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As developmental and clinical research on identity has largely developed in disconnect, scholars recommend adopting a developmental psychopathology perspective on identity, which considers adaptive and pathological identity functioning. Such a perspective has also been introduced in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Alternative Model for Personality Disorders (AMPD), which suggests that all personality disorders (PDs) are marked by moderate to extreme deficits in self-functioning (i.e., identity and self-direction). The present study aims to validate the Dutch Self-Concept and Identity Measure (SCIM), a 27-item self-report questionnaire that assesses consolidated identity, disturbed identity, and lack of identity, in 153 psychiatric inpatients with PDs (75.2% female; Mage = 31.73). We investigated the factor structure and reliability of the SCIM, and examined associations of SCIM scales with typical identity processes, AMPD domains of self-functioning, and symptoms of all PDs. Results indicated that a 23-item Dutch SCIM produced valid and reliable scores among patients with PDs. Furthermore, SCIM scales were significantly and differentially related to identity commitment processes, ruminative identity exploration, domains of self-functioning, and symptoms of all PDs. Moreover, findings indicated that PDs varied regarding the severity of identity impairment.

Affective variability is a defining feature of borderline personality disorder (BPD). We hypothesize that patients with BPD who score higher on self-criticism and/or dependency-patients with a relative emphasis on self-definition and interpersonal relatedness, respectively-are characterized by more affective variability in positive and negative emotions. To examine this hypothesis, a sample of 32 patients with BPD reported their momentary feelings of anger, depression, anxiety, cheerfulness, and relaxation in an experience sampling study with 10 random signals scheduled per day for 8 days. Using heterogeneous linear mixed models, results indicate that patients with BPD who score higher on self-criticism show more within-person variance (WPV) in anger, depression, anxiety, cheerfulness, and feeling relaxed, whereas patients who score higher on dependency show more WPV in anger but less WPV in anxiety and feeling relaxed. Consequently, individual differences in affective variability in BPD are, after adjustment for the confounding between the mean and WPV of affect, related to personality vulnerabilities like self-criticism and dependency. These results add evidence to two-polarities models of personality and the existing view that there is substantial heterogeneity in BPD. (PsycInfo Database Record (c) 2020 APA, all rights reserved). ispartof: Personality Disorders-Theory Research And Treatment vol:11 issue:4 pages:270-279 ispartof: location:United States status: published

Heterogeneity in borderline personality disorder (BPD) drives the search for BPD subtypes to optimize the assessment and treatment of these patients. Therefore, the aims of the present study were (1) to replicate previously identified BPD subtypes based on reactive and regulative temperament; (2) to compare them on symptomatology and coping; and (3) to investigate whether these subtypes show different treatment responses after 3 months of inpatient dialectical behaviour therapy (DBT). A total of 145 BPD inpatients were assessed by means of measures of temperament, symptomatology and coping. Through model‐based clustering on the Behavioural Inhibition and Behavioural Activation Scales (BISBAS) and Effortful Control Scale (ECS), we identified three BPD subtypes: an Emotional/Disinhibited subtype (15%, high BAS and low ECS); a Low Anxiety subtype (41%, low BIS) and an Inhibited subtype (44%, low BAS). After 3 months of DBT, 75 patients completed the measures for a second time. Repeated measure ANOVAs demonstrated a general improvement on all symptoms and coping strategies. In addition, the BPD subtypes showed trajectory differences in clinical and borderline specific symptomatology and dissociation. These findings indicate that BPD subtypes based on temperament demonstrate different treatment responses, which can contribute to the search of more BPD subtype tailored treatment interventions. © 2018 John Wiley & Sons, Ltd.

INTRODUCTION: Borderline personality disorder (BPD) is a serious mental illness that centers on the inability to effectively regulate emotions. A large amount of BPD patients engage in non-suicidal self-injury (NSSI). Given the NSSI contributes to serious health risks, it is important to know why some BPD patients engage in NSSI and others do not. A possible associated factor of NSSI in BPD may be alexithymia, which reflects difficulties in identifying and communicating feelings. Therefore the aim of the present study was to investigate whether NSSI was associated with alexithymia and whether this association still stood when controlling for gender and depression. METHODS: The current study explored the relationship between NSSI and alexithymia in 185 BPD patients by means of the Self-Injury Questionnaire-Treatment Related and the Toronto Alexithymia Scale-20 (TAS). RESULTS: Of the 185 BPD inpatients, 82.7% reported life-time NSSI, of whom 52.9% were still engaging in current NSSI; and 71.3% scored in the alexithymic range (cut-off score≥61). Current NSSI was significantly associated with TAS-total. Additionally, when considering the separate TAS subscales Difficulties Describing Feelings (DDF), Difficulties Identifying Feelings (DIF) and Externally Oriented Thinking (EOT), only DDF was significantly associated with NSSI, even after controlling for gender and depression. CONCLUSION: These results suggest that NSSI in BPD patients is associated with alexithymia. More specific, difficulties describing feelings can lead to NSSI, independently of the depressive status of the BPD patient. The implications for clinical treatment of self-injurious BPD patients will be discussed. ispartof: Comprehensive Psychiatry vol:77 pages:80-88 ispartof: location:United States status: published

BACKGROUND: Emotional instability, consisting of patterns of strong emotional changes over time, has consistently been demonstrated in daily life of patients with a borderline personality disorder (BPD). Yet, little empirical work has examined emotional changes that occur specifically in response to emotional triggers in daily life, so-called emotional reactivity. The goal of this study was to examine emotional reactivity in response to general emotional appraisals (i.e. goal congruence or valence, goal relevance or importance, and emotion-focused coping potential) and BPD-specific evaluations (trust and disappointment in self and others) in daily life of inpatients with BPD. METHODS: Thirty inpatients with BPD and 28 healthy controls participated in an experience sampling study and repeatedly rated the intensity of their current emotions, emotional appraisals, and evaluations of trust and disappointment in self and others. RESULTS: Results showed that the BPD group exhibited stronger emotional reactivity in terms of negative affect than healthy controls, however only in response to disappointment in someone else. BPD patients also showed weaker reactivity in positive affect in response to the appraised importance of a situation; the more a situation was appraised as important, the higher the subsequent positive affect for healthy controls only, not the patient group. CONCLUSIONS: These findings show that appraisals can trigger strong emotional reactions in BPD patients, and suggest that altered emotional reactivity might be a potential underlying process of emotional instability in the daily life. ispartof: Borderline Personality Disorder and Emotion Dysregulation vol:5 issue:5 pages:1-13 ispartof: location:England status: Published online

Disturbances in emotion regulation have been identified as a core feature of patients with a borderline personality disorder (BPD). Findings of studies using experimental measures of emotion processing are mixed, which may be partially explained by the heterogeneity of the BPD population. To address this issue, we investigated differences in experimental measures of emotional action tendencies (approach-avoidance behaviour) and attentional bias to emotional stimuli in BPD subtypes. Data of the Approach-Avoidance Task (AAT) and the Emotional Stroop Task (EST) were collected in 140 BPD patients, previously clustered into four BPD subtypes based on temperament dimensions. We investigated (1) the relationship between temperament dimensions and the performance on the AAT and EST and (2) compared performance on these tasks in previous defined BPD subtypes. The results of the present study demonstrated a positive relationship between effortful control (EC) and AAT effect-scores. A higher level of EC was positively associated with a general emotional action tendency towards faces with directed gaze, even when controlling for gender, age and BPD severity. Preliminary results on the comparison of the BPD subtypes demonstrated no significant differences in AAT and EST performance. These findings emphasize the relevance of EC in emotional action tendencies in BPD patients. ispartof: PSYCHIATRY RESEARCH vol:266 pages:247-252 ispartof: location:Ireland status: published

Objective Non-Suicidal Self-Injury (NSSI) has emerged as an important mental-health concern. However, epidemiological features like age of onset of NSSI have remained understudied. Therefore, the current study investigated the distribution of age of onset of NSSI in pooled sample of Dutch-speaking adolescents and emerging adults using event history analysis. Method Eleven datasets measuring age at first NSSI in community and clinical participants collected by researchers in the Dutch-speaking part of Belgium were pooled together. The final dataset consisted of 1973 community males, 1901 community females, and 505 clinical females. Discrete-time event history analysis was used to model the effect of gender and psychiatric disorders on the age of onset of NSSI. Results Twenty-one percent of adolescents from the community samples engaged in at least one episode of NSSI by the age of 25 years. Irrespective of the type of sample (community or psychiatric disorder), the probability of age of onset peaked around the age of 14-15 years. A second peak was observed around the age of 20 and 24 years in the community and psychiatric samples respectively. Conclusions Psychosocial interventions for prevention of NSSI should not only target adolescence through school mental health programs but also target emerging adults at the university level. ispartof: Comprehensive Psychiatry vol:80 pages:170-178 ispartof: location:United States status: published

Overgeneral memory (OGM), the tendency to retrieve categories of events from autobiographical memory instead of single events, is found to be a reliable predictor for future mood disturbances and post-traumatic symptom severity. Patients with borderline personality disorder (BPD) often report co-morbid episodes of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Therefore, we investigated whether OGM would predict depression severity and (post-traumatic) stress symptoms in BPD patients. At admission (N = 54) and at six-month follow-up (N ≥ 31), BPD patients completed the Structured Clinical Interview for DSM-IV Disorders, the Assessment of DSM-IV Personality Disorders, the Autobiographical Memory Test, the Beck Depression Inventory-2nd edition (BDI-II), and the Impact of Event Scale. OGM at baseline predicted (a) higher levels of depressive symptoms at follow-up and (b) more intrusions related to a stressful event over and above baseline levels of borderline symptoms, depressive symptoms, and intrusions, respectively. No association was found between memory specificity and event-related avoidance at follow-up. Despite previous findings suggesting that OGM in BPD is less robust than in MDD and PTSD, our results suggest that memory specificity in BPD patients may have some relevance for the course of depressive and stress symptomatology in BPD. peerreview_statement: The publishing and review policy for this title is described in its Aims & Scope. aims_and_scope_url: http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=pmem20 ispartof: Memory vol:24 issue:10 pages:1302-1310 ispartof: location:England status: published

Heterogeneity in borderline personality disorder (BPD) drives the search for BPD subtypes to optimize the assessment and treatment of these patients. Therefore, the aims of the present study were (1) to replicate previously identified BPD subtypes based on reactive and regulative temperament; (2) to compare them on symptomatology and coping; and (3) to investigate whether these subtypes show different treatment responses after 3 months of inpatient dialectical behaviour therapy (DBT). A total of 145 BPD inpatients were assessed by means of measures of temperament, symptomatology and coping. Through model-based clustering on the Behavioural Inhibition and Behavioural Activation Scales (BISBAS) and Effortful Control Scale (ECS), we identified three BPD subtypes: an Emotional/Disinhibited subtype (15%, high BAS and low ECS); a Low Anxiety subtype (41%, low BIS) and an Inhibited subtype (44%, low BAS). After 3 months of DBT, 75 patients completed the measures for a second time. Repeated measure ANOVAs demonstrated a general improvement on all symptoms and coping strategies. In addition, the BPD subtypes showed trajectory differences in clinical and borderline specific symptomatology and dissociation. These findings indicate that BPD subtypes based on temperament demonstrate different treatment responses, which can contribute to the search of more BPD subtype tailored treatment interventions. © 2018 John WileySons, Ltd.

Nonsuicidal Self-Injury (NSSI) is prominent in individuals with Borderline Personality Disorder (BPD), and there is abundant evidence that affect regulation plays an important role in NSSI in the majority of patients. Affective variability is a core feature of BPD, and thus, we hypothesize that NSSI has an affect stabilization function in BPD. Affect stabilization is a process through which individuals attempt to make their affect more stable by reducing affective variability. We tested this hypothesis in 32 participants with BPD who reported on their NSSI and affect using a displeasure-pleasure (valence) and activation-deactivation (activation) dimension in an experience sampling study with 10 random signals scheduled per day for 8 days. Results indicated that individuals who engaged in NSSI show more Within Subject (WS) variance in valence and activation than individuals who did not engage in NSSI. However, within the NSSI patients, individuals who engaged more frequently in NSSI during the study showed less WS variance in valence and activation than patients who engaged less frequently in NSSI. This suggests that NSSI may be reinforced by its affect stabilization function. In the discussion, we explore alternative explanations for the relation between NSSI and affective variability, and consider the clinical implications.

Considerable heterogeneity is observed among patients with a Borderline Personality Disorder (BPD). In the present study, we investigated whether we could identify and validate different personality subtypes in 150 BPD inpatients based on reactive and regulative temperament. We identified four BPD subtypes by means of cluster analysis on the Behavioral Inhibition and Behavioral Activation Scales (BISBAS) and the Effortful Control Scale (ECS): an Emotional/Disinhibited subtype (45%) scoring lowest on Effortful Control, an Inhibited subtype (24%) characterized bylaw levels of Behavioral Activation, a Low Anxiety subtype (21%) defined by low levels of Behavioral Inhibition, and a High Self-control subtype (10%) characterized by the highest score on effortful control. The four subtypes were validated by comparing them on clinical symptomatology, comorbid personality disorders, and coping. The current findings offer insight into meaningful differences among BPD patients based on temperamental features, which can offer guidelines for the treatment of BPD patients. (C) 2016 Elsevier Ltd. All rights reserved.

Studies using retrospective self-report or proxies of nonsuicidal self-injury (NSSI) in the lab have shown that NSSI is often preceded by intense negative emotions and followed by a decrease in negative emotions/tension, suggesting an emotion regulation function of NSSI. To investigate this emotion regulation function of NSSI in a more ecologically valid way, we used experience sampling methods to examine the temporal relationship between NSSI behavior and emotional experiences throughout the day in 30 inpatients currently staying in psychiatric hospitals. Because NSSI is especially prevalent and severe in patients with a borderline personality disorder (BPD), we focused on patients with high levels of BPD symptomatology. Results confirmed that high levels of negative emotion prospectively predicted a higher probability of engaging in NSSI in the next time interval. However, the occurrence of NSSI itself was related to concurrent increases in negative emotion and decreases in positive emotion, and even prospectively predicted an increase in negative emotion in the consecutive time interval. These preliminary results show that on a time scale of hours, instead of resulting in emotional relief, NSSI seems to be associated with a further increase in negative emotionality, shedding light on the cyclic nature of NSSI. General Scientific Summary Nonsuicidal self-injury (NSSI) is often considered as serving an emotion regulation function, leading to the decrease of negative feelings. Here, we show that while NSSI is indeed preceded by elevated levels of negative emotionality, it is in fact followed by an increase, not a decrease, of negative emotion within the timespan of hours in inpatients with borderline personality disorder features, shedding light on the cyclic nature of NSSI.

Problems with identity formation are associated with a range of psychiatric disorders. Yet, the mechanisms underlying such problems and how they are refined into specific diagnostic presentations require further investigation. The present study investigated identity processes among 123 women with eating disorders (ED) and age-matched community controls via a newly developed identity model. Several clinical outcome variables were assessed. Patients with ED scored lower on committing to and identifying with identity-related choices and scored higher on maladaptive or ruminative exploration, identity diffusion and identity disorder. They also experienced less identity achievement as compared with controls. The identity disorder status was associated with the highest scores on anxiety, depression, borderline personality disorder symptoms, and non-suicidal self-injury and the lowest scores on need satisfaction. Results indicate that patients with ED experience more identity problems than community controls and those captured by an identity disorder status experience the most problematic psychosocial functioning. Copyright © 2016 John WileySons, Ltd and Eating Disorders Association.

Despite large efforts to understand emotional instability in borderline personality disorder (BPD), it is still unclear exactly how this is manifested in the daily lives of people suffering from the disorder. Building on theoretical and clinical observations of BPD, we propose that the emotional instability in BPD particularly consists of the occurrence of strong changes between positive and negative emotional states from 1 moment to the next, labeled emotional switching. We tested this proposal by means of an experience sampling study in which 30 BPD patients and 28 healthy controls reported in their daily lives the level of pleasantness/unpleasantness of their emotional states 10 times a day for 8 consecutive days using handheld palmtops. Results showed that although BPD patients did not differ from healthy controls regarding their overall tendency to switch from a positive to a negative emotional state or vice versa, the size of such changes between positive and negative states was found to be significantly larger in BPD patients. In contrast, the magnitude of emotional changes that remained within the negative emotional range or positive emotional range was not particularly larger for BPD patients compared with healthy participants. These findings imply that the emotional instability in BPD is particularly characterized by larger changes from positive to negative states and vice versa, rather than overall larger changes in intensity, providing insight into possible processes underlying emotion dysfunction in BPD. ispartof: Personality Disorders: Theory, Research, and Treatment vol:7 issue:1 pages:50-60 ispartof: location:United States status: published

Overgeneral memory (OGM) refers to the tendency to recall categories of events from memory, rather than specific memories, even when it is explicitly instructed to recall specific events. Unlike depressed and traumatized patients, patients diagnosed with borderline personality disorder (BPD) inconsistently show OGM. Non-suicidal self-injury (NSSI) on the other hand, is very common in patients with BPD. Like OGM, NSSI is considered to be an affect-regulation mechanism. This study investigated how these strategies relate to each other. Based on earlier findings (Startup et al., 2001), we hypothesized that NSSI and OGM would be inversely associated. Fifty three BPD patients completed the Structured Clinical Interview for DSM-IV Disorders (Axis II as well as Axis I-mood modules), the Autobiographical Memory Test to assess OGM, and the Self-Injury Questionnaire - Treatment Related (SIQ-TR) to assess NNSI. We found that patients who engage in NSSI do not differ from patients who do not with respect to OGM. However, we found that participants who use more different NSSI methods showed less OGM, but this association disappeared when we controlled for age. We propose a balance-model of affect-regulation as one possible explanation for the relationship between these two affect-regulation behaviours, and discuss the clinical relevance of our findings. ispartof: JOURNAL OF EXPERIMENTAL PSYCHOPATHOLOGY vol:6 issue:4 pages:398-410 ispartof: location:Den Haag, The Netherlands status: published