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Borderline personality disorder is a common, treatable condition that usually presents in late adolescence or early adulthood. Patients with borderline personality disorder are disproportionately represented in many clinical settings. Early identification and intervention of borderline personality disorder could help address the current mental health affecting young adults. College and university mental health settings have an opportunity to identify borderline personality disorder and to help guide students and families to appropriate treatment. College-based clinicians also have a role in educating campus administrators who may have little or no familiarity with standard borderline personality disorder symptoms or the trajectory of the disorder. [ABSTRACT FROM AUTHOR]

Introduction: Traits of borderline personality disorder are important for the determination of the prognosis of mental illnesses and in evaluating risks of negativity as well as impulsivity. But, there is a lack of information about the distribution characteristics of borderline personality disorder traits and symptoms within clinical groups. The goal of the current study was to predict borderline personality disorder based on childhood trauma, using experiential avoidance as a mediator. Methods: All male patients hospitalized in local psychiatric health centers with a diagnosis of borderline personality disorder comprised the statistical population of the current study. The number of 60 patients were selected by the purposeful sampling method. The questionnaire included the Childhood Trauma Questionnaire (CTQ), the Experiential Avoidance Questionnaire (AAQ-II), and the Borderline Personality Disorder Symptoms (BSL-23). Results and discussion: The results demonstrated that there is a considerable and positive relationship between childhood trauma and experiential avoidance (r = 0.711, p< 0.01). In the mediating model, childhood trauma had significant direct predictive effects on borderline personality disorder (β = 0.546, p< 0.01). Also, between childhood trauma and BPD, experienced avoidance acts as a moderating factor. (β = 0.304, p< 0.01). [ABSTRACT FROM AUTHOR]

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder aims to improve care and treatment outcomes for individuals with BPD. The guideline provides evidence-based statements to enhance knowledge and optimize assessment and treatment. It addresses the high prevalence of BPD in clinical populations, the challenges of co-occurring disorders, and the importance of reducing stigma and discrimination. The document outlines assessment, treatment planning, psychosocial interventions, and pharmacotherapy recommendations based on available evidence and expert opinion. [Extracted from the article]

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Since Stern first started his work in 1938, the field has recognized several empirically supported models of the etiology of borderline personality disorder (BPD). Two such models are the Tripartite Model of the Development of BPD and the Biosocial Development Model of BPD. The Tripartite Model of the Development of BPD suggests that it is a combination of a hyperbolic temperament, traumatic childhood experiences, and an event or series of events that trigger the onset of BPD. Whereas the Biosocial Development Model of BPD elaborates on the work of Linehan's Biosocial Theory. This model suggests a combination of an emotionally vulnerable temperament and an invalidating environment cause BPD. Over 70 years of research support these models. This article covers a detailed description of each of these models, the decades of research supporting these models, similarities, differences, treatment implications, the latest research, and future directions. [ABSTRACT FROM AUTHOR]

Borderline personality disorder constitutes a significant medical challenge. Despite the fact that its occurrence among adolescents is currently attracting increasing interest from both clinicians and researchers, there is still insufficient data on this phenomenon. The etiology and maintenance of borderline personality disorder are not yet fully comprehended. Neuropeptides, including oxytocin and vasopressin, are considered to be involved in the development of this condition. The mechanism behind the actions of these neurohormones requires further investigation. Our work aims to collect and analyze the available research and existing hypotheses on the role of oxytocin and vasopressin in people with borderline personality disorder, with special attention drawn to adolescents suffering from this condition. [ABSTRACT FROM AUTHOR]

Copyright of Caspian Journal of Neurological Sciences is the property of Negah Institute for Social Research & Scientific Communication and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To review the literature on the impact of gonadal hormones on features of borderline personality disorder. Background: Oestrogen flux and absolute sex hormone levels are known to be associated with various mood states in women. We investigated whether this was particularly relevant for borderline symptoms in women with or without borderline personality disorder (BPD). Methods: Systematic literature review. Discussion: There is some evidence that borderline symptoms are more severe during certain phases on the menstrual cycle in non-clinical samples of women. There is also a small evidence base that suggests that women with BPD show symptom exacerbation during the late luteal phase of their menstrual cycle. Conclusion: More work is required to establish the nature and mechanisms of interactions between gonadal hormones and symptom expression in BPD patients, and therapeutic endeavours need stringent empirical testing. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is frequently understood as a diagnosis applicable mainly to women, despite population studies suggesting similar prevalence between men and women. The scarce available information suggests that compared to women, men may face additional gender-related barriers to diagnosis and treatment when attempting to engage with support and treatment for BPD-related difficulties. The current study presents a qualitative in-depth exploration of the help-seeking and diagnosis experiences of four men with BPD. Using Interpretive Phenomenological Analysis, three themes were generated: (1) "There's just no help out there": barriers to treatment; (2) self-understanding and insight; and (3) the importance of emotional and psychological connection with health care professionals and close family and friends. Having a greater understanding of male-specific experiences of BPD could improve the helpseeking journeys of men with BPD through early identification, accurate and timely diagnosis, to relevant and effective treatment and support. [ABSTRACT FROM AUTHOR]

Background: Borderline personality disorder (BPD) is a complex mental health condition marked by instability in mood, relationships, self-image, and behavior. Individuals with BPD often struggle with intense emotions, impulsivity, and maintaining stable relationships. Oxytocin, known as the "love hormone" or "bonding hormone," plays a crucial role in social bonding, trust, empathy, and emotional regulation and its dysregulation may contribute to BPD difficulties. This systematic review aims to analyze existing literature, examining the intricate interplay and encouraging future research and treatment strategies. Methods: A systematic search of Literature in PubMed, Embase and Psychinfo, without any language or time restriction, was performed until March 2024 combining thesaurus and free-search indexing terms related to "borderline personality disorder" and "oxytocin", producing 310 results (77 in PubMed, 166 in Embase and 67 in Psychinfo). Ninety-four full texts were analyzed, and 70 articles were included in qualitative analysis. Results: Oxytocin may influence attachment styles, parental behaviors, and stress responses, particularly in individuals with a history of childhood trauma. The interaction between oxytocin, genetics, early life experiences, and environmental factors contributes to the complexity of BPD. Genetic variations in the oxytocin receptor gene may influence social and emotional abilities and contribute to the development of psychopathology. Additionally, early adverse experiences, such as childhood maltreatment, can alter oxytocin functioning, impacting social cognition and emotional regulation. However, oxytocin's role in BPD treatment remains uncertain, with some studies suggesting potential benefits for specific symptoms like social threat avoidance, while others indicate adverse effects on nonverbal behavior and mentalizing. Conclusion: Understanding oxytocin's role in BPD offers insights into potential therapeutic interventions. While oxytocin-based treatments may hold promise for addressing specific symptoms, further research is needed. [ABSTRACT FROM AUTHOR]

Background: The adolescent depression associated with childhood trauma has been confirmed, but the underlying mechanisms remain unclear. This study aims to explore the chain-mediated role of borderline personality traits and self-control in the relationship between childhood trauma and adolescent depression. Methods: A cross-sectional study was conducted on 2,664 students from a senior high school through online questionnaires from October to December 2022 in Henan, China. Childhood Trauma Questionnaire-Short Form, Borderline Personality Dimension of Personality Diagnostic Questionnaire-4, Self-Control Scale, and Children's Depression Inventory were used to measure childhood trauma, borderline personality traits, and self-control. Results: The prevalence of depression in adolescents was 21.17%, while the prevalence of borderline personality was 12.00%. childhood trauma (r = 0.50, p < 0.001) and borderline personality traits (r = 0.60, p < 0.001) were positively correlated with adolescent depressive symptoms, while self-control was negatively correlated with depressive symptoms (r = − 0.50, p < 0.001). Borderline personality traits and Self-control both play a mediating role in childhood trauma and depressive symptoms, and the mediating effect values are 0.116 (95%CI = [0.098, 0.137]), and 0.022 (95%CI = [0.012, 0.032]) respectively. The chain mediating effect of borderline personality traits and self-control on the relationship between childhood trauma and depressive symptoms was significant (effect value: 0.034, 95%CI = [0.028, 0.042]). Conclusions: Childhood trauma can predict depressive symptoms in adolescents due to the formation of borderline personality traits and the reduction of self-control. These findings are important for understanding the formation of personality traits, self-control abilities and coping strategies shaped by traumatic experiences in adolescents. [ABSTRACT FROM AUTHOR]

Background: Differentiation of borderline personality disorder (BPD) and bipolar I disorder (BD) has been challenging. The assessment of shared symptoms in the context of the overall personality functioning, the patient's sense of self, and the quality of his object (interpersonal) relations is proposed to be valuable for the differential diagnosis of these disorders. Methods: We empirically investigated the level of personality organization (PO), identity integration, and quality of object relations in patients suffering from BD or BPD using the Structured Interview of Personality Organization (STIPO) and the Level of Personality Functioning Scale (LPFS) in 34 BPD and 28 BD patients as well as 27 healthy control persons. Group comparisons and a logistic regression model were calculated to analyze group differences. Results: The BPD group showed significantly greater impairment in several domains of personality functioning, namely "identity", and "self- and other-directed aggression", while showing lower impairment in "moral values". The overall level of PO in the BPD group was significantly lower when excluding not only BPD but any personality disorder (PD) in the BD sample. Severity of impaired personality structure had a major impact on symptom load independent of the main diagnosis BD or BPD. Conclusions: Our data show greater impairment in personality functioning in BPD than in BD patients. BD patients present with varying levels of PO, whereas in BPD severe deficits in PO are pathognomonic. The level of PO has a significant impact on symptom severity in both BD and BPD patients. Therefore, careful assessment of PO should be considered for differential diagnosis and adequate treatment planning. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is a complex psychiatric disorder characterized by an unstable sense of self and identity, emotional dysregulation, impulsivity, and disturbed interpersonal relationships. This narrative review examines the interplay between dysregulation of the autonomic nervous system, metabolic changes, and cardiovascular risk in BPD. Altered heart rate variability (HRV), reflecting the dysregulation of the autonomic nervous system, is associated with some BPD core symptoms, such as emotional instability and impulsivity. Dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, often stemming from early trauma, contributes to chronic inflammation and elevated allostatic load, which further increases cardiovascular risk. Metabolic dysfunctions in BPD, such as elevated body mass index (BMI), high blood pressure, and inflammatory markers like C-reactive protein (CRP), exacerbate these risks. Speckle-tracking echocardiography, particularly global longitudinal strain (GLS) and biomarkers such as homocysteine and epicardial fat, could be considered early predictors of cardiovascular events in individuals with BPD. Chronic stress, inflammation, and maladaptive stress responses further heighten cardiovascular vulnerability, potentially accelerating biological aging and cognitive decline. A literature search covering the period from 2014 to 2024 on PubMed identified 189 studies on this topic, of which 37 articles were deemed eligible for this review. These included cross-sectional, longitudinal, case–control, randomised controlled trials (RCTs), reviews, and meta-analysis designs, with sample sizes ranging from 14 to 5969 participants. The main limitations were that only one database was searched, the time of publications was limited, non-English manuscripts were excluded, and the quality of each paper was not commented on. This narrative review aims to provide an overview of recent evidence obtained on this topic, pointing out a direction for future research. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is diagnosed in 10-30% of patients with major depressive disorder (MDD), and the frequency of MDD among individuals with BPD reaches over 80%. The comorbidity of MDD and BPD is associated with more severe depressive symptoms and functional impairment, higher risk of treatment resistance and increased suicidality. The effectiveness of ketamine usage in treatment resistant depression (TRD) has been demonstrated in numerous studies. In most of these studies, individuals with BPD were not excluded, thus given the high co-occurrence of these disorders, it is possible that the beneficial effects of ketamine also extend to the subpopulation with comorbid TRD and BPD. However, no protocols were developed that would account for comorbidity. Moreover, psychotherapeutic interventions, which may be crucial for achieving a lasting therapeutic effect in TRD and BPD comorbidity, were not included. In the article, we discuss the results of a small number of existing studies and case reports on the use of ketamine in depressive disorders with comorbid BPD. We elucidate how, at the molecular and brain network levels, ketamine can impact the neurobiology and symptoms of BPD. Furthermore, we explore whether ketamine-induced neuroplasticity, augmented by psychotherapy, could be of use in alleviating core BPD-related symptoms such as emotional dysregulation, self-identity disturbances and self-harming behaviors. We also discuss the potential of ketamine-assisted psychotherapy (KAP) in BPD treatment. As there is no standard approach to the application of ketamine or KAP in individuals with comorbid TRD and BPD, we consider further research in the field as imperative. The priorities should include development of dedicated protocols, distinguishing subpopulations that may benefit most from such treatment and investigating factors that may influence its effectiveness and safety. [ABSTRACT FROM AUTHOR]

Introduction: In this study, we mainly evaluated the associations of borderline personality disorder (BPD), neuroticism, and childhood trauma with the selfrated and clinician-rated overall functional impairment levels of adult euthymic patients with bipolar disorder-1 (BD-1). In addition, we compared patient and healthy control groups regarding the levels of of childhood trauma, neuroticism, BPD and functional impairment. Methods: In total, 90 euthymic BD-1 patients and 90 healthy controls were enrolled. The Childhood Trauma Questionnaire-Short Form, the neuroticism subscale of the Eysenck Personality Questionnaire Revised-Abbreviated Form, the Borderline Personality Questionnaire, the Functioning Assessment Short Test, and the Sheehan Disability Scale were administered to the participants. Results: The study revealed that the levels of BPD, neuroticism, emotional abuse, physical abuse, global childhood trauma, self-rated overall functional impairment, all the subdomains of self-rated functional impairment, clinician-rated overall functional impairment, and all the subdomains of clinician-rated functional impairment (except leisure time) were significantly higher in the patients than those in the healthy controls (p < 0.05). Clinician-rated functional impairment levels were significantly correlated with levels of BPD (r = 0.555, p<0.001), neuroticism (r = 0.429, p < 0.001), global childhood trauma (r = 0.391, p <0.001), and all subtypes of childhood trauma except sexual abuse. Self-rated functional impairment levels were significantly correlated with levels of neuroticism (r= 0.289, p = 0.006), physical neglect (r = 0.213, p = 0.044), and BPD (r = 0.557, p < 0.001). In the regression analyses, the self-rated overall functional impairment levels were only significantly associated with the BPD feature levels (b = 0.319, p < 0.001) and the clinician-rated overall functional impairment levels were only significantly associated with the BPD feature levels (b = 0.518, p < 0.001). Conclusion: The present study's findings suggest that BPD features should be addressed in psychosocial interventions aimed at ameliorating functional impairment in patients with BD-1. Only BPD features were associated with selfrated and clinician-rated overall functional impairment levels in the regression analyses in the BD-1 patients. Performing self-rated and clinician-rated functional impairment assessments in the same clinical trial may give rise to relevant findings in the future. [ABSTRACT FROM AUTHOR]

Objective: Borderline Personality Disorder (BPD) begins in adolescence or early adulthood and can lead to difficulties in conflict resolution and emotion regulation. The aim of this study was to compare the effectiveness of Mentalization-Based Therapy (MBT) and Dialectical Behavior Therapy (DBT) on emotion regulation, impulsivity, and self-esteem in individuals with Borderline Personality Disorder. Methods and Materials: This study employed an applied research design and a quasi-experimental pretest-posttest and follow-up design with a control group. The statistical population included all individuals with Borderline Personality Disorder in Tehran. The sample comprised 45 individuals with Borderline Personality Disorder selected through convenience sampling. Data were collected using the Jackson and Claridge Borderline Personality Inventory (1991), the Garnefski et al. Emotion Regulation Questionnaire (2001), the Dickman Impulsivity Inventory (1990), and the Rosenberg Self-Esteem Scale (1965). Data were analyzed using repeated measures ANOVA and SPSS-26 software. Findings: The results indicated a significant difference between the two therapy groups (MBT and DBT) on emotion regulation, impulsivity, and self-esteem in individuals with Borderline Personality Disorder. Dialectical Behavior Therapy had a greater impact on improving emotion regulation, impulsivity, and self-esteem in individuals with Borderline Personality Disorder (P<0.001). Conclusion: It can be concluded that both Dialectical Behavior Therapy and Mentalization-Based Therapy can be effective intervention methods for improving emotion regulation, impulsivity, and self-esteem in individuals with Borderline Personality Disorder. [ABSTRACT FROM AUTHOR]

We tested whether dimensional personality disorder models such as the Alternative Model for Personality Disorders (AMPD) cause less prejudice toward people with borderline personality disorder (BPD) than categorical models, and we sought to identify the mechanisms underpinning this reduction in prejudice. Undergraduate psychology students (n = 183) were randomly assigned to one of three conditions (AMPD, categorical, control) and given descriptive information about BPD. Participants in the AMPD and categorical conditions also received a presentation about their respective BPD diagnostic criteria. Students in all conditions then completed a survey assessing their prejudice toward people with BPD. There was no difference between conditions on overall prejudice toward people with BPD. However, the AMPD increased continuum beliefs and decreased categorical beliefs, and these, in turn, affected perceptions of people with BPD as ingroup members, which indirectly reduced prejudice. We have identified pathways through which the AMPD indirectly reduces prejudice toward people with BPD. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: We know that there are similar rates of borderline personality disorder (BPD) diagnosed in both men and women; however, some research suggests that BPD is diagnosed later and less frequently in men. Some research suggests that males diagnosed with BPD present differently to women, but not much is known about how this influences the care men receive in inpatient mental health hospitals. What the paper adds to existing knowledge?: This paper is the first to specifically ask inpatient staff about men diagnosed with BPD, and to hear about their perceptions and experiences.It identified that some staff do not feel as knowledgeable in identifying and treating BPD in men compared to women. Some staff talked about how emotional difficulties like BPD are often not the first thought when men present with distress compared to women. Staff also talked about needing a safe, open and transparent working culture to be able to ask questions and to be questioned on their own assumptions, biases or lack of training. What are the implications for practice?: This paper suggests that inpatient staff may hold some assumptions about men and their emotions, such as assuming that they are less likely to struggle with emotional difficulties like BPD. Staff anxieties about risk management may influence how they perceive and care for men in inpatient wards. The findings suggest that male‐specific training in identifying and treating BPD should be provided for staff on inpatient wards, to improve knowledge and confidence. Introduction: Research highlights discrepancies in recognition of borderline personality disorder (BPD) in men, despite similar rates of prevalence across genders. Aim: To investigate inpatient mental health professionals' experiences of delivering treatment for males with a diagnosis of BPD. Method: Six mental health professionals working within adult acute inpatient wards completed a semi‐structured interview. All participants were members of the nursing team. Thematic analysis was used to analyse the data. Results: Five themes were identified: Gender Differences, Stereotyping, Facilitators to Care Delivery, Barriers to Care Delivery and Ways to Improve Care. Participants talked of a lack of awareness and understanding of BPD in males impacting both diagnosis and treatment in an acute inpatient setting. Discussion: There may be factors ranging from gender stereotypes, limited knowledge and understanding of gender differences in presentations, and personal/organisational cultures influencing the formulation and treatment of males with a diagnosis of BPD in inpatient settings. Implications for Practice: The findings suggest that gender stereotypes such as masculine norms may influence how male patients' emotional difficulties are understood and managed, and that additional training in male‐specific issues to improve knowledge and care provision. This research will support inpatient staff, service leads and clinical educators to identify ways to adapt care provision for men. [ABSTRACT FROM AUTHOR]

Background and Objectives: Fifty percent of individuals with borderline personality disorder (BPD) experience self-harm. One of the crucial factors related to self-harm is feelings of emptiness. While inner strengths, such as the Five Precepts, meditation, and equanimity, have been identified as potential buffers against negative mental health outcomes in BPD, their role in mediating the relationship between feelings of emptiness and self-harm is not well-documented. This study aimed to explore how these inner strengths mediate the relationship between feelings of emptiness and self-harm in individuals exhibiting BPD symptoms. Materials and Methods: A total of 302 Thai participants exhibiting BPD symptoms completed several assessments: the SCID-II Personality Disorder Questionnaire for BPD to assess feelings of emptiness and self-harm, the Inner-Strength-Based Inventory (i-SBI) to evaluate the Five Precepts, meditation, and equanimity, and the Outcome Inventory Depression (OI-Depression) to assess depression. Mean and standard deviation were used for continuous variables, such as age and OI-Depression. A t-test assessed mean differences in continuous variables between the self-harm group and the non-self-harm group. Chi-square tests examined differences in categorical variables with three or more levels, such as education. Pearson's correlation and linear regression analyzed relationships between continuous variables, including i-SBI and OI-Depression scores. Mediation analysis was performed using IBM SPSS and AMOS, with self-harm as the outcome variable, feelings of emptiness as the predictor, and inner strengths as mediators. Results: The participants had a mean age of 36.56, with 65.4% being female. The analysis showed that the Five Precepts, meditation, and equanimity significantly mediated the relationship between feelings of emptiness and self-harm, with a standardized coefficient of β = 0.534 (95% CI = 0.417 to 0.647, p < 0.001). The indirect effect of feelings of emptiness through these inner strengths was significant (β = 0.034, 95% CI = 0.009 to 0.075, p = 0.005). The mediation model explained 38% of the variance in self-harm with a 3% increase, albeit small but significant. Conclusions: This study highlights that inner strengths negatively mediate the relationship between feelings of emptiness and self-harm, indicating that as these inner strengths increase, the direct impact of feelings of emptiness on self-harm decreases. These findings suggest that targeting inner strengths as protective factors could be a valuable strategy in developing interventions aimed at reducing self-harm by addressing the underlying emotional challenges associated with BPD. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is a severe mental disorder characterized by pervasive patterns of relational instability, chronic feelings of emptiness, sense of abandonment, self-injurious and anticonservative attempts. Pharmacological treatment has been found useful only for the management of severe symptoms and management of comorbidities, while psychotherapy is the main treatment for BPD. Although the disorder has long been considered resistant to any treatment, in recent years research has not only shown that BPD can be treated but also provided several manualized and empirically validated psychotherapeutic treatments. This paper set out to examine the most effective current psychotherapies for the treatment of BPD. All articles published in the last five years on the new psychotherapic treatments for BPD were included. Articles not relevant to this topic, as well as case reports and articles on animal models, were excluded. EBs forms of psychotherapy directed at symptom control and comorbidities occurring in BPD and forms termed generalist, were analyzed. Overall, the study found that there is no single form of psychotherapy that can fully treat BPD. The most effective forms of psychotherapy in controlling impulsive and self-injurious symptoms and in managing comorbidities remain Dialectical Behaviour Therapy and Schema Therapy. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is characterized by a pathognomonic instability of interpersonal relationships. Therefore, a good working alliance in the treatment of BPD may go beyond qualitative aspects like agreement on goals and mutual trust, and in particular depend on a balancing of instability. Yet, little is known about working alliance dynamics in the treatment of BPD. Using daily ratings of the Therapy Process Questionnaire, we retrospectively investigated assessments of the stability of the therapeutic alliance during inpatient treatment in 51 patients with BPD and 66 patients with major depressive disorder. Regression analyses were used to investigate whether working alliance was more unstable in patients with BPD and how it was associated to outcome. The working alliance was found to be significantly more unstable in patients with BPD. Yet, a high dynamic complexity of the working alliance was found to be linked to better outcomes in BPD, possibly hinting at the importance of rupture and repair. [ABSTRACT FROM AUTHOR]

Introduction: Impulsivity is one of the overlapping symptoms common to borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD), but the neurobiological basis of these disorders remains uncertain. This systematic review aims to identify abnormalities in the gray and white matter associated with impulsivity in BPD and ADHD. Methods: We conducted a systematic search of the PubMed, Embase, and SCOPUS databases, adhering to PRISMA guidelines. Studies that investigated gray and white matter alterations in BPD or ADHD populations and their relationship with impulsivity were included. We reviewed information from 23 studies involving 992 participants, which included findings from structural MRI and DTI. Results: The review identified various nonhomogeneous changes associated with impulsivity in BPD and ADHD. BPD was mainly associated with abnormalities in the prefrontal cortex (PFC) and limbic areas, which correlated negatively with impulsivity. In contrast, impulsivity associated with ADHD was associated with structural changes in the caudate nucleus and frontal–striatal pathways. Despite the overlapping symptoms of impulsivity, the neurobiological mechanisms appeared to differ between the two disorders. Conclusions: These findings emphasize the distinct neurostructural correlates of impulsivity in BPD and ADHD. While both disorders show impulsivity as one of their main symptoms, the fundamental brain structures associated with this trait are different. BPD is primarily associated with abnormalities in the prefrontal cortex and limbic system, whereas the alterations seen in ADHD tend to focus on the caudate nucleus and frontostriatal pathways. Further research is needed to clarify these differences and their implications for treatment. [ABSTRACT FROM AUTHOR]

Background/objective: Emotional dysregulation is bidirectionally associated with sleep disturbances, with potentially critical implications for emotional reactivity, in patients with borderline personality disorder (BPD). This study evaluated subjective and objective sleep quality, emotional regulation, and emotional reactivity in 20 patients with BPD compared to 20 non-clinical individuals. Methods: Subjective and objective sleep quality was assessed using the Pittsburgh Sleep Quality Index and a 3-day actigraphic measurement. Emotional regulation was evaluated using the Difficulties in Emotion Regulation Scale and the Berkeley Expressivity Questionnaire. Furthermore, each participant underwent an emotional reactivity task selected from the International Affective Picture System. Results: Compared to control subjects, individuals with BPD reported poor subjective sleep quality and objective sleep continuity disturbances, with more sleep fragmentation and decreased sleep efficiency. Moreover, BPD patients showed emotional dysregulation and altered subjective reactivity to emotional stimuli, particularly positively valenced stimuli. Conclusion: These results suggest the importance of further clarifying the specific direction of sleep-dependent emotional modulation in individuals with BPD, with significant clinical implications for patients with co-occurring sleep disturbances. [ABSTRACT FROM AUTHOR]

Background: Borderline personality disorder (BPD) is a severe mental disorder that is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and mood as well as marked impulsivity. BPD has its peak incidence and prevalence from puberty through to emerging adulthood. BPD is a controversial diagnosis in young people. Commonly, young people with BPD are under-diagnosed, untreated, are not in employment or training and are estranged from their families. Yet, they have complex needs and are at high suicide risk. Aim: To assess the feasibility of conducting a randomised controlled trial (f-RCT) of a BRIDGE, a brief intervention programme for young people (age 14-24) with BPD symptoms (sub-threshold or threshold) in a community sample from Scotland, UK. Method: Forty young people (age 14-24) meeting criteria for BPD symptoms, will be randomised in a 1:1 ratio to receive either a) the BRIDGE intervention plus service-as-usual or b) service-as-usual alone. Follow up will be 12 weeks and 24 weeks post-intervention. The study is carried out between 2021 to 2024. Outcome: The two primary outcomes of the MQ funded, BRIDGE project (f-RCT) are i. recruitment rates and ii. retention rates. The study will present the acceptability and appropriateness of our putative outcome measures for a future definitive randomised controlled trial (d-RCT). Impact: Young people with BPD benefit from good clinical care and targeted intervention, however are regularly missed or mislabelled. The community based feasibility trial would provide initial evidence of variable needs of young people with complex needs, who maybe missed or excluded from services as they don't "fit" a model/diagnosis. Workable multi-agency service model proposed in the trial would be a major advance in understanding care pathways regardless of trial outcome. Clinical Trial Registration: ClinicalTrial.gov, identifier NCT05023447 [ABSTRACT FROM AUTHOR]

Background/objective: Emotional dysregulation is bidirectionally associated with sleep disturbances, with potentially critical implications for emotional reactivity, in patients with borderline personality disorder (BPD). This study evaluated subjective and objective sleep quality, emotional regulation, and emotional reactivity in 20 patients with BPD compared to 20 non-clinical individuals. Methods: Subjective and objective sleep quality was assessed using the Pittsburgh Sleep Quality Index and a 3-day actigraphic measurement. Emotional regulation was evaluated using the Difficulties in Emotion Regulation Scale and the Berkeley Expressivity Questionnaire. Furthermore, each participant underwent an emotional reactivity task selected from the International Affective Picture System. Results: Compared to control subjects, individuals with BPD reported poor subjective sleep quality and objective sleep continuity disturbances, with more sleep fragmentation and decreased sleep efficiency. Moreover, BPD patients showed emotional dysregulation and altered subjective reactivity to emotional stimuli, particularly positively valenced stimuli. Conclusion: These results suggest the importance of further clarifying the specific direction of sleep-dependent emotional modulation in individuals with BPD, with significant clinical implications for patients with co-occurring sleep disturbances. [ABSTRACT FROM AUTHOR]

Key Points: Question: Is the inability to explore multiple alternatives and take advantage of the best options associated with suicidal behavior? Findings: In 2 case-control studies of adults with borderline personality disorder and depression, inability to fully explore available options was associated with medically serious suicide attempts. In an ambulatory study, this pattern predicted suicidal ideation. Meaning: The findings suggest that the inability to explore a full range of solutions in a state of suicidal crisis may prevent one from discovering alternatives to attempting suicide; exploring novel ways to cope may help individuals build their safety plans. This case-control study explores the exploration-exploitation dilemma in suicidal behavior. Importance: Clinical theory and behavioral studies suggest that people experiencing suicidal crisis are often unable to find constructive solutions or incorporate useful information into their decisions, resulting in premature convergence on suicide and neglect of better alternatives. However, prior studies of suicidal behavior have not formally examined how individuals resolve the tradeoffs between exploiting familiar options and exploring potentially superior alternatives. Objective: To investigate exploration and exploitation in suicidal behavior from the formal perspective of reinforcement learning. Design, Setting, and Participants: Two case-control behavioral studies of exploration-exploitation of a large 1-dimensional continuous space and a 21-day prospective ambulatory study of suicidal ideation were conducted between April 2016 and March 2022. Participants were recruited from inpatient psychiatric units, outpatient clinics, and the community in Pittsburgh, Pennsylvania, and underwent laboratory and ambulatory assessments. Adults diagnosed with borderline personality disorder (BPD) and midlife and late-life major depressive disorder (MDD) were included, with each sample including demographically equated groups with a history of high-lethality suicide attempts, low-lethality suicide attempts, individuals with BPD or MDD but no suicide attempts, and control individuals without psychiatric disorders. The MDD sample also included a subgroup with serious suicidal ideation. Main Outcomes and Measures: Behavioral (model-free and model-derived) indices of exploration and exploitation, suicide attempt lethality (Beck Lethality Scale), and prospectively assessed suicidal ideation. Results: The BPD group included 171 adults (mean [SD] age, 30.55 [9.13] years; 135 [79%] female). The MDD group included 143 adults (mean [SD] age, 62.03 [6.82] years; 81 [57%] female). Across the BPD (χ23 = 50.68; P <.001) and MDD (χ24 = 36.34; P <.001) samples, individuals with high-lethality suicide attempts discovered fewer options than other groups as they were unable to shift away from unrewarded options. In contrast, those with low-lethality attempts were prone to excessive behavioral shifts after rewarded and unrewarded actions. No differences were seen in strategic early exploration or in exploitation. Among 84 participants with BPD in the ambulatory study, 56 reported suicidal ideation. Underexploration also predicted incident suicidal ideation (χ21 = 30.16; P <.001), validating the case-control results prospectively. The findings were robust to confounds, including medication exposure, affective state, and behavioral heterogeneity. Conclusions and Relevance: The findings suggest that narrow exploration and inability to abandon inferior options are associated with serious suicidal behavior and chronic suicidal thoughts. By contrast, individuals in this study who engaged in low-lethality suicidal behavior displayed a low threshold for taking potentially disadvantageous actions. [ABSTRACT FROM AUTHOR]

This research examines the intricate connection between Borderline Personality Disorder (BPD), life's meaning and the interpersonal difficulties related to the search for meaning, in the cultural context in Pakistan. As BPD is frequently accompanied by extreme interpersonal problems and problems with identity, it's valuable to learn how these elements interact to influence one's pursuit of meaning. Employing a mixed-methods design, the study included a quantitative assessment of BPD symptoms, interpersonal challenges, and meaning in life in a sample of 150 adults (75 with BPD and 75 controls) using validated scales. The qualitative component was based on semi structured interviews with 15 BPD members. Quantitative results showed significantly more interpersonal challenges in conjunction with an even more intense search for the meaning of life for those with BPD when compared with controls. BPD symptoms were positively correlated with interpersonal difficulties and negatively correlated with the presence of meaning. Cultural factors moderated the impact of interpersonal challenges on the search for meaning. Qualitative data were thematically analyzed and themes of familial expectation, societal pressure and cultural perception emerged about how these themes influenced participants' relational struggles and existential outlooks were identified. Thus, these findings help to support the need for culturally sensitive interventions that address the interpersonal and existential dimensions of those with BPD. [ABSTRACT FROM AUTHOR]

While research has shown that the prevalence of ADHD in the general population has increased over time, there have been no studies focused on ADHD prevalence in patients with borderline personality disorder (BPD). This study compares two cohorts of adults with rigorously diagnosed BPD recruited nearly three decades apart (1992 vs. 2020). Participants from the 1992 McLean Study of Adult Development (MSAD) (N = 290) and the 2020 Flourishing study (N = 147) were assessed for ADHD using DSM-III-R and DSM-5 criteria respectively. Compared to MSAD subjects, the prevalence of ADHD among Flourishing subjects was significantly higher overall, and in female (but not male) subjects. This increased prevalence, which is likely due to the broadening of the DSM criteria over time, highlights what many observers believe to be a problematic expansion of the diagnostic criteria for ADHD that may have decoupled this criteria set from capturing a neurodevelopmental disorder that typically begins in childhood. [ABSTRACT FROM AUTHOR]

Objective: Borderline Personality Disorder (BPD) is the most common personality disorder in psychiatric settings and one of the disorders that causes the most harm to individuals. The aim of the present study was to compare the effectiveness of Dialectical Behavior Therapy Skills Training (DBT-ST) and Mindfulness-Based Cognitive Therapy (MBCT) on cognitive emotion regulation in individuals with symptoms of Borderline Personality Disorder. Methods and Materials: This research was a semi-experimental study, utilizing a pre-test, post-test design with a control group and a follow-up period. The statistical population included all clients aged 18 to 45 who referred to counseling centers in the city of Sari during the first half of 2022 and had files. From all these individuals, those willing to cooperate were selected through purposive non-random sampling, resulting in a sample of 45 participants. These individuals were then randomly assigned to three groups (Group 1: Dialectical Behavior Therapy Skills Training, n = 15; Group 2: Mindfulness-Based Cognitive Therapy, n = 15; and Group 3: Control group, n = 15). Data collection was conducted using the Cognitive Emotion Regulation Questionnaire by Garnefski et al. (2001). The Dialectical Behavior Therapy Skills Training group (2003) participated in 12 weekly 90-minute group sessions, and the Mindfulness-Based Cognitive Therapy group (2002) participated in 8 weekly 90-minute group sessions. Data were analyzed using repeated measures ANOVA. Findings: The results indicated that Dialectical Behavior Therapy Skills Training and Mindfulness-Based Cognitive Therapy were effective on cognitive emotion regulation in individuals with symptoms of Borderline Personality Disorder (P = 0.001). There was a significant difference in the effectiveness of Dialectical Behavior Therapy Skills Training and Mindfulness-Based Cognitive Therapy on cognitive emotion regulation between the experimental groups and the control group. Conclusion: Based on the results of this study, it can be concluded that Dialectical Behavior Therapy Skills Training and Mindfulness-Based Cognitive Therapy, through individuals' cognitive coping strategies, can lead to improvements in psychological indicators and enhancement of mental health in individuals with symptoms of Borderline Personality Disorder. Keywords: Dialectical Behavior Therapy, Mindfulness-Based Cognitive Therapy, Cognitive Emotion Regulation, Borderline Personality Disorder. [ABSTRACT FROM AUTHOR]

Introduction: Non‐suicidal self‐injury (NSSI) is prevalent in individuals diagnosed with borderline personality disorder (BPD), particularly in inpatient settings. This poses challenges, leading to frustration and powerlessness among healthcare professionals. This, in turn, puts mental health nurses at risk of compassion fatigue (CF), impacting treatment quality. Aim: We conducted a systematic review and meta‐synthesis to investigate the experiences of mental health nurses caring for people with BPD and/or NSSI in inpatient settings. Method: Literature search was performed in MEDLINE, CINAHL, PsychINFO and Web of Science. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. For synthesis of findings from original studies, Thomas and Harden's thematic synthesis was used. Results: In total 1492 studies were screened of which seven met the inclusion criteria. We identified four main analytical themes: 'Notions on nursing', 'Reality calls', 'Fall of ideals' and 'Throw me a lifebuoy, please', with each two subthemes included. Discussion: Despite nurses' strong motivations for positive change and assistance, unexpected demands lead to emotional exhaustion, affecting their care provision. Implications for Practice: The study underscores the necessity of addressing nurses' emotional strain through education and skill‐oriented training, enhancing their resilience and reducing CF risk, ultimately securing adequate care, and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this proof-of-concept multimethod exploratory single case study is to increase knowledge of the underlying mechanisms of alliance ruptures and repairs in Borderline Personality Disorder treatment across and within the psychotherapeutic treatment process. Method: The multimethod includes outcome assessment of patient self-reporting questionnaires (the Affect Integration Inventory, the Hopkins Symptom Checklist), observation-based ratings of sessions with the Rupture Resolution Rating System, quantitative analysis of heart rate variability using recurrence quantification analysis, and a qualitative multimodal interaction analysis of within-session dynamics. Result: Results reveal how patterns of heart rate synchrony between patient and therapist reflect periodical patterns of emotional interaction corresponding to key therapeutic alliance processes throughout the treatment process. Particularly, heart rate synchronization and desynchronization correspond with increasing rupture resolution ratings and positive outcome measures in the last part of the therapy process, indicating increased productivity, affectivity, and positive change. The qualitative microanalysis highlights context sensitivity to alliance management within sessions. Physiological arousal is found to underlie important alliance processes, including emotion regulation, relatedness, security, empathic responding, sense-making, and validation in correspondence with different therapist verbal and non-verbal markerbs. Discussion: Clinical implications and study limitations are discussed. Recommendations are made for future directions in relation to applying multimethod approaches when studying rupture and repair processes in psychotherapy. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) has been a controversial diagnosis for over 40 years. It was to be removed from the latest version of the ICD, only to be reintroduced as a trait qualifier as a result of last-minute lobbying. Retaining BPD as a de facto diagnosis keeps us stuck at a deadlock that undermines the voices of patients who have persistently told us this label adds 'insult to injury'. Miranda Fricker's concept of epistemic injustice helps illuminate how this affects subjectivity and speech, hermeneutically sealing patients in ways of thinking that are not evidence-based, resulting in testimonial smothering (altering or withholding one's narratives) and testimonial quieting (dismissing a speaker's capacity to provide worthy testimony) that prevent more affirmative explanations. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this proof-of-concept multimethod exploratory single case study is to increase knowledge of the underlying mechanisms of alliance ruptures and repairs in Borderline Personality Disorder treatment across and within the psychotherapeutic treatment process. Method: The multimethod includes outcome assessment of patient selfreporting questionnaires (the Affect Integration Inventory, the Hopkins Symptom Checklist), observation-based ratings of sessions with the Rupture Resolution Rating System, quantitative analysis of heart rate variability using recurrence quantification analysis, and a qualitative multimodal interaction analysis of within-session dynamics. Result: Results reveal how patterns of heart rate synchrony between patient and therapist reflect periodical patterns of emotional interaction corresponding to key therapeutic alliance processes throughout the treatment process. Particularly, heart rate synchronization and desynchronization correspond with increasing rupture resolution ratings and positive outcome measures in the last part of the therapy process, indicating increased productivity, affectivity, and positive change. The qualitative microanalysis highlights context sensitivity to alliance management within sessions. Physiological arousal is found to underlie important alliance processes, including emotion regulation, relatedness, security, empathic responding, sense-making, and validation in correspondence with different therapist verbal and non-verbal markerbs. Discussion: Clinical implications and study limitations are discussed. Recommendations are made for future directions in relation to applying multimethod approaches when studying rupture and repair processes in psychotherapy. [ABSTRACT FROM AUTHOR]

Background : Current treatments for mental disorders, like pharmacotherapy or psychological approaches, do not lead to full remission in all individuals. Physical activity (PA) is effective at improving psycho-physical health in major depressive and anxiety disorders. However, the efficacy of PA as an adjunctive treatment for borderline personality disorder (BPD) has not been studied. To date, there are no approved pharmacological treatments for this severe condition and limited accessibility to effective psychotherapeutic interventions. This study tests the efficacy of a structured PA programme as an additional treatment for BPD outpatients. Methods: The PABORD is a randomised controlled trial for female outpatients (18–40 years) with a BPD diagnosis. The intervention group (n = 32) will participate in a 12-week structured PA programme supervised by a sport medicine physician and preceded by three psychoeducation sessions on healthy eating habits. The control group (n = 32) will receive a 12-week psychoeducation programme on PA, diet, and health risks of a sedentary lifestyle for a total of 8 sessions. The study aims to determine if the PA intervention is superior to the control in reducing BPD symptoms. Secondary aims include improving PA levels and physical and psychological health. Assessments will be conducted at baseline, post-intervention, and 3 months post-intervention. Discussion: The structured PA programme is expected to outperform the control group in terms of health and PA outcomes at the end of the intervention. Repeated assessments will also help to identify psychosocial factors that influence PA maintenance. Findings will support the potential widespread implementation of PA programmes for BPD treatment. Trial registration: ClinicalTrials.gov NCT06461104. Registered on 6 June 2024 {2a}. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this proof-of-concept multimethod exploratory single case study is to increase knowledge of the underlying mechanisms of alliance ruptures and repairs in Borderline Personality Disorder treatment across and within the psychotherapeutic treatment process. Method: The multimethod includes outcome assessment of patient self reporting questionnaires (the Affect Integration Inventory, the Hopkins Symptom Checklist), observation-based ratings of sessions with the Rupture Resolution Rating System, quantitative analysis of heart rate variability using recurrence quantification analysis, and a qualitative multimodal interaction analysis of within-session dynamics. Result: Results reveal how patterns of heart rate synchrony between patient and therapist reflect periodical patterns of emotional interaction corresponding to key therapeutic alliance processes throughout the treatment process. Particularly, heart rate synchronization and desynchronization correspond with increasing rupture resolution ratings and positive outcome measures in the last part of the therapy process, indicating increased productivity, affectivity, and positive change. The qualitative microanalysis highlights context sensitivity to alliance management within sessions. Physiological arousal is found to underlie important alliance processes, including emotion regulation, relatedness, security, empathic responding, sense-making, and validation in correspondence with different therapist verbal and non-verbal markerbs. Discussion: Clinical implications and study limitations are discussed. Recommendations are made for future directions in relation to applying multimethod approaches when studying rupture and repair processes in psychotherapy. [ABSTRACT FROM AUTHOR]

Objectives: The high prevalence of borderline personality disorder, along with comorbid psychiatric disorders and impulsive reactions (suicide attempts, self-mutilation, substance use, and impulsive behaviors) increase the need for effective psychological interventions. In this study, the effectiveness of dialectical behavior skills training based on the Soler method and family education with individual therapies are compared in this group of patients. Methods: In this single-blind case study, eight cases were selected through a targeted sampling method based on the inclusion and exclusion criteria. The participants were divided into two groups: Intervention individually and individual intervention with family education. Both group members and the family members of the second group received dialectical behavior skills training based on the Soler model. The participants completed the borderline personality inventory, self-harm inventory, and Barratt impulsivity scale in four stages: At the beginning of the sessions, in the middle of the treatment, at the end of the treatment, and three months after treatment. Results: The data were analyzed using the Wilcoxon test, Friedman test, and Mann-Whitney U test. The results indicate the effectiveness of the dialectical behavior skills training method based on the Soler model in reducing symptoms of borderline personality disorder and selfmutilation, as well as emotion regulation improvement at the significant level of P=0.05. Discussion: This treatment is recommended as an effective and short-term method for controlling symptoms of borderline personality disorder. Family education, in addition to dialectical behavior therapy, has been shown to have a positive effect on reducing symptoms in patients. [ABSTRACT FROM AUTHOR]

Introduction: Borderline Personality Disorder (BPD) traits play a crucial role in the prognosis of psychiatric disorders, as well as in assessing risks associated with negativity and impulsivity. However, there is a lack of data regarding the distribution characteristics of BPD traits and symptoms within clinical populations. Methods: A total of 3015 participants (1321 males, 1694 females) were consecutively sampled from outpatients at the psychiatric and psychocounseling clinics at the Shanghai Mental Health Center. BPD symptoms were assessed using a self-reported personality diagnostic questionnaire. Having BPD traits is defined as having five or more positive items in self-reported BPD characteristics. Participants were stratified into male and female groups, age groups, and diagnostic groups (schizophrenia, mood disorders, anxiety disorders). Exploratory factor analysis using principal components analysis was conducted. Three factors were identified: "F1: Affective Instability and Impulsivity", "F2: Interpersonal Unstable and Extreme Reactions", and "F3: Identity Disturbance". Results: Among 3015 participants, 45.9% of the patients self-reported BPD traits. Comparing of male and female patients, there was no statistically significant difference in the occurrence rate of BPD traits (χ² = 1.835, p=0.176). However, in terms of symptoms, female patients reported more symptoms than male patients. Female patients also exhibited more pronounced features on F2 compared to male patients (t =-1.972, p=0.049). There is a general decrease in BPD traits, symptoms, and factors with increasing age. Specifically, the proportion of positive BPD traits is approximately halved before the age of 30 and decreases to around one-third after the age of 30. BPD traits were most common in the Mood Disorders group at 55.7%, followed by the Anxiety Disorders group at 44.4%, and Schizophrenia group at 41.5% (χ² = 38.084, p<0.001). Discussion: Our study revealed the pervasive presence of BPD traits and symptoms among psychiatric outpatients, exhibiting distinctive distributions across gender, age, and diagnostic categories. These findings emphasize the significance of identifying and addressing BPD pathology in the clinical care of psychiatric outpatients. [ABSTRACT FROM AUTHOR]

Objective: The current study evaluated frequency of nonsuicidal self-injury (NSSI) and associated maladaptive traits between three time periods: pre-pandemic, early pandemic, and later pandemic. Participants: Two college student samples (n = 362; n = 337) were collected via two online studies. Method: Participants completed measures assessing maladaptive borderline personality traits, engagement in NSSI over the past month, and reasons for and types of NSSI engaged in across the lifetime. Results: Results demonstrated a stable and potentially a slight increase in general rates of NSSI over the course of the pandemic. Further, specific maladaptive traits that underly borderline personality disorder (i.e., despondence, fragility, self-disturbance, and anxious-uncertainty) were related to engagement in NSSI 1-month post COVID. Conclusion: The study highlights the need for added interventions that might reach at risk populations during these heightened periods of stress. [ABSTRACT FROM AUTHOR]

The neurobiological mechanism of borderline personality disorder (BPD) in adolescents remains unclear. The study aimed to assess the alterations in neural activity within prefrontal cortex in adolescents with BPD and investigate the relationship of prefrontal activity with emotional regulation and cognitive function. This study enrolled 50 adolescents aged 12–17 years with BPD and 21 gender and age-matched healthy control (HC) participants. Study assessment for each participant included a brain resting-state functional MRI (rs-fMRI), clinical assessment questionnaires such as Borderline Personality Features Scale (BPFS), Difficulties in Emotion Regulation Scale (DERS), Ottawa Self-Injury Inventory and Childhood Trauma Questionnaire (CTQ) and cognitive testing with Stroop Color-Word Test (SCWT). Fractional amplitude of low-frequency fluctuations (fALFF) and seed-based functional connectivity (FC) were obtained from rs-fMRI analysis. Correlation analysis was also performed to evaluate the associations of the neuroimaging metrics such as fALFF and FC with clinical assessment questionnaire and cognitive testing scores. Adolescents with BPD showed increased fALFF values in the right inferior frontal gyrus and decreased activity in the left middle frontal gyrus as compared to the HC group (p < 0.05, cluster size ≥ 100, FWE correction). In adolescents with BPD, increased fALFF in the right inferior frontal gyrus was related to the BPFS (emotional dysregulation), DERS-F (lacking of emotional regulation strategies) and Ottawa Self-Injury Inventory-4 C scores (internal emotional regulation function of self-injurious behavior). The reduced fALFF in the left middle frontal gyrus was associated with the SCWT-A (reading characters) and the SCWT-B (reading color) scores. Additionally, the fALFF values in the left middle frontal gyrus and the right inferior frontal gyrus were related to the CTQ-D (emotional neglect) (p < 0.05). The left middle frontal gyrus exhibited increased FC with the right hippocampus, left inferior temporal gyrus and right inferior frontal gyrus (voxel p < 0.001, cluster p < 0.05, FWE correction). The increased FC between the left middle frontal gyrus and the right hippocampus was related to the SCWT-C (cognitive flexibility) score. We observed diverging changes in intrinsic brain activity in prefrontal cortex, and neural compensatory changes to maintain function in adolescents with BPD. In addition, decreased neural function was closely associated with emotional dysregulation, while increased neural function as indicated by brain activity and FC was associated with cognitive dysfunction. These results indicated that alterations of intrinsic brain activity may be one of the underlying neurobiological markers for clinical symptoms in adolescents with BPD. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate factors associated with functioning in participants with and without borderline personality disorder (BPD). In particular, we were interested whether mentalizing and related social cognitive capacities, as factors of internal functioning, are important in predicting psychosocial functioning, in addition to other psychopathological and sociodemographic factors. Method: This is a cross‐sectional study with N = 53 right‐handed females with and without BPD, without significant differences in age, IQ, and socioeconomic status, who completed semi‐structured diagnostic and self‐report measures of social cognition. Mentalizing was assessed using the Reflective Functioning Scale based on transcribed Adult Attachment Interviews. A regularized regression with the elastic net penalty was deployed to investigate whether mentalizing and social cognition predict psychosocial functioning. Results: Borderline personality disorder symptom severity, sexual abuse trauma, and social and socio‐economic factors ranked as the most important variables in predicting psychosocial functioning, while reflective functioning (RF) was somewhat less important in the prediction, social cognitive functioning and sociodemographic variables were least important. Conclusions: Borderline personality disorder symptom severity was most important in determining functional impairment, alongside trauma related to sexual abuse as well as social and socio‐economic factors. These findings verify that BPD symptoms themselves most robustly predict functional impairment, followed by history of sexual abuse, then contextual factors (e.g. housing, financial, physical health), and then RF. These results lend marginal support to the conceptualization that mentalizing may enhance psychosocial functioning by facilitating social learning, but emphasize symptom reduction and stabilization of life context as key intervention targets. [ABSTRACT FROM AUTHOR]

Objective: The prominence of suicidal ideation, suicide attempts and death by suicide among people diagnosed with Borderline Personality Disorder (BPD) underscores the importance of conducting relevant and informative risk assessment. The purpose of this study was to examine risk assessment protocols used in state public mental health services to assess whether and in what manner they include factors specific to suicidality/self-harm risk in people with BPD. Method: A qualitative evaluation of risk assessment protocols from nine of the thirteen (70%) of Victoria's public mental health was undertaken. Content analysis methodology was utilised to identify themes and compare these to recommendations for risk assessment of BPD as outlined in Australian clinical guidelines Results: The risk assessment protocols comprised suicide risk factors generally relevant to psychiatric disorders. Only one protocol incorporated BPD-specific risk assessment principles. Conclusions: Fully incorporating BPD-specific risk factors into mental health service risk assessment protocols will better inform service responses and potentially improve clinical outcomes for people with BPD whose presentation includes chronic suicidality and/or high lethality non-suicidal self-injury. Key Points: What is already known about this topic: Borderline Personality Disorder (BPD) is associated with frequent deliberate self-injury, chronic suicidal ideation, and suicidal behaviour. Specific clinical features of BPD such as chronic suicidality and impulsivity can reduce the applicability of more general psychiatric risk assessments and desensitise clinicians to high-risk situations. BPD-specific risk assessment training enables mental health professionals to differentiate between low versus high risk, chronic versus acute risk, and be alert to changes in the risk profile. What this topic adds: The majority of risk assessment protocols surveyed in public mental health services comprised suicide risk factors related to psychiatric disorders in general. Risk factors specific to chronic suicidality, deliberate self-injury, and changes in the pattern of risky behaviours in people with BPD are not systematically incorporated within public mental health risk assessment protocols. Incorporating existing evidence-based risk assessment protocols that incorporate factors specific to people with BPD may improve the consistency and accuracy with which suicide risk is assessed in public mental health services. [ABSTRACT FROM AUTHOR]

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Introduction: People with a borderline personality disorder (BPD) diagnosis or symptoms may experience emotional crises which necessitate use of the emergency department (ED). No existing reviews focus specifically on experiences of consumersa, carersb and clinicians in relation to ED presentations by people diagnosed with BPD. Aim/Question: The aim of this study was to synthesise knowledge on consumer, carer and clinician experiences of BPD in the ED. Method: An integrative review methodology was chosen as it best captures the complexity of varied perspectives and emergent phenomena from diverse literature sources. EMBASE, CINAHL, PsycInfo and Medline were searched for papers published before 16 February 2022. Results: Nine papers met the inclusion criteria (five qualitative, one quantitative, one mixed methods and two letters to the editor). Key themes were barriers to timely and adequate care, and stigmatising attitudes and practices towards people diagnosed with BPD. Negative attitudes were perceived to perpetuate harmful outcomes and further ED visits. Discussion: Predominantly negative ED experiences were expressed by clinicians, consumers and carers. Further work is needed in ED models of care and staff education to improve the experience of care for consumers, carers and clinicians alike. Implications for Practice: Opportunities for change will exist through co‐designed innovation, education, advocacy and leadership. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the acceptance, feasibility and safety of a short-term group program for adults (18 years and older) and youth (16 to 18 years) with borderline personality disorder (BPD) symptoms. Termed Road Maps, the content and development were informed by common treatment factors identified from evidence-based therapies for BPD. Method: Two-hundred and eight people consented to participate in the research trial and completed baseline measures. Intervention participants rated the acceptability and subjective experience of the group. Attrition rates informed feasibility, and serious adverse events were tracked to identify potential harms. Results: Participant post-group ratings of the group's acceptability and subjective experience were above average across both adult and youth populations. Attrition rate after commencement of group was 38% for adults and 27% among youth. The incidence rate of emergency department presentations was reduced by 41% in the 6 months post-group, relative to 6 months pre-group. Conclusions: The current study provides preliminary support for the acceptability and feasibility of a short-term group therapy program for people with a diagnosis of BPD. Road Maps may be a useful intermediate intervention in a broader model of stepped care. Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ACTRN12622000849796.aspx, (ACTRN12622000849796) [ABSTRACT FROM AUTHOR]

Background: Psychological treatments for young people with sub-threshold or full-syndrome borderline personality disorder (BPD) are found to be effective. However, little is known about the age at which adolescents benefit from early intervention. This study investigated whether age affects the effectiveness of early intervention for BPD. Methods: N = 626 participants (M age = 15 years, 82.7% female) were consecutively recruited from a specialized outpatient service for early intervention in BPD in adolescents aged 12- to 17-years old. DSM-IV BPD criteria were assessed at baseline, one-year (n = 339) and two-year (n = 279) follow-up. Results: Older adolescents presented with more BPD criteria (χ2(1) = 58.23, p < 0.001) and showed a steeper decline of BPD criteria over the 2-year follow-up period compared with younger adolescents (χ2(2) = 13.53, p = 0.001). In an attempt to disentangle effects of early intervention from the natural course of BPD, a parametrized regression model was used. An exponential decrease (b = 0.10, p < 0.001) in BPD criteria was found when starting therapy over the 2-year follow-up. This deviation from the natural course was impacted by age at therapy commencement (b = 0.06, p < 0.001), although significant across all ages: older adolescents showed a clear decrease in BPD criteria, and young adolescents a smaller decrease. Conclusions: Early intervention appears effective across adolescence, but manifests differently: preventing the normative increase of BPD pathology expected in younger adolescents, and significantly decreasing BPD pathology in older adolescents. The question as to whether developmentally adapted therapeutic interventions could lead to an even increased benefit for younger adolescents, should be explored in future studies. [ABSTRACT FROM AUTHOR]

In clinical settings, among individuals diagnosed with borderline personality disorder (BPD), typically 75% are female and 25% male, although this discrepancy is not reported in the community. In the literature, little is known of the effectiveness and experiences of treatment of men with BPD. We aimed to review the effectiveness and experiences of treatment for men with BPD and outline future research priorities to promote better recovery. We searched Ovid MEDLINE and PsycINFO for eligible studies from inception until July 29, 2022. Peer-reviewed primary research articles on treatment effectiveness or experience for men with BPD were included. Data from eligible studies were synthesized in a narrative review. The protocol of our review was pre-registered on PROSPERO (CRD42022351908). Seventeen studies met the inclusion criteria, and men with BPD from eight countries were represented. Psychological therapies included Dialectical Behavioral Therapy, Systems Training for Emotional Predictability and Problem Solving, Mentalization Based Therapy, and psychoanalytic therapy. Pharmacologic treatment included topiramate, divalproex Extended-Release, and high-dose baclofen. Five studies investigated the service utilization of men with BPD. Compared to women, men were less likely to access treatment for BPD or find treatment helpful. Our findings demonstrated the potential efficacy of psychotherapy and pharmacologic interventions in reducing anger, aggression, and rule-breaking behavior, with limited evidence for reduction in suicide-related outcomes. Our findings are limited by inadequate power and heterogeneity of the included studies. Further research with larger sample sizes and qualitative studies is needed to better understand the treatment experience for men with BPD. [ABSTRACT FROM AUTHOR]

Introduction: In this study, we aimed to examine the relationship between decision-making processes and other cognitive characteristics associated with Borderline Personality Disorder (BPD) in comparison with healthy controls by using the neurocognitive tests. Method: The sample of the study consists of the patient group diagnosed with BPD (n=27) and the voluntary participants without any psychiatric diagnosis (n=28). Borderline Personality Inventory (BPI) was used for psychiatric evaluation, and Iowa Gambling Test (IGT), Stroop Test, Benton Face Recognition Test, Reading the Mind in the Eyes Test, Dokuz Eylül Theory of Mind Scale (DEToM), WMS-R Digit Span and Logical Memory Subscales were administered for neuropsychological examination. Results: A significant difference was found between the BPD and the control group in BPI scores (p=0.02). There were no significant differences on the duration of interference and the number of errors in the Stroop Test, but it was observed that the number of spontaneous correction responses differed significantly (p=0.02) between the groups. A significant difference was revealed (p<0.01) in the immediate recall scores of the WMS-R Logical Memory (subtest story A) between the groups. There were also differences in the Iowa Gambling Test between the groups in the response tendency to choose from deck A (p=0.028) in the first half and from deck B (p=0.03) in the second half of the test. Finally, among the total scores of DEToM there was significant difference between the two groups (p<0.01), and this difference was prominent in the second-degree false belief (p=0.024) and empathy (p=0.027) tasks. Conclusion: As a result of our study, it was concluded that individuals with BPD have minimal difficulty in inhibiting inappropriate response, and this difficulty is related to making disadvantageous choices in decision-making behavior. While BPD group was successful in predicting mental states from external cues in terms of social cognition, however, it was observed that they had difficulty integrating cues within a social pattern and making coherent narratives. [ABSTRACT FROM AUTHOR]

Personality disorders (PD) are described as enduring patterns of markedly deviant and pervasive inner experiences and behaviors, with onset in adolescence, which lead to severe distress or impairment. Patients suffering from major depressive disorder (MDD) display higher rates of comorbidity with personality disorders, often complicating the treatment, and worsening the outcomes. Borderline personality disorder (BPD) is the most common of PD and is frequently associated with MDD, with which shares several features. The most part of research agrees on the fact that comorbid BPD in MDD patients quite doubles the poor response to treatments. Moreover, no treatment strategy stands out currently to emerge as more effective in these cases, thus urging the call for the need of new approaches. Herein, we revise the current literature on BPD, its neurobiology and comorbidity with MDD, as well as the more recent treatment strategies used. Then, based on its pharmacology, we propose a possible role of trazodone as a valuable tool to approach comorbid BPD-MDD. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to determine how the dream themes of borderline personality disorder patients differ from those of without borderline personality disorder diagnosis and the mediating role of rejection sensitivity in this differentiation process. Methods: The convenience sampling method was used in the study, and the participants were 79 female borderline patients diagnosed with semi-structured interviews with criteria of DSM-5 and 79 female individuals who had not received a psychological diagnosis before and at the study interviews. Sociodemographic Information Form, Dream Themes Scale, Borderline Personality Questionnaire, and Rejection Sensitivity Scale were used in the study. Linear Regression Analysis, Hierarchical Regression Analysis, and Independent Groups T-Test were used during the investigations. Results: Borderline personality disorder patients scored higher in all sub-dimensions of the dream themes scale and rejection sensitivity scale than the control group. Borderline personality traits predicted rejection sensitivity. Borderline personality traits and rejection sensitivity together predicted dream themes. Borderline personality predicts anxiety dreams, fear dreams, and experience dreams, and rejection sensitivity mediates these predictive relationships. Conclusions: The dreams of borderline personality disorder patients have negative content covered by the impact of experiences sub-dimension on dream themes, as they contain reflections of negative content in beliefs, thoughts and emotions related to their daily lives. Rejection sensitivity plays a mediator role in borderline patient's dreams. The study results show that it would be beneficial not to ignore the content of dreams in patients with borderline personality disorder, considering the relationship of negative dreams with daily functioning, dissociative symptoms, self-harming behaviors, and suicide attempts. Results also indicate that it might be beneficial to target rejection sensitivity to reduce aggravating dream contents. [ABSTRACT FROM AUTHOR]

In this study, we examined the risk of sexually transmitted infections (STIs) among adolescents and young adults (AYAs) with borderline personality disorder (BPD). A total of 4649 AYAs with BPD and 46,490 age-, sex-, and socioeconomic-matched controls without BPD were enrolled from the National Health Insurance Research Database of Taiwan from 2001 to 2009 and were followed up until the end of 2011. Participants who contracted any STI during the follow-up period were identified. Cox regression analysis was conducted to examine the risk of contracting any STI among both patients and controls. A total of 4649 AYAs with BPD and 46,490 age-, sex-, and socioeconomic-matched controls without BPD were enrolled from the National Health Insurance Research Database of Taiwan from 2001 to 2009 and were followed up until the end of 2011. Participants who contracted any STI (ICD-9-CM code 042, 091–097, 087.11, 078.8, 078.88, 131, and 054.1) during the follow-up period were identified. Cox regression and sub-analyses stratified by sex, age, psychiatric comorbidity subgroups, and psychotropic medication usage were conducted to assess STI risk. AYAs with BPD were at a higher risk of contracting any STI (hazard ratio [HR] = 50.79, 95% confidence interval [CI] = 33.45–77.11) in comparison with controls, including HIV, syphilis, genital warts, gonorrhea, chlamydia, trichomoniasis, and genital herpes. The association of BPD with an increased risk of any STI was prevalent in both sexes, adolescents, and young adult patients. BPD with or without psychiatric comorbid subgroup were all associated with an elevated risk of contracting any STI relative to the control group. AYAs with BPD are highly susceptible to contracting STIs. Future studies should examine the role of the core symptoms of BPD, sexual orientation, risky sex behaviors, depressive and anxiety symptoms, and substance use before sex in the risk of STIs among AYAs with BPD. [ABSTRACT FROM AUTHOR]