Autonomic impairment in Borderline Personality Disorder: A laboratory investigation

Recent research suggests that emotional dysfunction in psychiatric disorders can be reflected in autonomic abnormalities. The present study examines sympathetic and parasympathetic autonomic nervous system activity in individuals with Borderline Personality Disorder (BPD) before, during, and following a social stressor task. Data were obtained from an analogue sample of participants screening positive for BPD (n = 12) and healthy controls (n = 28). In general, BPD participants exhibited increased sympathetic activity (indexed by Cardiac Sympathetic Index, CSI; Toichi et al., 1997) and decreased parasympathetic activity (indexed by Respiratory Sinus Arrhythmia, RSA) compared to controls. During the stressful task, BPD and control participants exhibited different trajectories of sympathetic activation: estimates of sympathetic activity increased for BPD participants and decreased for controls. Furthermore, BPD participants reported the task (but not baseline or recovery phases) to be more frustrating than controls. Findings are interpreted in the context of Polyvagal theory.     

Walking impairs cognitive performance among people with multiple sclerosis but not controls

People with multiple sclerosis (MS) complain of problems completing two tasks simultaneously; sometimes called ‘dual-tasking’ (DT). Previous research in DT among people with MS has focused on how adding a cognitive task interferes with gait and few have measured how adding a motor task could interfere with cognition. We aimed to determine the extent to which walking affects a concurrent working memory task in people with MS compared to healthy controls. We recruited MS participants (n = 13) and controls (n = 10) matched by age (±3 years), education (±3 years) and gender. Participants first completed the cognitive task (subtracting 7’s from the previous number) and then again while walking on an instrumented walkway. Although there were no baseline differences in cognition or walking between MS participants and controls, MS participants demonstrated a 52% decrease in number of correct answers during DT (p < 0.001). Mental Tracking Rate (% correct answers/min) correlated strongly with MS-related disability measured using the Expanded Disability Status Scale (EDSS; r(11) = −0.68, p < 0.01). We propose that compromised mental tracking during walking could be related to limited neural resource capacity and could be a potentially useful outcome measure to detect ecologically valid dual tasking impairments.     

Does intra-individual variability in narration matter and for what?

Building on calls to examine intra-individual variability in personality, we examined such variability in narrative. In Study 1, participants (n = 553) provided three narratives (either self-defining, turning point, transgression, low point, or trauma memories; n = 1659 narratives). Narratives were coded for coherence, autobiographical reasoning, resolution, and emotional expression. Variability was highest for resolution, lowest for coherence, and was related to well-being, depending on narrative feature and event type. In Study 2, participants (n = 103) engaged in a ‘narrative recognition’ task to see if they could identify which narratives came from the same individual. Recognizability was substantial, but not related to variability or well-being. Results showcase the importance of addressing intra-individual variability by narrative feature and event type.     

The perception of positive and negative facial expressions by unilateral stroke patients

There remains conflict in the literature about the lateralisation of affective face perception. Some studies have reported a right hemisphere advantage irrespective of valence, whereas others have found a left hemisphere advantage for positive, and a right hemisphere advantage for negative, emotion. Differences in injury aetiology and chronicity, proportion of male participants, participant age, and the number of emotions used within a perception task may contribute to these contradictory findings. The present study therefore controlled and/or directly examined the influence of these possible moderators. Right brain-damaged (RBD; n = 17), left brain-damaged (LBD; n = 17), and healthy control (HC; n = 34) participants completed two face perception tasks (identification and discrimination). No group differences in facial expression perception according to valence were found. Across emotions, the RBD group was less accurate than the HC group, however RBD and LBD group performance did not differ. The lack of difference between RBD and LBD groups indicates that both hemispheres are involved in positive and negative expression perception. The inclusion of older adults and the well-defined chronicity range of the brain-damaged participants may have moderated these findings. Participant sex and general face perception ability did not influence performance. Furthermore, while the RBD group was less accurate than the LBD group when the identification task tested two emotions, performance of the two groups was indistinguishable when the number of emotions increased (four or six). This suggests that task demand moderates a study’s ability to find hemispheric differences in the perception of facial emotion.     

Attention and memory biases toward body-related images among restrained eaters

This study examined biases in attention and memory toward body-related images among restrained (n = 31) and unrestrained (n = 29) eaters. Attentional allocation to images of thin and overweight bodies during a visual search task was measured by tracking participants’ eyegaze. This task was followed by a recognition test assessing participants’ memory for those images. Restrained and unrestrained eaters allocated more attention to body-related images than to control images, but there was no difference in attentional allocation between the two groups. Restrained eaters showed better recognition of body-related images that they had previously seen during the visual search task. Finally, increased attention was associated with better recognition of body-related images for both restrained and unrestrained eaters, but restrained eaters had better overall recognition regardless of the level of attention. These findings suggest that restrained eaters may have more organized strategies for processing body-related information than do unrestrained eaters.     

Acceptance and Commitment Therapy Group Treatment for Symptoms of Borderline Personality Disorder: A Public Sector Pilot Study

A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current treatment (ACT + TAU; N = 21) or to continue with treatment as usual alone (TAU; N = 20). There was significantly more improvement from baseline for the ACT + TAU condition than the TAU condition on the primary outcome variable—self-rated BPD symptoms. The ACT + TAU gain was both clinically and statistically significant. The ACT + TAU condition also had significantly more positive change on anxiety and hopelessness, and on the following ACT consistent process variables: psychological flexibility, emotion regulation skills, mindfulness, and fear of emotions. For all but anxiety, the improvements for the ACT + TAU condition were significant, while the TAU condition had no significant changes on any measure. Follow-up was possible for only a small number of participants. The improvements gained by the ACT + TAU participants were maintained except for fear of emotions. Anxiety continued to improve, becoming significantly different from baseline at follow-up. Examination of mediators found that psychological flexibility, emotion regulation skills and mindfulness, but not less fear of emotions, mediated BPD symptoms. Psychological flexibility and emotion regulation skills also mediated hopelessness. There is a need for a larger trial, for comparison with other established treatments for BPD, and for conducting a trial of a longer intervention. Nonetheless, this pilot study suggests that a brief group-based ACT intervention may be a valuable addition to TAU for people with BPD symptoms in the public sector.     

The role of BIS/BAS in the vulnerability for depression in adolescent girls

Reinforcement Sensitivity Theory (RST), the original (i.e. Gray, 1982) or revised (Gray & McNaughton, 2000), has yet to be used as a framework for investigating vulnerability to Major Depressive Disorder (MDD) in adolescents. The present study employed a high-risk design to examine whether aberrant BIS-FFFS/BAS activity was similarly present in both depressed girls and girls at high risk for depression.MethodsN = 85 age-matched biological daughters of mothers with differential MDD status: (a) MDD (n = 17), (b) high-risk (n = 34), and (c) healthy controls (n = 34) completed measures of the BIS/BAS, depression, and anxiety.ResultsMDD girls scored significantly higher on BIS than healthy controls but not high-risk girls, and the high-risk and control groups did not differ. No group differences were found on BAS or FFFS-Fear.ConclusionsElevated BIS was not identified as a vulnerability factor for MDD; however, it does distinguish depressed adolescents from healthy controls.     

Effects of domain-specific exercise load on speed and accuracy of a domain-specific perceptual-cognitive task

In the context of perceptual-cognitive expertise it is important to know whether physiological loads influence perceptual-cognitive performance. This study examined whether a handball specific physical exercise load influenced participants’ speed and accuracy in a flicker task. At rest and during a specific interval exercise of 86.5–90% HR_max, 35 participants (experts: n = 8, advanced: n = 13, novices, n = 14) performed a handball specific flicker task with two types of patterns (structured and unstructured). For reaction time, results revealed moderate effect sizes for group, with experts reacting faster than advanced and advanced reacting faster than novices, and for structure, with structured videos being performed faster than unstructured ones. A significant interaction for structure × group was also found, with experts and advanced players faster for structured videos, and novices faster for unstructured videos. For accuracy, significant main effects were found for structure with structured videos solved more accurately. A significant interaction for structure × group was revealed, with experts and advanced more accurate for structured scenes and novices more accurate for unstructured scenes. A significant interaction was also found for condition × structure; at rest, unstructured and structured scenes were performed with the same accuracy while under physical exercise, structured scenes were solved more accurately. No other interactions were found. These results were somewhat surprising given previous work in this area, although the impact of a specific physical exercise on a specific perceptual-cognitive task may be different from those tested generally.     

Time Course of Attention in Socially Anxious Individuals: Investigating the Effects of Adult Attachment Style

Theoretical models of social anxiety propose that attention biases maintain symptoms of social anxiety. Research findings regarding the time course of attention and social anxiety disorder have been mixed. Adult attachment style may influence attention bias and social anxiety, thus contributing to the mixed findings. This study investigated the time course of attention toward both negative and positive stimuli for individuals diagnosed with social anxiety disorder (SAD) and assessed whether attachment style moderates this relationship.One hundred and thirty participants (age: M = 29.03) were assessed using a semistructured clinical interview. Those meeting eligibility criteria for the clinical sample met DSM-IV criteria for SAD (n = 90, age: M = 32.18), while those in the control sample did not meet criteria for any mental disorder (n = 23, age: M = 26.04, 11 females). All participants completed self-report measures examining depression, social anxiety, adult attachment style, and completed an eye-tracking task used to measure the time course of attention. Eye-tracking data were analysed using growth curve analysis.The results indicate that participants in the control group overall displayed greater vigilance towards emotional stimuli, were faster at initially fixating on the emotional stimulus, and had a greater percentage of fixations towards the emotional stimulus as the stimulus presentation time progressed compared to those in the clinical group. Thus, the clinical participants were more likely to avoid fixating on emotional stimuli in general (both negative and positive) compared to those in the control group.These results support the Clark and Wells (1995) proposal that socially anxious individuals avoid attending to emotional information. Attachment style did not moderate this association, however anxious attachment was related to greater vigilance toward emotional compared to neutral stimuli.     

Biomechanical analyses of prolonged handwriting in subjects with and without perceived discomfort

Since wrist-joint position affects finger muscle length and grip strength, we studied its biomechanical relevance in prolonged handwriting. We recruited participants from young adults, aged 18–24, and separated them into control (n = 22) and in-pain (n = 18) groups, based whether or not they experience pain while handwriting. The participants then performed a writing task for 30 min on a computerized system which measured their wrist-joint angle and documented their handwriting kinematics. The in-pain group perceived more soreness and had a less-extended wrist joint, longer on-paper time, and slower stroke velocity compared to control group. There was no significant difference in handwriting speed and quality between the two groups. The wrist extension angle significantly correlated with perceived soreness. Ergonomic and biomechanical analyses provide important information about the handwriting process. Knowledge of pen tip movement kinematics and wrist-joint position can help occupational therapists plan treatment for individuals with handwriting induced pain.     

Agreeableness and brain activity during emotion attribution decisions

Within the Big 5 model of personality, Agreeableness is a trait-dimension associated with the tendency to behave prosocially; highly agreeable people tend to be highly cooperative and altruistic. This study was designed to test for associations between Agreeableness and the way people decide the cause of another person’s emotional reaction (emotion attribution). Behavioral and neuroimaging (fMRI) data were collected while participants (n = 72) performed an emotional attribution task. During the emotion attribution task, participants decided which of two social–emotional scenes they believed caused another person’s emotional reaction. Converging evidence indicated that highly agreeable people tend to make emotional attribution decisions more quickly and exhibit greater temporoparietal junction activity during emotion attribution decisions, compared to low agreeable people.     

Electrocortical Evidence of Enhanced Performance Monitoring in Social Anxiety

Self-focused attention is thought to be a key feature of social anxiety disorder. Yet few studies have used event-related potentials (ERPs) to examine whether socially anxious individuals display greater monitoring of their performance and attention to their errors. Similarly, only a few studies have used ERPs to examine how social anxiety is related to processing of performance feedback. Individuals with high (n = 26) and low (n = 28) levels of social anxiety completed a trial-and-error learning task. Self-focus was manipulated using false heart-rate feedback during a random subset of trials. Performance feedback was given using emotional and neutral faces in a positive context (correct = happy face; incorrect = neutral face) and negative context (correct = neutral face; incorrect = disgust face) in order to investigate biased interpretation and attention to feedback. Socially anxious subjects displayed enhanced amplitude of the ERN and CRN, suggesting greater response monitoring, and enhanced Pe amplitude, suggesting greater processing of errors relative to the low social anxiety group. No group differences were observed with respect to feedback processing. Before learning stimulus–response mappings in the negative context, the FRN was larger for self-focus compared to standard trials and marginally larger for socially anxious subjects compared to controls. These findings support cognitive models and suggest avenues for future research.     

Skepticism: Genuine unbelief or implicit beliefs in the supernatural?

We examined whether skeptics hold implicit supernatural beliefs or implicit cognitive underpinnings of the beliefs. In study 1 (N = 57), participants read a biological or a religious story about death. The story content had no effect on skeptics’ (or believers’) afterlife beliefs. Study 2 examined the relationships between religious and non-religious paranormal beliefs and implicit views about whether supernatural and religious phenomena are imaginary or real (n1 = 33, n2 = 31). The less supernatural beliefs were endorsed the easier it was to connect “supernatural” with “imaginary”. Study 3 (N = 63) investigated whether participants’ supernatural beliefs and ontological confusions differ between speeded and non-speeded response conditions. Only non-analytical skeptics’ ontological confusions increased in speeded conditions. The results indicate that skeptics overall do not hold implicit supernatural beliefs, but that non-analytically thinking skeptics may, under supporting conditions, be prone to biases that predispose to supernatural beliefs.     

A Test of the Habit-Goal Framework of Depressive Rumination and Its Relevance to Cognitive Reactivity

The aim of the present study was to test predictions derived from the habit-goal framework of depressive rumination and investigate its relevance to cognitive reactivity—another well-known vulnerability factor to depression. Formerly depressed (FD; n = 20) and never depressed (ND; n = 22) participants completed self-report measures of rumination, cognitive reactivity, and habitual characteristics of rumination (e.g., lack of awareness, control, intent). A standard mood-induction task was also used to measure cognitive reactivity and an outcome-devaluation task to measure general habit vs. goal-directed behavior control. Habitual characteristics of ruminative thoughts were greater in the FD group and were related to depressive brooding and cognitive reactivity, but not reflective pondering. Reliance on habit on the outcome-devaluation task was strongly correlated with number of depression episodes, although group differences were not observed in general habit vs. goal-directed control. Habitual characteristics of rumination (e.g., greater automaticity) may explain reactivity and persistence of negative thoughts in depression. Habitual behavior control may contribute to inflexible responding and vulnerability for depression episodes.     

Sense of body ownership in patients affected by functional motor symptoms (conversion disorder)

Background and aimPatients with functional neurological symptoms are commonly seen in neurological practice. Nevertheless their aetiopathology remains unclear. We have recently shown that patients affected by functional motor symptoms (FMS) present lower interoceptive awareness and higher alexithymia levels than healthy controls. Nevertheless sense of body ownership has never been studied in FMS patients.The aim of the present study was to systematically investigate the sense of body ownership, with the rubber hand illusion (RHI) paradigm, in patients with FMS and healthy controls.Materials and methodsWe included in the study 16 patients with FMS and 18 healthy controls (HC). Patients and HC were asked to complete the Toronto Alexithymia Scale (TAS-20) and the self-consciousness scale (self-objectification questionnaire). All participants underwent the RHI paradigm: illusionary experience was measured by self-report and by proprioceptive alteration.ResultsA Mann–Whitney U test performed revealed that FMS (median = 2.11) participants embodied the rubber hand to the same extent than HC participants (median = 2.0, Z = −0.86, p > 0.05, r = −0.15). The same test revealed no significant difference in the Proprioceptive Drift experience between FMS (median = 0.0) and HC participants (median = −0.5, Z = −0.96, p > 0.05, r = −0.16).ConclusionsOur study revealed that sense of body ownership is not impaired in patients affected by FMS. This, together with the results from our previous experiment (studying the interoceptive awareness), supports the hypothesis that interoceptive awareness and sense of body ownership may be dissociated in patients with FMS.     

Moral/conventional transgression distinction and psychopathy in conduct disordered adolescent offenders

To date there are no studies examining the ability to make a moral/conventional transgression distinction in adolescent offenders with psychopathic traits. Based on the Psychopathy Checklist: Youth Version, we compared males with high (HP, n = 45), medium (MP, n = 31) and low psychopathy scores (LP, n = 39) on the moral convention distinction task. Under normal rule conditions the psychopathy groups did not differ in their ability to make a moral/conventional distinction. The HP group tended to view both transgression types as more permissible and conventional transgressions as less serious, than the LP group. Under modified rule conditions, the HP group exhibited reduced moral/conventional distinction scores compared to the MP group. The findings only partially replicate findings from previous M/C studies in children and adults with psychopathic traits. The work fits with more recent reports suggesting that psychopathy is not strongly associated with marked difficulties in cognitive theory of mind, perspective taking and moral judgements. Future studies should focus on the affective aspects of moral reasoning in offender samples.     

Multidimensional body image comparisons among patients with eating disorders,body dysmorphic disorder,and clinical controls: A multisite study

Body image disturbance is considered a core characteristic of eating disorders and body dysmorphic disorder (BDD), however its definition has been unclear within the literature. This study examined the multidimensional nature of body image functioning among individuals with either anorexia nervosa (AN; n = 35), bulimia nervosa (BN; n = 26), or BDD (n = 56), relative to female (n = 34) and male (n = 36) psychiatric controls. Participants were recruited from 10 treatment centers in the United States and England and completed psychometrically validated and standardized self-report measures of body image. Overall, the AN, BN, and BDD groups were characterized by significantly elevated disturbances in most body image dimensions relative to their gender-matched clinical controls. There was variability, however, in the comparisons among the three groups of interest, including foci of body dissatisfaction and body image coping patterns. On omnibus indices of body image disturbance and body image quality of life, patients with BDD reported more body image impairment than those with eating disorders. Although AN, BN, and BDD are characterized by body image disturbances, similar and partially distinctive cognitive, behavioral, and emotional elements of body image functioning exist among these groups. The study's empirical and clinical implications are considered.     

Under what conditions do lay people and health professionals accept a breach of doctor-patient confidentiality regarding a patient with signs of terrorist radicalization?

IntroductionConfidentiality is crucial to the establishment of a strong patient-physician relationship. However, certain situations create a dilemma for the physician who is faced with the choice of either respecting medical confidentiality or protecting others from a serious risk of violence.ObjectiveThis study aimed to observe how lay people and health professionals assessed the acceptability of breaching confidentiality when a physician is confronted to a patient showing signs of terrorist radicalization.MethodA total of 228 participants (174 from the general population and 54 health professionals) judged the acceptability of 54 scenarios which were constructed through the orthogonal combination of 4 factors frequently mentioned in the literature: presence of a “Psychiatric disorder”; “Signs of radicalization”; “Projects of violence”; “Collegiality”. Variance and cluster analyses were performed on all the raw data.ResultsResults showed that all factors influenced the judgment of participants but that “Psychiatric disorders” had a weaker impact. Five clusters were identified: “Favorable if collegiality” (n = 23); “Favorable to breach confidentiality” (n = 77); “Unfavorable to breach confidentiality” (n = 26); “Sensitive to all factors” (n = 71); “Favorable if violence” (n = 31), respectively with mean ratings of 5.87, 8.42, 3.64, 6.30 and 7.16, on an acceptability scale of 0–10.ConclusionThe importance that the great majority of participants attribute to these factors indicates that they influence their judgments in this specific context.     

Experiential avoidance in body dysmorphic disorder

Experiential avoidance (i.e., the attempt to avoid certain internal experiences including bodily sensations, thoughts, emotions, memories, and urges) has been studied in various psychological disorders. However, research examining experiential avoidance in individuals with body dysmorphic disorder (BDD) is limited and inconsistent. The present study compared experiential avoidance in individuals with primary BDD (n = 23) to healthy controls (n = 22). Standardized measures were used to assess baseline clinical characteristics as well as experiential avoidance. Compared to healthy controls, individuals with BDD presented with significantly greater experiential avoidance (p < .001, d = −2.51). In BDD, experiential avoidance was positively correlated with depressive symptoms (p < .01) and avoidant coping strategies (p < .01). Clinician sensitivity to experiential avoidance may serve to improve the course of treatment for BDD.     

Variability of kinematic graphomotor fluency in adults with ADHD

Although graphomotor differences and variability of performance have been observed in children with attention deficit hyperactivity disorder (ADHD), no study has investigated whether this variability manifests in the kinematic graphomotor domain in adults with ADHD. Fourteen ADHD and 20 control participants wrote a novel grapheme and common word on a digitizing tablet 30 times each, with ADHD participants counterbalanced on and off stimulant medication. Variability of graphomotor fluency was significantly greater in ADHD versus control participants only in the novel writing task, both on, F(1, 31) = 5.988, p = .020, and off stimulant medication, F(1, 32) = 8.789, p = .006. Results suggest that motor control differences in ADHD are not limited to childhood and extend into adulthood. Given sufficient additional research, variability of kinematic graphomotor fluency may increase the sensitivity/specificity of differential diagnoses and/or represent a biomarker for ADHD.