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Objectives: Dialectical behavior therapy (DBT) is an evidence-based treatment for people with emerging borderline personality disorder (BPD). In "real world" clinical settings, standard DBT is resource intensive. Emerging evidence suggests that group-based DBT skills training alone can lead to promising outcomes. This hybrid type 1 effectiveness-implementation trial directly compared the effectiveness of an 8-week group DBT-skills training program and a 16-week DBT-informed program including individual treatment and group-based skills training., Methods: This pragmatic trial employed a staggered, parallel-groups design. We recruited 104 participants, aged 16-25 years, with emotion dysregulation or emerging BPD symptoms. Participants were randomized to receive either program at a youth mental health service located in the Gold Coast, Australia. Data was collected via online surveys at baseline, 8-week, 16-week, and 24-week follow-up. Mixed effect linear models compared groups on the primary outcomes of emotion dysregulation and BPD symptoms, and secondary outcomes of suicidal ideation, coping skills, depression, anxiety, and stress., Results: Across groups there were significant and sustained improvements relating to emotion dysregulation, BPD symptoms, stress, depression, and emotion-focused coping; but not suicide risk, anxiety, or task-focused coping. There was no significant time by group differences between the 8-week and 16-week interventions on any primary or secondary outcome., Conclusion: The more intensive mode of delivering DBT was not more effective than the brief group-based skills training. Both interventions resulted in significant improvements across both primary and most secondary outcomes. These results have implications for clinical practice regarding length and intensity of DBT treatment in young people., (© 2024 The Author(s). Journal of Clinical Psychology published by Wiley Periodicals LLC.)

A significant number of borderline personality disorder (BPD) symptoms are manifested in the interpersonal context. This can be explained by the difficulties in attributing the mental states of oneself and others, which constitutes social cognition. Errors in social cognition are interrelated with the affective, cognitive, impulsive, and interpersonal areas of the person with BPD. The aims of this study was to analyze social cognition in women with BPD compared with a control group and to analyze social cognition in BPD based on BPD symptoms and its severity. To assess social cognition, we used a full range of social cognition categories provided by the Movie for the Assessment of Social Cognition (MASC): correct theory of mind (ToM); attribution of mental states (thoughts, emotions, or intentions); errors of mentalization; types of ToM; and attribution of mental states through perceptive or cognitive cues and through hot or cold emotions. The MASC has high ecological validity and has been validated in Spanish. The sample comprised 79 women, including 47 women with BPD and 32 healthy women. Worse social cognition performance was observed in women with BPD. More severe borderline symptoms were related to worse functioning in the correct ToM and to errors of no mentalization. Involvement of the cognitive area in borderline symptoms was associated with worse functioning in correct ToM and worse social cognition in cognitive areas as well as with hypermentalization. This is the first study that uses all the MASC categories and considers BPD heterogeneity and its severity to study social cognition., (© 2024 Wiley Periodicals LLC.)

Posttraumatic nightmares (PTN) are a frequent symptom after a traumatic event and often play part in the psychopathology of patients with borderline personality disorder (BPD). Imagery rehearsal therapy (IRT) currently offers the best evidence for an effective treatment to reduce PTNs, although high drop-out rates are common. Art therapy in IRT may counteract this, by its indirect, nonverbal, and often playful approach that helps to break through avoidance. This case study focusses on the perception of a patient with BPD in an art therapy based IRT treatment for patients with PTNs. It tells the story of Aurelia, a 40-year-old woman who, within this treatment, processes traumatic contents of her childhood like physical and sexual violence, but also current interactional problems that manifest themselves in her nightmares. Following the IR-AT treatment for PTNs Aurelia noticed a reduction in her nightmares, was less afraid of them and felt calmer towards her trauma. She expressed herself in the art medium and by this developed more self-efficacy. Her process resulted in an integration of the trauma and a perceived decrease in borderline symptoms. Future research can build on this basis to further explore the mechanisms and effects of IR-AT for PTNs., (© 2024 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Objective: Negative urgency (NU) and distress tolerance (DT) are two similar yet distinct constructs with putative transdiagnostic relevance, particularly across psychopathology characterized by impulsivity (e.g., substance use disorders [SUD], eating disorders featuring binging and/or purging ED-B/P, and borderline personality disorder [BPD]). Yet, there remains a lack of research into NU and DT across SUD, ED-B/P, and BPD symptomatology in clinical populations. The present study sought to elucidate the transdiagnostic utility of NU and DT across impulsive-type psychology by examining the unique and interactive roles of NU and DT across SUD, ED-B/P, and BPD symptomatology within a treatment-seeking sample of young people., Method: Participants (N = 385; 62.3% female; aged 16-25 years) were recruited from youth health services across Melbourne, Australia. Participants completed an online survey including self-report measures of NU and DT as well as SUD, ED-B/P, and BPD symptoms. Mixed effects logistic regression was used to explore unique and interactive associations of NU and DT with symptoms., Results: Both NU (adjusted odds ratio [OR adj ] = 1.22; 95% confidence interval [CI] = [1.16, 1.28]) and global DT (OR adj  = 0.59; 95% CI = [0.47, 0.74]) uniquely predicted symptoms. However, associations with global DT and most of its components differed across psychopathology types. No significant interactions between NU and DT in predicting symptoms were found., Conclusions: These results support the transdiagnostic utility of NU across SUD, ED-B/P, and BPD, while suggesting the role of DT across these disorders is more nuanced. These findings have important implications for NU and DT as potential intervention targets., (© 2023 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

ABSTRACT This article presents a case study of a 31‐year‐old woman with a dual diagnosis of Borderline Personality Disorder (BPD) and Eating Disorder Not Otherwise Specified (EDNOS). Paula received a 12‐month Dialectical Behavior Therapy (DBT) outpatient treatment. DBT is considered a transdiagnostic treatment approach to address emotion dysregulation, which shifts the therapy focus traditionally placed only on behavioral change toward including also validation and acceptance and dialectical strategies. DBT addresses eating symptomatology as a dysfunctional form of emotional regulation and has shown promising results regarding its efficacy for the treatment of BPD and EDNOS comorbidity. Given the growing evidence, a standard DBT treatment plan was developed for this case. Specifically, pretreatment and phase 1 of the DBT program are described. During pretreatment and phase 1, individual therapy aims to improve and maintain client's motivation to change and engage in treatment, as well as to establish and prioritize treatment goals. As for group therapy, the main goal of the skills training in DBT is to enhance individual's capability by increasing skillful behavior (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills). Paula received 24 weekly skills training sessions over a year. The results after a 12‐month standard DBT treatment showed that Paula no longer met criteria for BPD, she had a significant decrease in difficulties in emotional regulation and impulsiveness and in EDNOS symptomatology. This case study may enhance learning about how to apply a transdiagnostic treatment to address BPD and EDNOS together in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: The present review investigates the impact of digital interventions for individuals with features of borderline personality disorder (BPD)/emotional unstable personality disorder (EUPD) as digital interventions show promise as therapeutic tools in underserved groups. BPD/EUPD features are identified as clinically relevant, yet previous reviews on the use of digital interventions fail to include subthreshold symptomatology., Methods: Five online databases were searched for terminology in three categories: BPD/EUPD and related symptoms, mental-health interventions, and digital technology. Additionally, four relevant journals and two trial registers were searched for additional papers meeting the inclusion criteria., Results: Twelve articles met all inclusion criteria. Meta-analyses revealed statistically significant differences in symptom measures between intervention and control groups at postintervention and decreases in BPD/EUPD symptomatology and well-being from pre- to postintervention. Service users' engagement, satisfaction, and acceptability of interventions were high. Results support the previous literature on the value of using digital interventions in populations with BPD/EUPD., Conclusion: Overall, it was identified that digital interventions show promise for successful implementation with this population., (© 2023 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Background: Borderline personality disorder (BPD) is increasingly diagnosed in perinatal and infant settings, and research suggests that as well as an escalation of BPD symptoms in this period, these symptoms may also be detrimental to infant development. Providing tailored treatments during the postnatal period may help women and prevent an intergenerational cycle of emotional and interpersonal symptoms in infants. Mother-infant dialectical behavior therapy (MI-DBT) has produced promising, yet inconsistent, improvements on quantitative scales of maternal mental health and the mother-infant relationship. The qualitative evaluation may provide complementary information., Aims: This study aimed to explore the subjective experiences of women who had completed MI-DBT., Material and Methods: Thematic analysis of semistructured interviews conducted on 13 women undertaking MI-DBT before, post, and 12 months after MI-DBT were analyzed for themes., Results: Five major themes were identified. Overall, the women expressed that their emotional literacy and regulation improved after MI-DBT, subsequently addressing key risks and challenges such as uncertainty around their child's cues, and low self-esteem, and potentially improving the women's mentalization capability., Discussion and Conclusions: This study consolidates previous research on maternal BPD, and provides qualitative evidence of the benefits of MI-DBT for mothers as both individuals and as parents with likely flow-on effects for infants. Lived experience input for future adaptations was a valuable gain., (© 2022 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Objective: Mentalization-based therapy (MBT) is an evidence-supported, long-term psychotherapy program developed to treat borderline personality disorder (BPD). A short-term, 20-week adaptation to the original MBT format including case formulation, psychoeducation, and group and individual therapy has recently been proposed. The current case material will illustrate how the recent adaptation to the mentalization-based practice can enhance personality functioning using a short-term format., Methods: Case material is presented to demonstrate the clinical application of short-term MBT in the treatment of a young woman diagnosed with BPD who has a history of failed treatment attempts and who showed signs of affective dysregulation, unstable relationships, and intense abandonment anxiety., Results: The case illustration shows how short-term MBT can facilitate improvement in personality functioning, specifically targeting situations in which the patient lost her temper and became overwhelmed by abandonment anxiety. By continuously employing therapeutic shifts toward greater autonomy and agency, and by maintaining a balanced empathetic therapeutic stance, the therapists were able to enhance the patients mentalizing and personality functioning., Conclusions: Short-term MBT can be effectively implemented to enhance the mentalizing capacity and personality functioning in outpatients with BPD., (© 2022 Wiley Periodicals LLC.)

Objective: The current quantitative review aims at comprehensively clarifying the role of rumination in borderline personality disorder (BPD) considering its relevance for several clinical models of the disorder., Method: This meta-analysis included 29 independent studies assessing different forms of rumination-general tendency to engage in ruminative thinking patterns and four types of emotion-based rumination among both nonclinical subjects reporting BPD features and patients with BPD. Furthermore, the study tested whether rumination could be considered a widespread emotion-based cognitive vulnerability in BPD., Results: Meta-analytic procedures were based on 46 r coefficients that showed large pooled effect sizes for all forms of rumination. With the exception of interpersonal rumination, the remaining forms of rumination were equally involved in BPD features., Conclusions: Rumination should be considered a widespread emotion-based cognitive vulnerability in BPD. Future studies should provide longitudinal and contextual-based evaluations of rumination among treatment-seeking individuals with BPD., (© 2021 Wiley Periodicals LLC.)

Background: Attachment theory has served as an influential framework for understanding psychopathology, partly due to reliable assessment methodology. The influence of insecure attachment on attitudes toward the body and the impact this might have for the development of psychopathology is however less well elucidated., Method: A total of 123 adolescents (35 with borderline personality disorder or BPD, 25 with other personality disorders [OPD] and 63 comprising a normative control group) were interviewed with the Adult Attachment Interview (AAI) and the Mirror Interview (MI). The MI questions respondents about how they feel about their bodies, as they look in the mirror., Results: The AAIs from the Borderline group were predominantly insecure-preoccupied and unresolved. These adolescents had significantly lower levels of a positive and integrated sense of self and body than the other groups. Regression results revealed a high loving relationship with fathers, low involving anger with father, high coherence of mind, slight derogation of mother & low levels of unresolved loss uniquely and additively predicted 55% of variance in the summary score assigned to MI responses, that is, the summary score for a Positive and Integrated Body Representation (PIBR)., Conclusion: Unfavorable attachment experiences and current states of mind regarding attachment may give rise to problems with establishing PIBRs, and thus play a role in the development of psychopathology, especially BPD., (© 2024 The Author(s). Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Background: Despite the pervasiveness of patient-reported emptiness and the high burden it carries, emptiness is poorly understood. In the current study, we used a general inductive approach to examine experiences with emptiness in a diagnostically diverse sample of treatment-seeking patients with severe and acute psychopathology. As a secondary aim, we also examined whether identified themes differed among patients with a primary diagnosis of borderline personality disorder or major depressive disorder., Method: Participants (n = 150) ranged from 18 to 69 years old (M = 33.15, SD = 12.41; 79.3% non-Hispanic White; 57.3% females). All patients completed the borderline personality disorder module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Personality Disorders and the Mini International Neuropsychiatric Interview. Interviewers documented patients' responses to follow-up questions. Patients were included in the study if they endorsed chronic feelings of emptiness and elaborations were documented., Results: We identified 10 themes associated with patient-reported emptiness: (1) purposeless, (2) lack of connection, (3) numbness, (4) self-deprecation, (5) lack of identity, (6) lack of motivation, (7) hopelessness, (8) lack of pleasure, (9) physical sensation, and (10) dissociation. Themes were consistent across diagnostic status, with one exception: patients with borderline personality disorder were more likely to report that emptiness was associated with dissociation relative to patients with major depressive disorder., Conclusion: Our results suggest that emptiness may reflect a multifaceted and transdiagnostic construct. Identified themes may help to support the assessment of emptiness and can be used to guide individualized treatments., (© 2024 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Objectives: This study aimed to understand therapists' lived experiences of delivering mentalisation-based therapy (MBT), including their experiences of service user change., Method: One-to-one semi-structured interviews or focus groups were conducted with 14 MBT therapists and analysed using interpretative phenomenological analysis (IPA)., Results: Four superordinate themes were identified: (1) experiencing the challenges and complexities of being with service users during MBT; (2) being on a journey of discovery and change; (3) being an MBT therapist: a new way of working and developing a new therapeutic identity; and (4) being a therapist in the group: seeing it all come together., Conclusion: Our findings highlight the complexity, challenges and individualised experience of working therapeutically with service users with a diagnosis of BPD. The study provides a perspective of service use change that is enriched by idiosyncrasies within the therapeutic encounter. We conclude with a consideration of implications for MBT research and clinical practice., (© 2021 Wiley Periodicals LLC.)

Background: Problematic interpersonal patterns, as defined by the core conflictual relationship theme (CCRT) method, are part of the clinical presentation of clients with borderline personality disorder (BPD). So far, we do not know whether the pervasiveness of interpersonal patterns changes and if this change explains therapy outcome., Methods: In a secondary analysis of a randomized controlled trial on a brief version of psychiatric treatment for BPD, a treatment with a psychodynamic focus, the present study included N = 39 clients. One early session and one late session of the treatment were transcribed and analyzed using the CCRT method., Results: It appeared that pervasiveness of the predominant CCRT decreased over the course of the brief treatment; this effect was robust across treatment conditions. Change in pervasiveness in any CCRT component explained a small portion of variance of the decrease in borderline symptoms observed at the end of treatment., Discussion: Lessening of pervasiveness of problematic in-session interpersonal patterns may be hypothesized as potential mechanism of effective treatment for BPD which should be tested in controlled designs., (© 2021 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Objectives: Cognitive processes, such as schema modes and cognitive distortions, may play a role in the genesis and maintenance of affective, interpersonal, and behavioral difficulties in individuals with Borderline Personality Disorder (BPD). This study aimed at exploring the schema modes and cognitive distortions in individuals with BPD., Methods: Using a mixed-method approach, 30 individuals with BPD and 30 healthy participants were assessed on the Borderline Personality Questionnaire, the Schema Mode Inventory, the Cognitive Distortions Scale, and a semi-structured interview schedule., Results: The BPD group had higher scores than the control group on all the maladaptive schema modes and cognitive distortions subscales. The child modes were the commonest and were also the strongest correlate of BPD symptomatology. Qualitative analysis of the content of the semi-structured interview also corroborated these findings., Conclusions: There could be many schema modes and cognitive distortions operating behind the diverse psychopathology seen in BPD., (© 2021 Wiley Periodicals LLC.)

Objective: Impulsivity impacts life domains and in a psychiatric context is often associated with disorders severity and stigmatization. Borderline personality disorder's (BPD), Schizophrenic disorder's (SZD), and obsessional compulsive disorder's (OCD) impulsivity issues relate to worse prognosis. This study aims to compare these disorders assessing their proneness to impulsivity and urgency., Methods: We recruited 90 patients among them OCD (n = 25), SZD (n = 23), and BPD (n = 50), and 24 healthy control participants (HC). We assessed the diagnosis according and measured the impulsivity level., Results: Our results showed that BPD was significantly more impulsive than HC, SZD, and OCD. HC, SZD, and OCD being equivalent on their global Urgency-Premeditation-Perseverance-Sensation seeking scores. For urgency, BPD was also superior to others, OCD was superior to HC, but SZD and HC were equivalent. The urgency was correlated to SZD's scale for SZD, no link appeared between borderline personality questionnaire and Yale-Brown Obsessive-Compulsive Scale's score., Conclusion: These results question the existent literature relating impulsivity and SZD., (© 2021 Wiley Periodicals LLC.)

Objective: This study evaluated the effectiveness of the Dialectical Behavior Therapy Skills Training Group (DBT-ST) component of DBT., Method: Participants (N = 114) attended an 18-20-week DBT-ST. The study utilized a quasi-experimental design with a within-persons control group for a measure of borderline personality disorder (BPD) symptoms (at referral), and emergency department (ED) presentations, and psychiatric bed-days (both assessed for 6 months pre- and post-intervention). Primary outcomes were the number of BPD symptoms, psychological distress, depression, rate of ED presentations, and psychiatric inpatient bed-days., Results: After completing DBT-ST, participants had reduced BPD symptoms, psychological distress, and depression (p < 0.001). The waitlist control group showed no improvement in BPD symptoms (p = 0.085). The rate of ED presentations was reduced (p = 0.001). There was no reduction in psychiatric inpatient bed-days (p = 0.160), likely due to insufficient power., Conclusions: DBT-ST participation in addition to treatment-as-usual is an effective treatment for people with BPD., (© 2021 Wiley Periodicals LLC.)

Objectives: The aim of the present study was to investigate whether patients with borderline personality disorder (BPD) show lower self-compassion and self-esteem than healthy controls and whether patients' self-compassion and self-esteem moderate the association between childhood trauma and the severity of their BPD symptoms., Method: Self-reported self-compassion, self-esteem, and the current severity of BPD symptoms were assessed in 35 female patients with BPD and 35 age-matched control participants. Further, traumatic childhood experiences were recorded in the patient group., Results: Patients with BPD reported significantly lower self-compassion and self-esteem compared to healthy controls. In addition, self-compassion but not self-esteem moderated the positive correlation between childhood trauma and the severity of BPD symptoms., Discussion: Self-compassion appears to buffer the negative consequences of childhood traumatization. Therefore, cultivating self-compassion may be an important therapeutic aim for patients with BPD., (© 2020 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Objective: This study investigated the co-occurrence of borderline personality disorder (BPD), attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) features in elementary-aged youth., Method: Latent profile analysis characterized subgroups of youth based on the presence of BPD, ADHD, and ODD features, and subgroups were compared on academic, social, and emotional impairment., Results: Seven subgroups were identified, including subgroups with slight, subclinical, clinical, and severe levels of co-occurring BPD, ADHD, and ODD features, and a subgroup of youth with no elevations in these symptom domains. Subgroups of youth with only clinical elevations in ADHD and only clinical levels in BPD features were also identified. Groups differed on level and type of impairment., Conclusion: Youth with ADHD and ODD represent a high-risk group likely to also show early prodromal clinical elevations in BPD. Future work is needed to examine the longitudinal outcomes of these subgroups to inform prevention and treatment., (© 2020 Wiley Periodicals LLC.)

Objective(s): Interpersonal problems are one of the most persistent difficulties facing those with personality disorders (PDs) and are linked with dysfunction across numerous social domains. Using an interpersonal model of PDs, we examined the indirect effects of Avoidant PD (AvPD) symptoms and social dysfunction through interpersonal problems, as well as Borderline PD (BPD) symptoms and social dysfunction., Methods: Participants were 226 adults taking part in an outpatient treatment program., Results: Using cross-sectional data from self-reported measures, we found that cold (b = 0.10, 95% confidence interval (CI) [0.038, 0.176]) and overly nurturant (b = 0.04, 95% CI [0.001, 0.090]) interpersonal problems showed an indirect association between AvPD symptoms and social dysfunction. The only significant indirect association between BPD symptoms and social dysfunction was overly nurturant (b = 0.05, 95% CI [0.001, 0.120])., Conclusions: Results may aid in the development of more individualized treatments for AvPD and BPD symptoms., (© 2020 Wiley Periodicals LLC.)

Objective: The current study used network analysis to explore associations between specific groupings of borderline personality disorder (BPD) and eating disorder (ED) symptoms, and other transdiagnostic variables including insecure attachment, rejection sensitivity, emotion dysregulation, a theory of mind, and emotion recognition., Method: Network analysis was undertaken on self-report data from 753 adults (81.5% women), of whom 109 reported a lifetime ED diagnosis., Results: Comorbidity between BPD and ED symptoms was only partially conceptualized through the transdiagnostic variables. The centrality indices from the network analysis indicated that emotion dysregulation and abandonment were the most central elements in the network. Conversely, the theory of mind and emotion recognition had very few connections with the other transdiagnostic variables in the network., Discussion: The findings provide empirical insight into the nature of the observed co-occurrence between BPD and ED symptoms and serve to improve clinical decision-making regarding psychological interventions for both problem sets., (© 2020 Wiley Periodicals, Inc.)

ABSTRACT In this case study we present the course of the psychotherapy of Myriam, a 19‐year old female with a severe personality disorder and comorbid eating disorder. During the initial assessment she reported high levels of neuroticism that parallel the diagnosis of obsessive‐compulsive personality disorder, borderline personality disorder, and anorexia nervosa. Myriam showed a severely impaired personality functioning defined by perfectionism, self‐criticism, interpersonal guilt and overcontrol. Her daily experience was shaped by a self‐recriminative inner dialogue associated with maladaptive patterns in the form of food, water and sleep restrictions, self‐harm behaviors, and suicidal ideation. She accessed an integrative treatment based on individual (Evolutionary Systems Therapy) and group psychotherapy (Mindful Compassion for Perfectionism). At the end of 14‐month intervention she remitted from all the categorical diagnoses and showed reliable changes in several measures. These outcomes were maintained at 3‐month follow‐up. We describe the integrative conceptualization based on Myriam's perfectionistic self‐recrimination patterns, and the consequent treatment that targeted these patterns rather than focusing on symptom reduction exclusively. [ABSTRACT FROM AUTHOR]

Objective: We tested whether negative interpersonal events (NIEs) precipitate rumination at times of distress in the daily lives of those with borderline personality disorder (BPD) features and whether such responses mediate associations between BPD and the reactivity and recovery components of emotion dysregulation., Materials and Method: One hundred twenty-one women completed clinical interviews, survey measures, and a 7-day ecological momentary assessment., Results: Elevated BPD features predicted ruminative response deployment only in the context of NIEs. Though elevated BPD features and NIEs predicted heightened distress reactivity, the indirect effect of BPD on distress reactivity via ruminative responses was conditional on NIE occurrence. Ruminative responses also mediated the conditional effects of BPD features on prolonged recovery from distress; trait rumination served as a second indirect pathway between BPD features and distress recovery., Conclusion: Results suggest that though contextual, rumination is a common pathway for emotional hyperarousal and slow recovery from distress for those with elevated BPD features., (© 2019 Wiley Periodicals, Inc.)

Objective: The development of a constructive therapeutic alliance may represent an important feature of interpersonal adaptation in clients with Borderline Personality Disorder (BPD). The present study explores cognitive heuristics as dynamic features of change in relationship with the therapeutic alliance in the treatment of BPD., Method: In total, N = 60 clients with BPD, are included in the present study. In the context of brief therapy, the therapeutic alliance (WAI) is assessed from the client and the therapist perspectives after each therapy session; cognitive heuristics are assessed three times (CERS). The data analyses are on the basis of non-parametric clusters (kml3d) linked with the therapeutic alliance., Results: The results showed that clusters of cognitive heuristics trajectories are linked with the client's therapeutic alliance (t(55) = 2.30, p = .03), but they remained unrelated with the evolution of the therapist's alliance., Conclusions: These results are discussed with regard to the interpersonal adaptiveness of cognitive heuristics in the context of BPD undergoing treatment., (© 2019 Wiley Periodicals, Inc.)

Objective: Distress tolerance is an important but understudied construct for those with schizophrenia‐spectrum disorders. This study compared levels of distress tolerance between people diagnosed with schizophrenia and borderline personality disorder (BPD) to better characterize distress tolerance in schizophrenia‐spectrum disorders. Method: Using cross‐sectional data, we examined group differences in distress tolerance in people with schizophrenia‐spectrum disorders (n = 55) and BPD (n = 32) through mean comparison and equivalence analyses. Results: Our results indicate that, in our data, distress tolerance did not differ between those with schizophrenia and those with BPD, and was in fact statistically equivalent between groups. In contrast, those with BPD tended to report more difficulty on some aspects of emotion regulation. Conclusion: Findings from this study suggest that increased focus on distress tolerance is called for in research on schizophrenia. Furthermore, people with schizophrenia‐spectrum disorders may benefit from interventions targeting distress tolerance. [ABSTRACT FROM AUTHOR]

Objectives: Substance use disorders and borderline personality disorders (BPD) often co-occur and may be concurrently treated by Dialectical Behavior Therapy (DBT). However, there is limited information on how drug use and suicidal ideation may interact in the daily lives of individuals receiving DBT treatment., Methods: This study examined the DBT diary cards of 47 individuals in a community mental health center's partial hospital and intensive outpatient program. Multilevel modeling techniques were used to examine the moderating effects of BPD symptom severity on the relationship between same day, 1-, 2-, and 3-day lagged drug use and suicidal ideation., Results: Results indicated a significant relationship between same-day, 1-day lagged, 2-day lagged drug use and suicidal ideation. BPD was a moderator for the relationship between 1-day lagged drug use and suicidal ideation., Conclusion: Limitations of the study include the measure for BPD symptom severity was only collected pretreatment and the results are likely limited to the effects of cannabis use on suicidal ideation. Clinicians may need to consider the prolonged effects of drug use on suicidal ideation when conducting chain analyses on suicidal behaviors., (© 2023 Wiley Periodicals LLC.)

Objective: To examine pathways to borderline personality disorder (BPD), focusing on childhood abuse and emotional attention and clarity., Method: Among 293 community residents (mean age = 43.1; 53.9% female), measured associations between the BPD symptom factors of disturbed relatedness, affective dysregulation, and behavioral dysregulation and (a) childhood abuse (emotional, physical, and sexual); (b) emotional attention and clarity; and (c) negative affect, using structured interviews, the Schedule for Non-Adaptive and Adaptive Personality-2, the Trait Meta Mood Scale, and the Positive and Negative Affect Scale, respectively., Results: All forms of childhood abuse were associated with BPD symptom factors. Emotional attention and clarity moderated the effects of childhood physical and emotional abuse on behavioral dysregulation and disturbed relatedness. All results held when controlling for negative affect., Conclusion: The relations between childhood abuse and BPD are robust. Emotional attention and clarity may help elucidate the links between childhood abuse and BPD., (© 2016 Wiley Periodicals, Inc.)

Objective: We examined the relationship between mindfulness skills acquisition and symptom reduction. Method: Participants were adults (n = 35) with a diagnosis of borderline personality disorder (BPD) who completed a 20‐week dialectical behaviour therapy (DBT) skills training group program in a community mental health setting. We used the Five Facet Mindfulness Questionnaire, which measures five dimensions of mindfulness: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience. Results: Linear mixed model results suggested that increases in some mindfulness facets, especially in acting with awareness and nonjudging of inner experience were more strongly related to changes during treatment including reductions in BPD symptomology, depression, and distress with increases in nonjudging also predicting a reduction in the hospital use. Conclusions: These results suggest the usefulness of emphasising mindfulness skills that develop awareness and encourage a nonjudgmental stance. [ABSTRACT FROM AUTHOR]

Objective: The present study investigated the effectiveness of dialectical behavioral therapy (DBT) and the effect of improvement in DBT skills on clinical outcomes., Method: Participants included 57 adults who attended a community mental health service and underwent one of two modes of DBT. Twenty-six adults had been diagnosed with borderline personality disorder (BPD) and participated in comprehensive DBT (DBT-C; including group skills training, individual therapy, and phone coaching). Thirty-one adults had BPD traits and participated in DBT skills training (DBT-S; group skills training only). In the present study, the DBT skills examined were mindfulness, emotion regulation, and interpersonal effectiveness; the clinical outcomes examined were borderline symptoms, psychological distress, and quality of life., Results: Six 2 × 2 analysis of covariances indicated significant improvements in psychological distress, quality of life, mindfulness, and interpersonal effectiveness (but not borderline symptoms and emotion regulation), over a 6-month period. Mode of delivery of DBT did not impact on the improvement in DBT skills and clinical outcomes over the 6-month period. Hierarchical multiple regression results indicated that improvement in DBT skills (mindfulness, emotion regulation, and interpersonal effectiveness) were associated with reductions in borderline symptoms and psychological distress, with emotion regulation the only skill uniquely associated with improvements in clinical outcomes., Conclusions: The results of the present study support the effectiveness of DBT and the specific role of emotion regulation for favorable clinical outcomes over a 6-month period, independent of the mode of delivery of DBT., (© 2022 Wiley Periodicals LLC.)

Individuals diagnosed with Complex PTSD (C‐PTSD) have experienced repeated and often prolonged traumatic events. From a therapeutic perspective this can lead to difficulties in emotion regulation within‐session, challenges with patient‐therapist attunement, and impaired coregulation of emotions during therapeutic interactions. As a result, frequent therapeutic alliance ruptures can emerge, which in turn pose challenges for symptom‐focused work. We describe a case study involving a 38‐year‐old woman presenting with C‐PTSD, dissociation, anxiety and borderline and dependent personality disorder traits. We explore how difficulties in attunement and emotion regulation during therapy were mostly attributable to (i) maladaptive ideas regarding the self and others; and (ii) difficulties in recognizing both her own mental states and those of her therapist. For instance, the patient believed that the therapist was distant and critical; which she held to be fact rather than reflective of a mental state. We show how the therapist addressed these difficulties, incorporating repair of the therapeutic alliance, which enabled a return to symptom focused work. The case description offers guidance on how to maintain a dual focus on therapeutic alliance alongside symptoms when treating C‐PTSD (with or without comorbidity). [ABSTRACT FROM AUTHOR]

Objective(s): For a case of severe perfectionism, comorbid with complex trauma symptomatology including suicidality, self-harming, and other markers of borderline personality, we demonstrate the use of the empirically confirmed process identified in memory reconsolidation (MR) research for the unlearning and nullification, or "erasure," of emotional and behavioral responses driven by learned expectations and mental models. MR has been proposed as a transtheoretical, unifying mechanism underlying profound psychotherapeutic change. The therapist (first author), under the second author's supervision, used a varied set of clinical skills woven together through a focus on the MR process., Results: The result was a depotentiation of underlying, traumatic emotional learnings and near-total disappearance of perfectionistic and self-harming behaviors, urges and attitudes after 1 year of therapy., Conclusions: Implications of this case are discussed in terms of symptom generation by implicit emotional learnings and MR as a promising framework for advancing the effectiveness and unification of psychotherapy., (© 2020 Wiley Periodicals LLC.)

Objective: Extant literature has documented a significant relationship between borderline symptoms and substance use disorders. As supported in past work, there is a significant theoretical relationship between borderline symptoms and compulsive sexual behaviors because both disorders share common underlying behaviors and traits. There is no known research that has examined the empirical relationship between borderline symptoms and compulsive sexual behaviors in a population with substance use disorders. To fill this important gap in the literature, this relationship was examined in the current study., Method: Medical records from 120 women admitted to a private, residential treatment program for substance use disorders were reviewed for the current study., Results: Hierarchical multiple regression analysis demonstrated that borderline symptoms were significantly associated with compulsive sexual behaviors after controlling for alcohol use and problems, drug use and problems, age, and positive impression management., Conclusion: Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between symptoms and compulsive sexual behaviors., (© 2016 Wiley Periodicals, Inc.)

Objectives: Some researchers suggest that borderline personality disorder (BPD) is characterized by elevated negative emotion; others argue that BPD involves both reduced positive and increased negative emotion. This study characterizes the emotional experiences of individuals with BPD symptoms in a combined university and community sample., Method: Participants (N = 150) completed a clinical interview assessing BPD symptoms and self-report measures of positive and negative emotion. A subset (n = 106) completed a measure of emotion daily for 2 weeks. Pearson's correlations and multilevel modeling were used to examine the cross-sectional and longitudinal relationships between BPD symptoms and emotions., Results: BPD symptoms were robustly related to increased negative emotion; this relationship remained after accounting for positive emotion. BPD symptoms were weakly related to decreased positive emotion; this relationship was no longer significant after accounting for negative emotion. BPD symptoms predicted higher levels of negative and not positive emotion over 14 days. These patterns held for subscales assessing intensity, frequency, and duration of negative and positive emotions., Conclusion: Findings suggest that individuals with BPD features are chiefly distinguished by elevated negative emotional experience., (© 2016 Wiley Periodicals, Inc.)

Objective: As part of a larger study investigating biological risk factors for bipolar disorder (BD) and borderline personality disorder (BPD), we investigated the prevalence of psychiatric diagnoses presented by young BD or BPD offspring. With respect to the scarcity of studies interested in psychiatric disorders among BPD offspring, we have chosen to report these results despite the small sample size for a prevalence study. Method: We recruited 21 BD and 22 BPD offspring and 23 control subjects. All subjects were assessed with a structured interview. Results: Our main finding suggests that BPD offspring present a higher rate of psychiatric disorders compared to BD offspring. Attention deficit and hyperactivity disorder was the most prevalent disorder. Conclusion: Our results contribute to the evidence that offspring of patients with BPD, are at high risk with regard to their mental health and deserve both more research and special attention at the clinical level. [ABSTRACT FROM AUTHOR]

Individuals diagnosed with Complex PTSD (C-PTSD) have experienced repeated and often prolonged traumatic events. From a therapeutic perspective this can lead to difficulties in emotion regulation within-session, challenges with patient-therapist attunement, and impaired coregulation of emotions during therapeutic interactions. As a result, frequent therapeutic alliance ruptures can emerge, which in turn pose challenges for symptom-focused work. We describe a case study involving a 38-year-old woman presenting with C-PTSD, dissociation, anxiety and borderline and dependent personality disorder traits. We explore how difficulties in attunement and emotion regulation during therapy were mostly attributable to (i) maladaptive ideas regarding the self and others; and (ii) difficulties in recognizing both her own mental states and those of her therapist. For instance, the patient believed that the therapist was distant and critical; which she held to be fact rather than reflective of a mental state. We show how the therapist addressed these difficulties, incorporating repair of the therapeutic alliance, which enabled a return to symptom focused work. The case description offers guidance on how to maintain a dual focus on therapeutic alliance alongside symptoms when treating C-PTSD (with or without comorbidity)., (© 2024 Wiley Periodicals LLC.)

Borderline personality disorder (BPD) has a reputation as a clinical challenge. However, although BPD presents difficulties in acute phases, most patients recover over time, and most will respond to psychotherapy. Even so, BPD patients, even in remission, can suffer from residual dysfunction in work and relationships. These problems can benefit from further treatment, using a model in which patients retain access to treatment but are seen intermittently. This article describes a stepped care model for treatment and rehabilitation in the chronic phases of the disorder., (© 2015 Wiley Periodicals, Inc.)

Although borderline personality disorder (BPD) usually has its onset in young people, its diagnosis and treatment is often delayed. The past 2 decades have seen a rapid increase in evidence establishing that BPD can be diagnosed before 18 years of age and that BPD in young people is both continuous with BPD in adults and more notable for its similarities than for any differences. This knowledge has led to the first wave of controlled treatment trials, which have established that early intervention through appropriate BPD diagnosis and treatment leads to clinically meaningful improvements for patients. However, there is still much work to do in terms of treatment development and innovation and overcoming challenges to successful translation of evidence into practice. To advance early intervention for BPD, access to evidence-based treatments needs to improve, the variety of available treatments (including novel pharmacotherapies) needs to increase, treatments need to be matched to individual development and to the phase and stage of disorder, and workforce development strategies need to update knowledge, culture, and practice in relation to BPD in young people., (© 2015 Wiley Periodicals, Inc.)

Understanding and processing life experiences are essential in the treatment of personality disorders to promote personal recovery and psychological wellbeing. In this qualitative case report, drafted in co-creation between the client, clinical psychologist, and art therapist, individual treatment consisted of two psychotherapeutic interventions, "An Empowering Story" and life-story-focused art therapy, in 12 parallel sessions for 24 weeks. Hilda, 68 years of age, had been diagnosed with an unspecified personality disorder and various traits of borderline personality disorder. She experienced emotional exhaustion following long-term mental health problems rooted in a traumatic early childhood. This affected her ability to manage her emotions and social relations, resulting in the sense that her life had no meaning. Hilda was invited to reconstruct her life experiences, divided into the past, turning point, and present/future, in a written and a painted life story. This allowed for the integration of traumatic as well as positive memories, enhanced self-compassion, and meaning making. She developed self-reflection and integration of internal conflicts leading to a better emotional balance and self-understanding. Art therapy emphasizes bottom-up regulatory processes, while narrative psychology supports top-down regulatory processes. The combined approach effectively integrated bottom-up, experiential, sensory experiences with top-down, cognitive emotion-regulation processes. The results suggest that psychotherapeutic interventions involving a multi-pronged, complementary, and thus more holistic approach can support personal recovery in personality disorders., (© 2024 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Borderline personality disorder (BPD) is a severe, highly prevalent mental disorder. Effective psychological treatments for BPD are available. However, most patients do not receive evidence-based treatments partly because of high treatment delivery costs and lack of specialized therapists. By integrating specialized e-health tools into BPD-specific treatments, treatment intensity can be increased, frequency of face-to-face sessions and burden for psychotherapists can be reduced, and implementation of new skills and experiences in the everyday life of these patients can be promoted. This bears great potential to increase the availability of evidenced-based psychotherapy for BPD patients and close the gap between demand and supply. In this article we present such an innovative e-health tool, priovi, which has been developed for schema therapy. The concept and application of priovi are described and illustrated with a case example., (© 2015 Wiley Periodicals, Inc.)

General psychiatric management for patients with borderline personality disorder was devised to be an outpatient intervention that could be readily learned and easily delivered by independent community mental health professionals. To disseminate the approach, Drs. Gunderson and Links developed the Handbook of Good Psychiatric Management for Borderline Personality Disorder (Gunderson & Links, ) that presented the basics of the approach, videos to illustrate the appropriate clinical skills, and case examples to practice adherence to the approach. Unfortunately, the inclusion of "psychiatric" in the treatment's name may discourage psychologists and other mental health professionals from using this therapy. In this article, we review the basic principles and approaches related to general psychiatric management. With a case example, we illustrate how psychologists can use all the general psychiatric management principles for their patients with BPD, except medications and, as a result, provide and deliver this approach effectively., (© 2015 Wiley Periodicals, Inc.)

There is a high rate of comorbidity between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD; Pagura et al., 2010). Preliminary studies have evaluated the treatment of PTSD in a BPD population and found positive outcomes for the integration of dialectical behavior therapy (DBT) and prolonged exposure (PE). This case study illustrates the implementation of a PE protocol into standard DBT treatment, specifically focusing on the management of self-harm and severe dissociation for a client with co-occurring PTSD and BPD. The client entered into treatment with severe and persistent dissociation and a recent history of self-harm, and the case includes consideration of two separate pauses in PTSD treatment related to elevated dissociation and self-harm behaviors. The client successfully completed the DBT PE protocol and results indicate significant improvements in PTSD symptoms as well as outcomes related to self-harm and dissociation. These findings demonstrate the efficacy of combining DBT with PE for clients with comorbid BPD and PTSD and exemplify how complex clients with BPD who present with severe dissociation and self-harm behavior can safely and successfully receive treatment for PTSD., (© 2015 Wiley Periodicals, Inc.)

Objective: This study examined whether a history of childhood abuse (CA) strengthened the association between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) in the aftermath of intimate partner violence (IPV). This hypothesis arises from clinical literature but has not been examined empirically. We predicted that a history of CA would enhance associations between BPD features and PTSD symptoms., Method: Dimensional assessment of both PTSD and BPD was made in a sample of 211 women who sought mental health services following IPV. Two analyses were conducted using clinician-assessed DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) PTSD symptoms: (a) total score and (b) symptom clusters., Results: Using path analysis, results indicated significant associations between BPD features and PTSD symptoms, but no significant interaction between BPD and CA in either analysis., Conclusions: Results are discussed given current understanding of comorbidities involving PTSD, with particular attention to potential implications for clinical practice. Areas for future research are proposed., (© 2019 Wiley Periodicals, Inc.)

Background: Dialectical behavior therapy (DBT) is an effective approach to decreasing suicidal behaviors; the adapted, family-based model for adolescents (through 18 years old; DBT-A) also demonstrates efficacy. Data on higher dropout rates based on age, initial research on DBT with young adults in the community, and the theory that underlies DBT suggest that adaptations may also be appropriate for young adults. This study examines the effectiveness of DBT-A, presents preliminary data on delivering DBT-A to young adults (ages 18-26), and compares clinical characteristics, service utilization, and outcomes to adolescent clients (ages 13-17) to guide clinical considerations and future research on implementing DBT-A., Methods: Data were collected from a DBT-A clinic and included results from semi-structured diagnostic interviews, chart review, and scores on self-report measures. The Suicide Ideation Questionnaire and Beck Depression Inventory (BDI), given at program entry, after completion of one rotation through the skills modules, and at graduation, were used to evaluate outcomes. Outcomes were benchmarked against prior DBT-A trials. Adolescents' and young adults' clinical characteristics, service utilization, and outcomes were compared., Results: The effect size observed was smaller than in efficacy trials. Few differences were observed between teens (n = 87) and young adults (n = 45). Young adults were more likely to have participated in intensive services before DBT-A. They participated in fewer family sessions and graduated in fewer months compared to teens., Conclusion: This study supports the use of the family-based model of DBT for suicidal teens and young adults although future research is needed to improve the effectiveness of this model when implemented in real-world settings., (© 2022 Wiley Periodicals LLC.)

Background: The aim of this study was to investigate the relationship between patients' mentalizing problematics and their personality; specifically, it aimed to identify clusters of individuals characterized by specific patterns of mentalizing imbalances and to analyze the relationship between these and diagnosis of personality disorder (PD), nonmentalizing modes, emotion dysregulation, and interpersonal reactivity., Methods: Four hundred therapeutic dyads were recruited. A part of these (n = 183) only completed clinician-report measures, Mentalization Imbalances Scale, and Modes of Mentalization Scale, while others (n = 217) also completed patients' self-report measures, which were Reflective Functioning Questionnaire, Difficulties in Emotion Regulation Scale, and Interpersonal Reactivity Index., Results: A latent profile analysis enlightened the presence of four clusters with problematics in the dimensions of mentalization, indicated by cluster names: (1) Affective-self-automatic profile (ASA-P) (with higher percentage of PDs); (2) External profile (E-P) (with lower percentage of PDs); (3) Others-automatic-affective profile (OAA-P); (4) Cognitive-self-automatic profile (CSA-P). Multivariate analysis of variances confirmed that the four clusters differed in relation to the quality of mentalization, emotional dysregulation and interpersonal reactivity, with higher levels of nonmentalization modes, uncertainty about mental states and emotion dysregulation in ASA-P, higher levels of good mentalization in E-P, lower impulsivity in CSA-P, and greater empathic concern in OAA-P., (© 2022 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Background: A common aspect of evidence-based treatments for people with borderline personality disorder (BPD) is pedagogical interventions and formats. In mentalization-based treatment (MBT) the introductory course has a clear pedagogical format, but a pedagogical stance is not otherwise defined., Methods: Treatment integrity was quantitatively assessed in a sample of 346 individual MBT sessions. Nine group sessions and 24 individual MBT sessions were qualitatively subjected to interpretative phenomenological analysis (IPA)., Results: The dominating intervention type was MBT Item 16-therapist checking own understanding (31% of the interventions). IPA unveiled the following: (1) a pervasive, but hidden/implicit psychopedagogical agenda, (2) psychopedagogical content seemed precious for the patients, and (3) four tentative strategies for pedagogical interventions in MBT (a) independent reasoning; (b) epistemic trust; (c) mental flexibility; and (d) application of verified insights, knowledge, or strategies., Conclusion: Development and clarification of the pedagogical stance in MBT could further improve the quality of therapists' interventions., (© 2022 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Objective: Complex post‐traumatic stress disorder (CPTSD) is a classification within the International Classification of Diseases, 11th Revision (ICD‐11) that, besides the DSM‐5 symptom clusters of post‐post‐traumatic stress disorder (PTSD), includes the presence of negative self‐concept, difficulties in regulating emotions and relationship skills. The purpose of the present study was to provide guidance on how to deliver Eye Movement Desensitization and Reprocessing (EMDR) therapy in the context of CPTSD, based on current clinical knowledge and the latest scientific research findings. Method: This paper describes the treatment of a 52‐year‐old woman with CPTSD and borderline personality disorder for which immediate trauma‐focused EMDR therapy was used. Results: First, a description of what EMDR therapy entails and some important treatment strategies that the therapist may employ to assist in trauma‐focused treatment of clients with CPTSD using EMDR therapy are outlined. Conclusion: The treatment results are in line with mounting evidence supporting the notion that EMDR therapy is a safe and potentially effective treatment alternative for individuals with CPTSD or personality problems. [ABSTRACT FROM AUTHOR]

Objectives: The current preliminary study investigated whether deficits in mindfulness (awareness, attentiveness, and acceptance of the present experience) may underlie the relationship of borderline personality disorder (BPD) features to self-injury and overall acts of harmful dysregulated behavior., Method: Nonparametric bootstrapping procedures were used to examine theoretical relationships among variables in a psychiatric sample of adults (N = 70). Participants were asked to imagine themselves in distress-inducing situations and then write what they would actually do to decrease distress in such situations., Results: As hypothesized, mindfulness statistically mediated the relationship of BPD features to reported acts of (a) self-injury and (b) overall harmful dysregulated behaviors., Conclusions: Difficulties in the ability to be aware, attentive, and accepting of ongoing experience may play a role in the relationship of BPD features to harmful dysregulated behaviors. Future research should clarify potential reciprocal effects between BPD features and mindfulness with prospective, multioccasion designs., (© 2013 Wiley Periodicals, Inc.)

Objective: Theories point to different mechanisms through which borderline personality disorder (BPD) symptoms may be developed and maintained: (a) emotion regulation dysfunction, (b) problematic relations, and (c) nonintegrated self. However, researchers have not investigated the relative contribution of these mechanisms simultaneously in accounting for the variance observed in BPD symptoms., Method: Drawing from university students and Internet users, 462 adults (63% female, 77% Caucasian) completed self-report measures of emotion regulation, interpersonal problems, sense of self, BPD symptoms, and depressive symptoms., Results: All predictors were independently associated with BPD symptoms, with emotion regulation difficulties having the strongest relation. For high BPD individuals (N = 94), emotional regulation difficulties was the only predictor uniquely associated with BPD symptoms and interpersonal problems was the sole unique predictor of depressive symptoms., Conclusion: These results suggest that emotion regulation difficulties and interpersonal problems may be particularly problematic for those with high BPD symptoms in different ways. Implications and future directions are discussed., (© 2012 Wiley Periodicals, Inc.)