Autistic traits in mentalization-based treatment for concurrent borderline personality disorder and substance use disorder: Secondary analyses of a randomized controlled feasibility study

Autism is suggested to be a dimensional construct and often represents a comorbid state. However, research on the clinical implications of the presence of autistic traits is scarce. This study aimed to investigate the impact of subclinical autistic traits in mentalization-based treatment (MBT) for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Based on the data of a randomized controlled feasibility study by Philips, Wennberg, Konradsson, and Franck (2018), secondary analyses were conducted. It was tested, if patients’ (N = 46) levels of autistic traits were associated with treatment outcome measured in the course of and after treatment using interviews and self-report measures. Participants’ autistic traits were not associated with the change in the severity of BPD throughout and at the end of the treatment. However, results showed associations between autistic traits and the change in patients’ consumption of alcohol in the course of MBT. Furthermore, there was an association between autistic traits and the change in mentalizing capacity at the end of MBT, indicating that elevated autistic traits were associated with an improvement in mentalizing capacity. Autistic traits on a subclinical level do not appear to be a complicating factor in MBT for concurrent BPD and SUD. On the contrary, in terms of mentalizing capacity autistic traits might be associated with a larger potential for improvement or facilitate treatment outcome. Further research is needed to explore the role of higher autistic traits in treatment of this special patient group.     

Adverse childhood experiences in substance use disorder outpatients of a Lebanese addiction center

Childhood adversities (CAs) are well reviewed in mental health and addiction research internationally. However, these variables have not been studied within the framework of addiction in the Middle East region. The present study reports the prevalence of Childhood Adversities in a sample of outpatients seeking treatment for Substance Use Disorder. We used the Adverse Childhood Experiences – International Questionnaire (ACE-IQ) to map out the prevalence of childhood adversities. The studied population was composed of a clinical outpatient sample that met criteria for substance use disorder (N = 144). Results indicated that almost all the sample reported having experienced at least 1 CA, whereby three quarters of the clinical sample reported experiencing 6 or more adversities. Childhood adversities are highly prevalent in a Lebanese substance use disorder population which raises the need for better screening strategies and more understanding of Adverse Childhood Experiences in this specific population     

The relationship between religion and health-related behaviours in patients with borderline personality disorder

With addictive disorders frequently co-occurring among patients with borderline personality disorder (BPD), exploring factors that may influence health-related behaviours, like religious involvement, is important. This study assesses whether religious involvement is associated with smoking and alcohol use disorders (AUDs) in BPD subjects. This study used data from Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), which used the Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV (AUDADIS-IV) as its assessment instrument. The AUDADIS-IV assessed personality disorders, tobacco usage, the presence of AUDs, and religious involvement. Attending a place of worship and weekly or more frequent worship attendance were significantly associated with reduced likelihood of current smoking and AUDs among BPD subjects. AUDs were also significantly less common in those reporting higher subjective religiousness. In conclusion, people with BPD who are religiously inclined are less likely to engage in addictive behaviours, specifically smoking and AUDs.     

Borderline personality disorder,complex trauma,and problems with self and identity: A social-communicative approach

Borderline personality disorder (BPD) is a relatively highly prevalent psychiatric disorder that is associated with very high personal and socioeconomic costs. This paper provides a state-of-the-art review of the relationship between complex trauma and key features of BPD, with a focus on problems with self-coherence and self-continuity. We first review evidence for the high prevalence of complex trauma in BPD patients. This is followed by a discussion of emerging knowledge concerning the biobehavioral mechanisms involved in problems related to self and identity in BPD. We emphasize three biobehavioral systems that are affected by complex trauma and are centrally implicated in identify diffusion in BPD: the attachment system, mentalizing or social cognition, and the capacity for epistemic trust—that is, an openness to the reception of social communication that is personally relevant and of generalizable significance. We formulate a new approach to personality and severe personality disorders, and to problems with self and identity in these disorders, rooted in a social-communicative understanding of the foundations of selfhood. We also discuss how extant evidence-based treatments address the above-mentioned biobehavioral systems involved in identity diffusion in BPD and related disorders, and the supporting evidence. We close the paper with recommendations for future research.     

Gender-sensitive training for substance use disorder treatment: Results and implications of a pilot health professionals needs assessment

This study explored mental health practitioner training needs in gender-sensitive substance use disorder (SUD) counselling genderqueer populations. Informants were health professionals in SUD practices and from the Eastern Cape, South Africa (females = 75%; black = 90%, 10% = white, clinical and counselling psychologists = 10%, social workers = 65%, auxiliary health workers = 25%). They completed focus group interviews regarding their needs for gender-sensitive (GS) training in SUD treatment. Thematic analysis of the data indicated training needs in how to deal with their own bias and prejudice beliefs about the genderqueer population. Furthermore, results indicated that they needed training on how to manage the treatment setting once genderqueer clients were integrated in treatment with cisgender clients. Training for SUD treatment and care with genderqueer clients should prioritise gender sensitisation. Health professionals’ need gender equality awareness training for health care equity with the genderqueer community.     

Conscious knowledge influences decision‐making differently in substance abusers with and without co‐morbid antisocial personality disorder

Decision‐making impairment, as measured by the Iowa Gambling Task (IGT), is a consistent finding among individuals with substance use disorder (SUD). We studied how this impairment is influenced by co‐morbid antisocial personality disorder (ASPD) and conscious knowledge of the task. Three groups were investigated: SUD individuals without co‐morbid ASPD (n = 30), SUD individuals with co‐morbid ASPD (n = 16), and healthy controls (n = 17). Both SUD and SUD+ASPD participants had poor overall IGT performance. A block‐by‐block analysis revealed that SUD participants exhibited slow but steady improvement across the IGT, whereas SUD+ASPD participants exhibited initial normal improvement, but dropped off during the last 40 trials. Conscious knowledge of the task was significantly correlated to performance for controls and SUD participants, but not for SUD+ASPD participants. Our findings suggest that decision‐making proceeds differently in SUD and SUD+ASPD individuals due to differences in acquisition and application of conscious knowledge.     

反社会人格障碍的神经生物学基础及其司法启示

反社会人格障碍(Antisocial Personality Disorder, ASPD)是一种漠视或侵犯他人权益的普遍行为模式, 是与犯罪关联极高的精神障碍。ASPD的形成受基因和环境因素的影响, 表现为神经递质和激素系统的紊乱, 以及自主神经系统活跃程度和大脑结构与功能的异常。上述神经生物学因素可能导致ASPD患者表现出执行控制障碍、情绪功能障碍、无视惩罚信息和奖赏偏好等特点。神经生物学研究的证据为ASPD罪犯的循证矫治、风险评估、定罪量刑等司法实践提供了启示。建议未来从神经生物学角度对ASPD的诊断分类标准、治疗方法和影响因素等方面开展研究。     

Changes in personality in pre‐ and post‐dialectical behaviour therapy borderline personality disorder groups: A question of self‐control

Dialectical behaviour therapy (DBT) is an evidence‐based therapy for people with borderline personality disorder (BPD). Past research has identified behavioural changes indicating improved functioning for people who undergo DBT. To date, however, there has been little research investigating the underlying mechanism of change. The present study utilised a between‐subjects design and self‐report questionnaires of Self‐Control and the five factor model of personality and drew participants from a metropolitan DBT program. We found that pre‐treatment participants were significantly lower on Self‐Control, Agreeableness and Conscientiousness when compared to both the post‐treatment assessment and the norms for each questionnaire. Neuroticism was significantly higher both before and after treatment when compared to the norms. These findings suggest that Self‐Control may play a role in both the presentation of this disorder and the effect of DBT. High levels of Neuroticism lend weight to the Linehan biosocial model of BPD development.     

Trauma and substance use: the role of defences and religious engagement

Substance use disorders commonly co-occur with posttraumatic stress disorder and are associated with greater impairment. There is some evidence to suggest that different coping strategies, including defence mechanisms and religious forms of coping, may buffer the relationship between trauma and SUDs. The purpose of this study was to evaluate the potential moderating roles of defence mechanisms and religious coping on the already-established relationship between trauma symptoms and substance abuse. Data were gathered from a sample of college students (N?=?380). Trauma symptoms were associated with increased substance use and abuse. The use of immature defences was significantly associated with trauma and substance use. Increased substance abuse was also associated with higher rates of negative religious coping. Individuals who endorsed trauma symptoms were also more likely to use positive and negative religious coping. Defences and coping did not moderate the relationship between trauma and substance use.     

Distress tolerance but not impulsivity predicts outcome in concurrent treatment for posttraumatic stress disorder and substance use disorder

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) commonly co-occur. Emerging research suggests that both distress tolerance and impulsivity may underlie this comorbidity. However, to our knowledge no studies have examined whether these 2 constructs predict outcome in PTSD-SUD treatment. The current study investigated whether pretreatment distress tolerance and impulsivity predicted posttreatment PTSD and cravings severity in a sample of 70 Veterans receiving concurrent treatment for PTSD and SUD in a residential day treatment program. Veterans completed measures of symptom severity before and after treatment. Results demonstrated that pretreatment distress tolerance predicted posttreatment PTSD severity while controlling for pretreatment PTSD. By contrast, pretreatment impulsivity was not predictive of posttreatment PTSD while controlling for pretreatment values. Neither distress tolerance nor impulsivity predicted posttreatment cravings severity. The findings support the notion that distress tolerance may help to explain the co-occurrence of PTSD and SUD and suggest that targeting this construct in PTSD-SUD treatment may be important for successful outcomes.     

An empirical typology of perfectionism in early-to-mid adolescents and its relation with eating disorder symptoms

Although the association between perfectionism and eating disorder (ED) symptoms is well-established, debate remains about the relative contribution of two central dimensions of perfectionism, that is, Personal Standards (PS) perfectionism and Evaluative Concerns (EC) perfectionism, in the prediction of ED symptoms. This study used cluster analysis to establish naturally occurring combinations of PS and EC perfectionism in early-to-mid adolescents (N = 656; M age = 13.9 years). Evidence was obtained for four perfectionism profiles: (1) maladaptive perfectionism (high PS and high EC), (2) pure evaluative concerns perfectionism (high EC only), (3) adaptive perfectionism (high PS, low EC), and (4) non-perfectionism (low on both PS and EC). A comparison of participants in these four clusters in terms of ED symptoms suggests that a combination of high personal standards and evaluative concerns (rather than the presence of one of these two dimensions alone) is most strongly related to ED symptoms.     

Borderline personality disorder features and cognitive,emotional, and predicted behavioral reactions to teasing

Borderline personality disorder (BPD) involves interpersonal dysfunction. It is unknown to what extent these problems are due to perceptual biases, emotional reactivity, or impulsivity above and beyond emotional reactions. The present study experimentally tested these mechanisms in the context of predicted reactions to teasing. Participants completed the Personality Assessment Inventory-Borderline Features scale [PAI-BOR; Morey, L. C. (1991). Personality assessment inventory: Professional manual. Odessa, FL: Psychological Assessment Resources], and the Rejection Sensitivity Questionnaire [Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70(6), 1327–1343], and imagined a scenario that involved teasing. Participants rated the teaser and their own predicted emotional and behavioral reactions. Analysis of Covariance results indicated that individuals who endorsed more BPD features showed elevated emotional reactions and predicted behavioral reactions to teasing, but not perceptual biases. Ratings of predicted behavioral responses could be accounted for by emotional responses, supporting the emotional reactivity perspectives of BPD [Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford].     

Examining the relationship between emotion regulation deficits and borderline personality disorder features: A daily diary study

This study used a six-day daily diary methodology to precisely specify the nature of emotion regulation deficits associated with borderline personality disorder (BPD) features. Three possibilities were explored: that BPD features are associated with (1) the overall underuse of emotion regulation strategies; (2) the overuse of dysfunctional and the underuse of functional strategies; and (3) the lower perceived effectiveness of emotion regulation strategies. One hundred and fifty-four undergraduate participants completed self-report measures of BPD feature severity, and then reported their daily negative emotional intensity, whether or not they used various emotion regulation strategies, and whether or not the strategies that they used were effective across a six-day period. Higher BPD features were associated with (a) higher total frequency use of emotion regulation strategies; (b) higher frequency use of dysfunctional and functional emotion regulation strategies; and (c) less self-reported effectiveness of functional strategies. BPD features may be characterized by increased attempts to regulate emotions, without corresponding increases in perceived effectiveness.     

From personality disorders to the fact-value distinction

Louis Charland’s claim that DSM Cluster B personality disorders are moral rather than clinical kinds has recently triggered a lively debate. In order to deliver a reliable report of the latter, both (1) Charland’s arguments concerning the impossibility of identifying and treating personality disorders without applying a morally laden conceptual framework and (2) some critical responses they provoked are discussed. Then, in turn, the conceptual history of the notion of personality disorder is traced, including not only well-recognized contributions from (3) medical psychiatry, psychoanalysis, and DSM nosology, but also (4) an important, but often neglected, tradition of virtue and moral character. Finally, (5) the idea of a normatively neutral concept of personality disorder is scrutinized in the context of its logical dependence on the fact-value distinction. The latter dichotomy’s recent criticism, in particular, is employed to support Charland’s argument and to suggest that the normative character of personality disorders may go much deeper than this or that DSM formulation.     

Theory of mind and its relationship with executive functions and emotion recognition in borderline personality disorder

Impaired social cognition has been claimed to be a mechanism underlying the development and maintenance of borderline personality disorder (BPD). One important aspect of social cognition is the theory of mind (ToM), a complex skill that seems to be influenced by more basic processes, such as executive functions (EF) and emotion recognition. Previous ToM studies in BPD have yielded inconsistent results. This study assessed the performance of BPD adults on ToM, emotion recognition, and EF tasks. We also examined whether EF and emotion recognition could predict the performance on ToM tasks. We evaluated 15 adults with BPD and 15 matched healthy controls using different tasks of EF, emotion recognition, and ToM. The results showed that BPD adults exhibited deficits in the three domains, which seem to be task‐dependent. Furthermore, we found that EF and emotion recognition predicted the performance on ToM. Our results suggest that tasks that involve real‐life social scenarios and contextual cues are more sensitive to detect ToM and emotion recognition deficits in BPD individuals. Our findings also indicate that (a) ToM variability in BPD is partially explained by individual differences on EF and emotion recognition; and (b) ToM deficits of BPD patients are partially explained by the capacity to integrate cues from face, prosody, gesture, and social context to identify the emotions and others' beliefs.     

Hoarding and its relation to obsessive-compulsive disorder

Although hoarding is observed in some patients with obsessive-compulsive disorder (OCD), it has not been shown to share a specific relation with OCD. Across two studies, we found that (a) whereas the classic OCD symptoms of checking, rituals, and contamination intercorrelated consistently strongly with one another, hoarding related only moderately to both these OCD symptoms and to depression; (b) OCD patients were distinguished from both other patients and non-patients by classic OCD symptoms, but not by hoarding; and (c) whereas OCD symptoms showed consistent relations with Negative Affect, hoarding largely was uncorrelated with this dimension. These results do not support a specific OCD-hoarding relation but rather call into question the trend of considering it a specific symptom of OCD.