Salome Vanwoerden

Emotion dysregulation, psychological inflexibility, and shame as explanatory factors between neuroticism and depression

BACKGROUND The association between neuroticism and depression is well documented. However, neuroticism is a general risk factor associated with many forms of psychopathology, such as anxiety, eating, and personality disorders. Past research has suggested that other factors may mediate the relationship between neuroticism and symptoms of particular disorders. METHODS Self-report questionnaires measuring neuroticism, emotion dysregulation, psychological inflexibility, shame, and symptoms of depression were administered to 105 inpatient adolescents (aged 12-17). The current study examined three factors (emotion dysregulation difficulties, psychological inflexibility, and shame) as concurrent mediators of the neuroticism/depression association. RESULTS Neuroticism was significantly associated with depression, as expected. Neuroticism was also associated with emotion dysregulation and psychological inflexibility, which, in combination, fully mediated the association between neuroticism and depression. Shame was not significantly associated with neuroticism or depression, when controlling for anxiety, externalizing, sex, and age. Follow-up analyses examined six sub-factors of emotion dysregulation as multiple mediators of the neuroticism/depression association. Goal directed behavior, lack of emotion regulation strategies, and impulse control were significant mediators, controlling for the other three emotion dysregulation sub-factors. LIMITATIONS The study is limited by the cross sectional design, sample size, and self-report measurement. CONCLUSIONS Despite limitations, this study demonstrated that the link between neuroticism and depression is explained by both emotion dysregulation and psychological inflexibility and that specific emotion dysregulation facets may be at play in adolescent depression.

First empirical evaluation of the link between attachment, social cognition and borderline features in adolescents.

OBJECTIVE Several developmental models of borderline personality disorder (BPD) emphasize the role of disrupted interpersonal relationships or insecure attachment. As yet, attachment quality and the mechanisms by which insecure attachment relates to borderline features in adolescents have not been investigated. In this study, we used a multiple mediational approach to examine the cross-sectional interplay between attachment, social cognition (in particular hypermentalizing), emotion dysregulation, and borderline features in adolescence, controlling for internalizing and externalizing symptoms. METHODS The sample included 259 consecutive admissions to an adolescent inpatient unit (Mage=15.42, SD=1.43; 63.1% female). The Child Attachment Interview (CAI) was used to obtain a dimensional index of overall coherence of the attachment narrative. An experimental task was used to assess hypermentalizing, alongside self-report measures of emotion dyregulation and BPD. RESULTS Our findings suggested that, in a multiple mediation model, hypermentalizing and emotion dysregulation together mediated the relation between attachment coherence and borderline features, but that this effect was driven by hypermentalizing; that is, emotion dysregulation failed to mediate the link between attachment coherence and borderline features while hypermentalizing demonstrated mediational effects. CONCLUSIONS The study provides the first empirical evidence of well-established theoretical approaches to the development of BPD.

Social Cognition Mediates the Relation Between Attachment Schemas and Posttraumatic Stress Disorder.

Objective: A social–cognitive perspective on posttraumatic stress disorder (PTSD) has been proposed and posits that impaired social cognition, rooted in attachment insecurity, plays a role in the development of PTSD. Support for the role of impaired social cognition in PTSD has been found in adults, but the social–cognitive perspective on PTSD has not been examined in adolescents. This study sought to explore differences in social cognition and PTSD on the basis of attachment security, and it examined social cognition as a mediator in the relation between attachment security and PTSD and with regard to PTSD symptom change during inpatient treatment. Method: We recruited 142 adolescents from an inpatient psychiatric hospital, where adolescents and their parents completed assessments at admission and discharge. Results: Adolescents with a secure attachment demonstrated better social–cognitive skills than did those with an insecure attachment. Social cognition mediated the relation between adolescents’ maternal attachment representations and PTSD at admission across 3 self- and parent-report measures. Social cognition also mediated the relation between adolescents’ maternal attachment representations at admission and PTSD treatment outcome. Conclusion: This study provides the 1st support for the application of Sharp, Fonagy, and Allen’s (2012) social–cognitive perspective of PTSD to adolescents by showing a link between clinically significant symptoms of PTSD and attachment security through social–cognitive impairment. Findings indicate that improvement in PTSD during medium-stay inpatient treatment is partially driven by baseline attachment security and social–cognitive abilities, highlighting the potential of social–cognitive skills as important targets of clinical intervention among adolescents with PTSD.

Hypermentalizing in Borderline Personality Disorder: A Model and Data

Interpersonal difficulties are a widely accepted characteristic of borderline personality disorder (BPD). However, the results of empirical findings of deficits in social-cognitive abilities that may underlie interpersonal difficulties in this population have been mixed. In this paper, we review the literature on social-cognitive impairment in BPD by organizing studies based on patterns of positive and negative of findings. We provide a new model of mentalizing impairment in BPD by integrating findings into one framework that suggests hypermentalizing as the core feature of social-cognitive impairment in BPD. We review data in support of a hypermentalizing model of BPD and situate this data in the broader context of current work on hypermentalizing.

Callous-unemotional traits are associated with deficits in recognizing complex emotions in preadolescent children.

The aims of the current study were to show that the affective component of psychopathy (callous-unemotional traits) is related to deficits in recognizing emotions over and above other psychopathy dimensions and to show that this relationship is driven by a specific deficit in recognizing complex emotions more so than basic emotions. The authors administered the Child Eyes Test to assess emotion recognition in a community sample of preadolescent children between the ages of 10 and 12 (N = 417; 53.6% boys). The task required children to identify a broad array of emotions from photographic stimuli depicting the eye region of the face. Stimuli were then divided into complex or basic emotions. Results demonstrated a unique association between callous-unemotional traits and complex emotions, with weaker associations with basic emotion recognition, over and above other dimensions of psychopathy.

Experiential avoidance mediates the link between maternal attachment style and theory of mind.

Theoretical and empirical models suggest a relation between attachment style and theory of mind (ToM) in childhood and adulthood; however, this link has not been evaluated to the same extent in adolescence. Additionally, these models typically fail to consider mechanisms by which attachment style affects ToM abilities. The present study sought to test a mediational model in which experiential avoidance mediates the relation between maternal attachment style and ToM. A sample of 282 adolescents (Mage=15.42years, SD=1.44, 62.8% female) was recruited from an inpatient psychiatric hospital. Findings revealed that maternal attachment style in females was related to ToM, through experiential avoidance. Specifically, those with a disorganized maternal attachment were most likely to engage in experiential avoidant cognitive and emotional strategies, which in turn related to lower levels of ToM ability. Implications and areas for future research are discussed.

Exploring the clinical utility of the DSM-5 conduct disorder specifier of 'with limited prosocial emotions' in an adolescent inpatient sample.

BACKGROUND With the recent addition of a callous-unemotional (CU) specifier to the diagnosis of conduct disorder (CD) in the DSM-5, studies are needed to evaluate the clinical utility of this specifier and the best ways to identify youth meeting criteria for this specifier in clinical samples. METHODS To this end, the current study examined cross-sectional correlates and treatment response across four groups of inpatient adolescents (N=382, ages 12-17): those with CD without the specifier, with CD and the CU specifier, CU alone, and a group of psychiatric controls. We used two different measures to identify adolescents with high levels of CU traits: the Antisocial Process Screening Device (APSD) [1] and the Inventory of Callous-Unemotional Traits (ICU) [2]. Questionnaires and structured interviews were used to evaluate a range of outcomes including presence of baseline levels and treatment outcomes of both externalizing and internalizing problems. FINDINGS Results indicated that the ICU, but not the APSD differentiated between conduct disordered youth with and without the specifier on externalizing behaviors in both cross-sectional relations and treatment response. CONCLUSIONS The results of the current study caution the use of the most frequently used measure to identify the CU specifier, and make suggestions about alternatives.

Convergence in Reports of Adolescents’ Psychopathology: A Focus on Disorganized Attachment and Reflective Functioning

Although convergence in parent–youth reports of adolescent psychopathology is critical for treatment planning, research documents a pervasive lack of agreement in ratings of adolescents’ symptoms. Attachment insecurity (particularly disorganized attachment) and impoverished reflective functioning (RF) are 2 theoretically implicated predictors of low convergence that have not been examined in the literature. In a cross-sectional investigation of adolescents receiving inpatient psychiatric treatment, we examined whether disorganized attachment and low (adolescent and parent) RF were associated with patterns of convergence in adolescent internalizing and externalizing symptoms. Compared with organized adolescents, disorganized adolescents had lower parent–youth convergence in reports of their internalizing symptoms and higher convergence in reports of their externalizing symptoms; low adolescent self-focused RF was associated with low convergence in parent–adolescent reports of internalizing symptoms, whereas low adolescent global RF was associated with high convergence in parent–adolescent reports of externalizing symptoms. Among adolescents receiving inpatient psychiatric treatment, disorganized attachment and lower RF were associated with weaker internalizing symptom convergence and greater externalizing symptom convergence, which if replicated, could inform assessment strategies and treatment planning in this setting.

Experiential avoidance in the vulnerability to depression among adolescent females

BACKGROUND Although various mechanisms in the maternal transmission of Major Depressive Disorder (MDD) have been investigated, it is unknown whether experiential avoidance (EA) is a vulnerability factor in the development of depression or a consequence of the illness. The present study utilized a high-risk design to determine if EA indeed poses vulnerability to adolescent MDD. Secondly, we examined the means by which adolescent EA may come to pose vulnerability, namely that it explains the relation between maternal EA and adolescent depressive symptoms. METHODS One-hundred and forty-six biological mother/adolescent daughter dyads comprised three diagnostic groups: mothers with a history of MDD and their depressed daughters (MDD; n=21), mothers with a history of MDD and their never-depressed daughters (high-risk, HR; n=69), and healthy controls (HCs; n=56). RESULTS Groups differed on daughter EA such that the MDD group reported greater EA than the HR group, which in turn reported greater EA than HCs. Daughter EA mediated the relation between maternal EA and daughter depressive symptoms after controlling for maternal depressive symptoms. LIMITATIONS Strengths aside, this study included a relatively small group of depressed mother-daughter dyads and relied on cross-sectional self-report data. CONCLUSIONS EA appears to serve as a vulnerability factor for adolescent MDD, and the mechanistic role of daughter EA highlights the significance of intergenerational EA in the maternal transmission of depression. Therapeutic approaches may therefore consider reducing the transmission of EA from mothers to daughters.

Borderline Personality Features Scale for Children-11: Measurement invariance over time and across gender in a community sample of adolescents.

The Borderline Personality Features Scale for Children (BPFS-C) was recently shortened using item response theory to an 11-item version that is optimal for use in epidemiological studies and repeated assessment over time. Only 1 study has examined invariance of the BPFS-C-11 items across gender and no study has done so over time. The present study employed a longitudinal design to address this gap by evaluating measurement invariance across gender and over time during the transition into adulthood in a diverse community-based sample of 755 adolescents (56% female). Results indicated measurement variance for items measuring personal relationships and impulsivity/recklessness, with females having a greater probability of endorsing items regarding relationship instability and males more likely to endorse impulsivity, despite an equal position on the latent trait. Overall, there was partial measurement invariance of a single dimension of borderline features between males and females and full longitudinal invariance of this factor through the transition into young adulthood. The current findings provide empirical evidence supporting the reliability of BPFS-C-11 scores as a measure of borderline pathology (BP) during late adolescence and early adulthood.