Malte Stopsack

Interpersonal evaluation bias in borderline personality disorder

BACKGROUND The cognitive theory of personality disorders hypothesizes that the emotional dysregulation and interpersonal problems in individuals with borderline personality disorder (BPD) are, at least partially, caused by dysfunctional cognitive schemas. These schemas lead to biased evaluation of environmental and interpersonal stimuli. METHOD This study examined the interpersonal evaluations of individuals with BPD, depressive and healthy control participants with the thin-slice judgments paradigm. Participants were asked to evaluate six persons in six film clips, which showed these persons for 10s, during which these persons entered a room and took a seat. Interpersonal style of the BPD group was investigated with the Inventory of Interpersonal Problems (IIP-C) questionnaire. RESULTS Individuals with BPD judged the persons as being more negative and aggressive and less positive than the healthy participants, and more aggressive than the depressive individuals. In addition, individuals with BPD reported more extreme interpersonal behavior relative to the controls. CONCLUSIONS The findings indicate an aggressivistic evaluation bias and elevated levels of interpersonal problems in individuals with BPD as suggested in the cognitive theory.

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.

Temperament and character in patients with borderline personality disorder taking gender and comorbidity into account

This study examined correlations of borderline personality disorder (BPD) symptoms with scales from Cloninger’s psychobiological model taking gender and psychiatric comorbidity into consideration. Inpatients with BPD (n = 202) were compared to several control groups including psychiatrically healthy persons (n = 327), subjects with affective disorders (n = 46), alcohol use disorders (n = 47), cluster C personality disorders (n = 23) and antisocial personality disorder (n = 25). The results indicate that only males with BPD presented an ‘explosive’ temperament suggested by Cloninger, with simultaneously high levels of novelty seeking and harm avoidance. In contrast, women with BPD were characterized by high levels of harm avoidance, but not novelty seeking. Regarding temperament and character dimensions our analyses suggest that patients with BPD could be characterized, in particular, by a combination of high harm avoidance and very low self-directedness. The specific temperament configuration of BPD postulated by Cloninger’s psychobiological model could only partially be supported. The results provide support for the importance of controlling for gender effects when investigating the applicability of dimensional models with respect to personality disorders.

Neuroticism developmental courses - implications for depression, anxiety and everyday emotional experience; a prospective study from adolescence to young adulthood

BackgroundNeuroticism is frequently discussed as a risk factor for psychopathology. According to the maturity principle, neuroticism decreases over the course of life, but not uniformly across individuals. However, the implications of differences in personality maturation on mental health have not been well studied so far. Hence, we hypothesized that different forms of neuroticism development from adolescence to young adulthood are associated with differences in depression, anxiety and everyday emotional experience at the age of 25.MethodsA sample of 266 adolescents from the general population was examined three times over ten years (age at T0: 15, T1: 20 and T2: 25) using questionnaires, interviews and ecological momentary assessment (EMA). At all measurement points, neuroticism was assessed with the NEO inventory. At T2, diagnoses of major depression and anxiety disorders were captured with a structured clinical interview (M-CIDI). Phone-based EMA was used to assess emotional experience and affective instability over a two-week period at T2.ResultsThe best fitting model was a latent class growth analysis with two groups of neuroticism development. Most individuals (n = 205) showed moderate values whereas 61 participants were clustered into a group with elevated neuroticism levels. In both groups neuroticism significantly changed during the ten year period with a peak at the age of 20. Individuals with a higher absolute level were at 14-fold increased risk for depression and 7-fold risk for anxiety disorders at the age of 25. In EMA, increased negative affect and arousal as well as decreased positive emotions were found in this high group.ConclusionsOther than expected, personality did not mature in our sample. However, there was a significant change of neuroticism values from adolescence to young adulthood. Further, over 20% of our participants showed a neuroticism development which was associated with adverse outcomes such as negatively toned emotional experience and a heightened risk to suffer from depressive and anxiety disorders in young adulthood. These high-risk persons need to be identified early to provide interventions supporting continuous personality maturation.

The association between depressive symptoms and emotion recognition is moderated by emotion regulation

In this study, we examined the associations between depression and aspects of emotional functioning, namely emotion recognition, affectivity and interpersonal problems. Particularly, the moderating role of emotion regulation in these interrelations was tested in a sample of 85 women, who exhibited a wide range of depressive symptoms (Composite International Diagnostic Interview (CIDI), Beck Depression Inventory (BDI)). Emotion recognition was assessed with a paradigm displaying a widely used set of photographs of the six basic emotions in graded intensities. Further, participants were examined regarding emotion regulation (Emotion Regulation Questionnaire (ERQ)), interpersonal problems (Inventory of Interpersonal Problems-Circumplex (IIP-C)) and affectivity (Affect Intensity Measure (AIM), Positive and Negative Affect Schedule (PANAS)). Besides correlation analyses, Johnson-Neyman technique for probing interactions in linear regression models was applied to test for possible moderating effects. Depressive symptoms were positively correlated with error rates in anger recognition, but not with the other basic emotions. This association was moderated by suppression in that regard that more severely depressed women who more frequently used suppression showed superior recognition of angry faces than those with lower suppression values. Further, suppression was associated with an affective imbalance and interpersonal problems in women with current depressive disorder. In sum, our results emphasize the importance of differentiating subtypes of depression depending on emotion regulation capabilities for research on or treatment of emotional functioning in depression.

Borderline Personality Disorder in Four Different Age Groups: A Cross-Sectional Study of Community Residents in Germany

Studies examining the natural course of borderline personality disorder (BPD) over the life span have yielded declining prevalence rates in older age groups. However, there is evidence that different BPD symptoms have different longitudinal patterns, with impulsivity decreasing with advancing age and negative affect remaining stable into late adulthood. However, since all studies dealt with treated, clinical samples of BPD patients, it is not yet known whether this represents the natural course of BPD symptoms or just mirrors difference in treatability of these symptoms. The authors addressed this issue by investigating a nonclinical population and compared prevalence of BPD, impulsivity, and depressivity in various age groups from adolescence to late adulthood (N = 2,488); all individuals were assessed by standardized clinical interviews. Syndromal and subsyndromal BPD rates sharply decreased between adolescents and young adults and remained stable thereafter. Whereas the same course was found for impulsivity, depressivity increased between young, middle-aged, and older adults. The present results support the hypothesis that age-related decreases in BPD diagnosis might be attributable to declining levels of impulsivity, whereas the persistence of a subsyndromal BPD might be attributable to an enduring negative affect.

Longitudinal transmission pathways of borderline personality disorder symptoms: from mother to child?

Background: There is evidence that the borderline symptomatology of the mother longitudinally predicts the number of borderline criteria met by the children. However, possible underlying mechanisms have rarely been examined. In line with transactional models of borderline personality disorder (BPD), we analyzed a broad concept of maladaptive mother-child interactions of mothers with BPD symptoms towards their children, including insensitive parenting and mother-child discrepancies, in reporting the childs psychopathological behavior. Sampling/Methods: The sample was drawn from the population-based Greifswald Family Study and consisted of 295 children and their biological mothers. Both were examined at two points in time, first when the children were about 15 years old (T₀) and again 5 years later (T1), using path analyses. Results: Maladaptive mother-child interactions (especially an overprotective and rejecting parenting style and high discrepancies regarding internalizing problems) mediate the longitudinal transmission of borderline symptoms from mother to child. Furthermore, our data revealed that this result is consistent for various youth symptoms which are associated with BPD such as impulsivity or dissociation. Conclusion: The data of the current study imply that the transmission of borderline symptoms from mother to child is mediated by maladaptive mother-child interactions. For this reason early and professional support may be useful to prevent these children from developing severe psychopathology.

Cortical inhibition in alexithymic patients with borderline personality disorder

High levels of alexithymia, a personality trait closely associated with emotion dysregulation, have been found in several psychiatric disorders including borderline personality disorder (BPD). Both BPD and alexithymia have been related to impaired cortical inhibition; however, this relationship has not been tested directly. The aim of the present study was, therefore, to investigate whether cortical inhibition is modulated by alexithymia in BPD. Fifteen BPD patients with Toronto-Alexithymia Scale (TAS-20) scores ≥61, 14 BPD patients with TAS-20 <61, and 16 healthy controls were examined using different TMS paradigms. High-alexithymia patients showed a shortened cortical silent period (CSP) compared to low-alexithymia patients and controls. Additionally, a significant inverse correlation was found between the TAS-20, the left CSP and the left transcallosal conduction time. These findings indicate that alexithymia is associated with changes in GABAergic neurotransmission and facilitated transcallosal inhibition. The results highlight the importance of considering alexithymia in BPD.

Forensic inpatient male sexual offenders: The impact of personality disorder and childhood sexual abuse

Abstract Given the great epidemiological, social, and psychological importance of sexual offences, and their deleterious consequences for victims, it seems vital to focus on potential risk factors for becoming a sexual offender. Our study aims to contribute to a better understanding of specific risk factors for sexual offenders by including a number of potentially important variables: biographical, clinical, and forensic. The sample consisted of 51 male inpatients at two maximum security forensic hospitals in Germany. The 19 sexual offenders were compared to the 32 non-sexual offenders. Personality disorder diagnoses and childhood maltreatment were assessed by experts; current psychopathology and interpersonal problems were measured using self-report questionnaires. Narcissistic personality disorders were significantly more frequent in sexual offenders than in the comparison group. Moreover, sexual offenders had been sexually abused as children significantly more often than the non-sexual offenders. Our findings indicate that sexual victimization in childhood might be an important risk factor for sexual offending in later life. Therapeutic interventions for offenders focusing on their childhood sexual abuse might improve their psychosocial well-being and functioning, and their criminal prognosis.

Testing the diathesis-stress model: 5-HTTLPR, childhood emotional maltreatment, and vulnerability to social anxiety disorder†‡

Regarding the development of social anxiety disorder (SAD), a diathesis‐stress paradigm including biological vulnerabilities and environmental stressors can be assumed. However, studies dealing with the etiology of SAD did not integrate both aspects so far. We examined a particular diathesis‐stress model for SAD in which we included a functional polymorphism of the serotonin transporter (5‐HTTLPR) as a genetic vulnerability factor and childhood emotional maltreatment (CEM) as an environmental stressor. Current analyses were based on individuals who participated in the Study of Health in Pomerania. Psychiatric disorders were assessed with diagnostic interviews according to DSM‐IV criteria. The triallelic genotype of 5‐HTTLPR was determined. Statistical analyses were performed in 78 individuals with SAD and 1,035 without an axis I disorder. Logistic regression analysis revealed that the experience of CEM (odds ratio [OR] 4.56; 95% confidence interval [CI] 2.65–7.84), the l/l genotype of 5‐HTTLPR (OR 2.13; 95% CI 1.31–3.48), female gender (OR 3.03; 95% CI 1.80–5.08) and younger age (OR 1.04; 95% CI 1.02–1.06) increased the odds for SAD. The data suggest that CEM, the l/l genotype of 5‐HTTLPR, female gender and younger age are risk factors for SAD. This is in favor of the tested diathesis‐stress model.