormal activity in this network may be due to structural alterations in white-matter tracts connecting prefrontal and (para-)limbic brain regions. To test this hypothesis, we investigated the structural integrity of major white-matter tracts connecting these regions in BPD. METHOD Using diffusion tensor imaging, we investigated fractional anisotropy (FA), axonal anisotropy (AD) and radial diffusivity (RD) in the uncinate fasciculus, the major white-matter tract connecting (para-)limbic and prefrontal brain regions, in 26 healthy controls (HC) and 26 BPD participants. To clarify the specificity of possible white-matter alterations among HC and BPD participants, FA, AD and RD were also investigated in the cingulum. RESULTS We found distinct structural alterations in the uncinate fasciculus but not in the cingulum of BPD participants. Compared to HC participants, BPD participants showed lower FA and higher RD in the uncinate fasciculus. By contrast, AD did not differ in the uncinate fasciculus of HC and BPD participants. CONCLUSIONS Our finding of abnormal FA and RD in the uncinate fasciculus indicates distinct white-matter alterations in BPD, presumably due to stress-induced myelin degeneration in the aftermath of stressful life events. Although these alterations may account for abnormal activity in brain regions implicated in emotion dysregulation, such as the amygdala, anterior cingulate cortex and prefrontal cortex, it remains to be determined whether these alterations are specific for BPD.