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Previous studies have reported that patients with borderline personality disorder (BPD) often have negative experiences in psychiatric inpatient care. To address this issue, a novel intervention known as patient-initiated brief admission (PIBA) has been developed. PIBA offers a constructive approach to crisis management in situations of heightened anxiety, as well as during instances of self-harm and suicidal ideation. The intervention allows patients to directly contact the psychiatric ward to initiate a brief admission lasting 1-3 days. This easily accessible care option during a crisis has the potential to prevent harm to the patient and reduce the need for prolonged hospital stays. The aim of the present study is to investigate the effects of PIBA on psychiatric care consumption among patients diagnosed with BPD. This retrospective register-based study includes data from both inpatient and outpatient care registries for patients diagnosed with BPD. Data were extracted from the National Board of Health and Welfare in Sweden. The study period encompasses 2013-2020, with the PIBA intervention occurring between 2016 and 2019. The sample included 107 patients in the PIBA group and 5659 matched controls. Data were analysed using a difference-in-differences (DiD) approach through ordinary least squares (OLS) regression and ordinal logistic regression. Throughout the 3-year follow-up, both groups exhibited a reduction in the number of days of utilisation of psychiatric inpatient care services. The DiD analysis indicated an additional decrease of 1.5 days at the 6-month mark for the PIBA group (β = -1.436, SE = 1.531), expanding to 3 days fewer at the 12-month follow-up (β = -3.590, SE = 3.546), although not statistically significant. For outpatient care, the PIBA group displayed an increase in the number of visits, averaging to half a visit more every 6 months (β = 0.503, SE = 0.263) compared with the controls. Statistically significant differences were observed for two out of six measurements at the 12-month (β = 0.960, SE = 0.456) and 18-month follow-up period (β = 0.436, SE = 0.219). The PIBA group had a statistically significant lower odds of experiencing extended lengths of inpatient care days after the index date than the controls (OR 0.56, 95% CI: 0.44-0.72). In conclusion, PIBA was associated with a significant reduction in the length of individual hospital stays, but not in the overall number of inpatient care days. PIBA may be linked to a shift from longer inpatient care utilisation to outpatient care utilisation. These findings suggest that PIBA may reduce the risk of prolonged hospitalisations for patients who have access to the intervention. Future research should explore the impact of PIBA on healthcare costs and cost-effectiveness, both in relation to health care for the individual and cost-effectiveness in relation to recovery and health., (© 2024 The Author(s). International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

This article focuses on the narratives that circulate about borderline personality disorder (BPD) in health-care settings in Australia and the effects such narratives can have on how people practice and seek out care. People with a BPD diagnosis frequently access health-care services, often encountering stigma and discrimination. Drawing on narrative theory, we critically unpack the circulation and capacities of BPD narratives and the ways they can often contribute to poor and troubling experiences. This article is based on qualitative interviews with people living with a BPD diagnosis, as well as health practitioners who work with people with a BPD diagnosis. Our findings identified insidious and powerful BPD narratives that circulate in health-care settings, particularly in short-term, acute, or non-specialist contexts, such as emergency departments and in-patient units. These narratives influenced the ways that participants both practiced and sought out care. To improve health service quality for people with a BPD diagnosis, or those experiencing mental distress, it is important to challenge the sociocultural-political norms and relations that can influence approaches to care and practice. Disrupting and reframing negative BPD narratives and raising awareness about the impact of stories that are told about BPD have the potential to generate social change., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

This study conducted in-depth, largely unstructured interviews with 31 involved family members in a metropolitan area of the United States (US) Midwest on their experiences of BPD in a close relative. Narrative analysis employing concepts from anthropology (the logic of care and family assemblage) was used to examine the nature and quality of care practices and identify human, environmental, and cultural supports needed for family recovery. Findings indicate that these US family caregivers provided intensive and extensive care over the long term. They acted in situations of risk to their relative, and often disconnected from professional support. Parents labored under unforgiving normalizations: judgments (real or perceived) of not properly raising or "launching" their children and norms of parental self-sacrifice. The dearth of housing options for the young person hindered recovery. While duly recognizing the care practices provided by family members for a relative with BPD, I argue that there is a significant omission. Our conceptualizing of supports for family members of a relative with BPD needs to encompass supports for their own recovery. Respite, mental health care for caregivers, housing, support groups, and collaborative care (with professionals, peers and family members) could productively assist recovery of all family members., Competing Interests: Declarations Conflict of interest There are no conflicts of interest in this research. Ethical Approval I received approval for this study from the Institutional Review Board of my university., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Prolonged grief disorder (PGD) is a new diagnosis that is often mistaken for other psychopathologies. We report a case of PGD in a patient who screened positive for personality disorder. Both PGD and personality disorder symptoms were much improved after a course of prolonged grief disorder therapy., Case Presentation: A bereaved woman in her mid-20s sought treatment for depression 9 months after the death of her father. Her depressive symptoms responded well to antidepressant medication and a brief course of interpersonal psychotherapy. However, prolonged grief symptoms persisted at a clinically significant level. Elements of her history, as well as her score of 9 out of 10 on the McLean Screening Instrument for Borderline Personality Disorder, indicated a possible diagnosis of borderline personality disorder. Yet, after completing a course of prolonged grief disorder therapy, both her grief and borderline symptoms were much reduced., Conclusions: This case raises the possibility of an association between prolonged grief and borderline symptoms. Disruption of attachment relationships provides a possible way of understanding this association. The case we present raises the possibility that prolonged grief disorder may better explain symptoms in some patients presenting with borderline personality disorder symptoms., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Treatments for borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) are less effective for patients with co-occurring symptoms of both disorders, who are considered to have complex PTSD (cPTSD), compared with patients with either condition alone. Evidence suggests that co-occurrence of symptoms indicates greater impairment in mentalizing. This study examines evidence for targeting mentalizing when treating individuals with co-occurring symptoms, irrespective of their exposure to developmental trauma and, for the first time, investigates the mediational role of mentalizing in the associations between BPD symptomatology and cPTSD., Design: We identified in a routine clinical service a group of patients with BPD, with or without co-occurring symptoms of PTSD. We hypothesized that patients with co-occurring symptoms and a history of childhood maltreatment will show more severe clinical profiles and greater mentalizing problems, which in turn lead to symptoms consistent with cPTSD., Method: Clinical profiles of 72 patients with BPD (43 with and 29 without co-occurring symptoms of PTSD; mean age in both groups 28 years, 79% and 83% female, respectively) were identified using the Structured Clinical Interview for DSM-IV Axis II Disorders. Patients completed self-report measures of BPD and PTSD symptoms, well-being, dissociation and reflective functioning. Childhood trauma histories were evaluated., Results: Compared with patients with BPD-only, those with co-occurring BPD and PTSD showed greater severity in terms of BPD and dissociative symptoms, met a broader range of BPD diagnostic criteria, had a greater sense of personal worthlessness and self-evaluated their well-being as considerably diminished. This group was also more inclined to recall increased instances of childhood sexual abuse. In a mediation analysis, mentalizing acted as a partial mediator for the relationship between BPD severity and cPTSD, as well as between dissociative symptoms and cPTSD. Interestingly, mentalizing did not mediate the relationship between childhood sexual abuse and cPTSD., Conclusions: Overall, the correlational findings are consistent with an intended focus on mentalizing to treat cPTSD symptoms in individuals who also meet criteria for a diagnosis of BPD., (© 2023 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

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., (© 2024 The British Psychological Society.)

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.)

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., Abstract: 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., (© 2024 John Wiley & Sons Ltd.)

Background: Borderline personality disorder (BPD) is a serious disorder with a lifetime prevalence of 2.7-5.9% and is thought to correlate with altered neuroplasticity. The aim of the present study is to investigate possible associations of BPD (-severity) and alterations in neurological soft signs (NSS) and olfactory function., Methods: For the monocentric observational study, 39 female subjects with a BPD diagnosis and 19 female healthy control subjects were recruited. The groups were matched by age. Olfactory functions were examined using Sniffin' Sticks. NSS were assessed by a standardized test with 50 items., Results: BPD subjects have higher NSS scores in group comparison. By contrast, there are no alterations in the total score of olfactory function, while the BPD subjects scored higher in smell identification. Within the BPD group, the total NSS score was discovered to have a negative correlation with olfactory function. BPD subjects taking antipsychotics show more NSS than those without. We found no significant influence of posttraumatic stress disorder on the NSS or olfactory function. The BPD-severity correlates with NSS., Limitations: Due to the cross-sectional design, we did not have a follow up examination. The sample size was small, and all patients had psychiatric comorbidities. Additionally, we did not perform MRI to connect our findings with possible structural abnormalities., Conclusions: Our study confirmed altered NSS in BPD patients, whereas no impairment in the olfactory function was found. Further research is required to establish NSS and smell tests as clinical screening tools in BPD patients and to uncover the disorder's impact on neuroplasticity., Competing Interests: Declaration of competing interest RS took part in an educational event sponsored by Livanova. HF received speaker‘s honararia and served as advisor for Recordati Pharma GmbH and Janssen-Cilag Gmbh. AN received lecture fees from Novartis and Merck. HBM took part in educational events sponsored by Livanova and Rovi. SBe, SH, SDG, LS, FMM, CW, SBl declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Empirically-based developmental psychopathology approach identified three domains involved in the emergence of borderline personality disorder (BPD): i) underlying liabilities to develop psychopathology (i.e., early patterns of internalizing and externalizing manifestations); ii) invalidating relational experiences (e.g., childhood traumatic experiences, maladaptive parenting, problematic peer relationships); iii) regulatory mechanisms of emotions and behaviors. Nevertheless, no studies have quantitatively summarized empirical findings concerning how and to what extent these domains might be temporally associated to the emergence of BPD features from adolescence to adulthood., Methods: The current multi-level meta-analysis included 106 studies (N = 86,871 participants) assessing the role of previously mentioned antecedents and risk factors for BPD., Results: The analysis showed moderate effect sizes capturing temporal associations between early internalizing/externalizing psychopathological manifestations, different invalidating relational experiences, emotion/behavior regulation processes with later BPD features. The effect sizes of these domains were not statistically different from each other., Conclusion: This evidence supports a transactional developmental model of BPD. Consistently, the emergence of BPD could be viewed in the light of dynamic interplays between an underlying liability to psychopathology and invalidating relational experiences across different stages of development, which are progressively reinforced through increasing alterations of emotion and behavior regulation mechanisms., Competing Interests: Declaration of competing interest The authors alone are responsible for the content and writing of this paper. All authors approved the final version of the manuscript. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors report no relevant financial conflicts., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Individuals with borderline personality traits are known to have disturbed representations of self and others. Specifically, an unstable self-identity and difficulties distinguishing between self and others can impair their mentalizing abilities in interpersonal situations. However, it is unclear whether these traits are linked to differences in neural representation of self and others., Methods: In this study involving 156 young adults, changes in neural function during self-other processing were measured using a Functional Near-Infrared Spectroscopy (fNIRS) task and a self-report survey. During the fNIRS task, participants were asked about their own traits, others' traits, how they believed others perceived them, and the basic meaning of words. The study aimed to determine whether the degree of neural differentiation between the task conditions was related to borderline personality traits., Result: The study found that traits indicative of identity instability could be predicted by similarities in task-dependent connectivity. Specifically, the neural patterns when individuals estimated how others perceived them were more similar to the patterns when they judged their own traits., Conclusions: These findings suggest that borderline personality traits related to identity issues may reflect difficulties in distinguishing between neural patterns when processing self and other information., Competing Interests: Declaration of competing interest The authors report no competing interests to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

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.

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., (© 2024 The Author(s). Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

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., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Borderline personality disorder (BPD) is a mental health condition with insufficient care availability worldwide. Digital mental health interventions could reduce this treatment gap. Persuasive system design (PSD) is a conceptual framework outlining elements of digital interventions that support behavior change., Objective: This systematic review aims to characterize digital interventions targeting BPD symptoms, assess treatment efficacy, and identify its association with intervention features, including PSD elements., Methods: A systematic review of automated digital interventions targeting symptoms of BPD was conducted. Eligible studies recruited participants aged ≥18 years, based on a diagnosis of BPD or one of its common comorbidities, or as healthy volunteers. OVID Embase, OVID MEDLINE, OVID PsycINFO, and the Cochrane Central Register for Controlled Trials were searched on July 19, 2022, and February 28, 2023. Intervention characteristics were tabulated. A meta-analysis of randomized controlled trials (RCTs) determined treatment effects separately for each core symptom of BPD using Hedges g. Associations between the treatment effect and intervention features, including PSD elements, were assessed by subgroup analysis (Cochran Q test). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the National Institutes of Health Quality Assessment Tool for pre-post studies., Results: A total of 40 (0.47%) publications out of 8520 met the inclusion criteria of this review, representing 6611 participants. Studies comprised examinations of 38 unique interventions, of which 32 (84%) were RCTs. Synthesis found that included interventions had the following transdiagnostic treatment targets: severity of BPD symptoms (4/38, 11%), suicidal ideation (17/38, 45%), paranoia (5/38, 13%), nonsuicidal self-injury (5/38, 13%), emotion regulation (4/38, 11%), and anger (3/38, 8%). Common therapeutic approaches were based on dialectical behavioral therapy (8/38, 21%), cognitive behavioral therapy (6/38, 16%), or both (5/38, 13%). Meta-analysis found significant effects of digital intervention for both symptoms of paranoia (Hedges g=-0.52, 95% CI -0.86 to -0.18; P=.01) and suicidal ideation (Hedges g=-0.13, 95% CI -0.25 to -0.01; P=.03) but not overall BPD symptom severity (Hedges g=-0.17, 95% CI -0.42 to 0.10; P=.72). Subgroup analysis of suicidal ideation interventions found that evidence-based treatments such as cognitive behavioral therapy and dialectical behavior therapy were significantly more effective than alternative modalities (Cochran Q=4.87; P=.03). The degree of human support was not associated with the treatment effect. Interventions targeting suicidal ideation that used reminders, offered self-monitoring, and encouraged users to rehearse behaviors were associated with a greater reduction in ideation severity., Conclusions: Evidence suggests that digital interventions may reduce the symptoms of suicidal ideation and paranoia and that the design of digital interventions may impact the efficacy of treatments targeting suicidal ideation. These results support the use of transdiagnostic digital interventions for paranoia and suicidal ideation., Trial Registration: PROSPERO CRD42022358270; https://tinyurl.com/3mz7uc7k., (©Julia A B Lindsay, Niall M McGowan, Thomas Henning, Eli Harriss, Kate E A Saunders. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.11.2024.)

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., Competing Interests: Declarations. Ethics approval and consent to participate: The study was reviewed and approved by the Ethics Committee of the Medical University of Vienna (Approval number: 1116/2015). Consent for publication: Written informed consent was obtained from all participants. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

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.

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.

The prevalence of borderline personality disorder (BPD) in the general population is estimated to be 1.8 % whereas the rates of BPD among people in prison have been reported between 9 and 30 %. To date, there are no published systematic reviews into the rates of BPD among adults in prison. Understanding the prevalence of BPD in this setting can help to inform prison-staff education, funding and intervention options, and adequate care for an already at-risk population. We aimed to explore the global prevalence of BPD diagnoses and self-reported symptomology among adults in prisons via systematic review and meta-analysis. We also aimed to explore gender differences between women and men in prison. Following the PRISMA guidelines, we conducted a systematic review and meta-analysis of papers where a BPD diagnosis or self-reported symptoms were reported within a prison population of male or female adult offenders (18+ years). Our search yielded 33 studies comprising diagnostic interviews, and 15 studies which included self-reported symptom measures. The results indicated that for women and men in prison, the prevalence of BPD was (27.4 % and 18.8 %, respectively) when assessed via diagnostic interview. Results were similar for both women and men in studies that used a self-report measure to assess a BPD diagnosis (29.1 % and 16.4 %). Findings suggest that the prevalence of BPD in prisons should be considered when making decisions about mental health and criminogenic interventions. Self-report measures could be a resource-efficient method for screening prisoners for personality pathology in prison settings. Contemporary, well-structured, large-scale studies are required to better understand the prevalence of personality disorder in prisons., Competing Interests: Declaration of competing interest Authors completed this work as part of their paid employment at the Borderline Personality Disorder Collaborative., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study describes the 6-year course of grit scores among patients with borderline personality disorder (BPD) who have and have not experienced a symptomatic and psychosocial recovery. This study also explores predictors of grittiness in BPD patients. These patients (N = 224) were assessed as part of the McLean Study of Adult Development (MSAD). Levels of grit were assessed using the Grit Scale, a self-report measure assessing overall grittiness and three sub-scales of grit: consistency of interest, perseverance, and ambition. Recovered patients reported significantly higher levels of grit on three outcomes (overall grit, perseverance, and ambition) compared to non-recovered patients across time. One temperamental factor (conscientiousness) and one childhood factor (competency) were significant multivariate predictors of overall grit scores in patients with BPD. Taken together, these results suggest that recovered BPD patients have higher levels of grit that are stable across time. These results also suggest that grit is related to both temperamental and environmental factors., (© 2024 John Wiley & Sons Ltd.)

Borderline personality disorder (BPD) is characterized by affective, interpersonal, and identity instability, as well as marked impulsivity. There is evidence that BPD may be best operationalized dimensionally using models such as the Alternative Model for Personality Disorders (AMPD) described in Section III of the Diagnostic and Statistical Manual for Mental Disorders (DSM). Moreover, biosocial theory is a well-known etiological theory of BPD emphasizing emotion dysregulation, inherited impulsivity, and development within invalidating contexts as key etiological mechanisms. Given that current research and clinical efforts for BPD are informed by both nosology and etiology, this narrative review examined how well biosocial theory (a) aligns with AMPD conceptualizations, (b) accounts for psychiatric comorbidity, and (c) accounts for heterogeneity in BPD presentation. Findings suggested that tenets of biosocial theory align well with Criteria A and B of the AMPD; however, biosocial theory focuses narrowly on roles of emotion dysregulation, impulsivity, and invalidating contexts, and empirical support is lacking in some ways for several etiological explanations proposed by biosocial theory. Additionally, although biosocial theory captures empirically supported features of BPD and emphasizes high-risk subgroups, the theory may not account for lower-risk subgroups. Finally, the theory accounts for diagnostic co-occurrence via the central role of emotion dysregulation, but biosocial theory may not be specific to BPD and may broadly apply to a range of psychopathology. Based on the literature reviewed, implications for future research and clinical efforts are highlighted., (© 2024 John Wiley & Sons Ltd.)

The potential efficacy of psychosocial interventions in the treatment of borderline personality disorder (BPD) is impacted by significant treatment non-completion (TNC), with meta-analytic studies reporting rates of attrition of between 25% and 28%. Increasing patient retention could facilitate outcomes and improve resource utilization, given limited healthcare services. A systematic search of PsycINFO, CINAHL, EMBASE, CENTRAL, and Web of Science Core Collection identified 33 articles that met the criteria for inclusion. Although substantial heterogeneity in terms of methodology and quality of analysis limited conclusions that could be drawn in the narrative review, a few consistent patterns of findings were elucidated, such as Cluster B personality disorder comorbidities and lower therapeutic alliance were associated with TNC. Interestingly, the severity of BPD symptoms was not a predictor of TNC. These findings are discussed in terms of their potential theoretical contribution to TNC. Clinically, there may be value in applying mindfulness and motivational interviewing strategies early on in treatment for individuals who present uncertainty about engaging in treatment. Further research to develop this empirical landscape includes focusing on high-powered replications, examining burgeoning lines of research, and investigating dynamic predictors of TNC., (© 2024 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.)

Background: Borderline personality disorder (BPD) is a severe mental illness, with high rates of co-morbid depression and suicidality. Despite the importance of optimizing treatment in BPD, little is known about how neural processes relate to individual treatment response. This study examines how baseline regional brain blood oxygen level dependent (BOLD) activation during a functional magnetic resonance imaging (fMRI) task of emotion regulation is related to treatment response following a six-month randomized clinical trial of Dialectical Behavior Therapy (DBT) or Selective Serotonin Reuptake Inhibitor (SSRI) treatment., Methods: Unmedicated females with BPD (N = 37), with recent suicidal behavior or self-injury, underwent an fMRI task in which negative personal memories were presented and they were asked to distance (i.e., downregulate their emotional response) or immerse (i.e., experience emotions freely). Patients were then randomized to DBT (N = 16) or SSRI (N = 21) treatment, with baseline and post-treatment depression and BPD severity assessed., Results: BOLD activity in prefrontal cortex, anterior cingulate, and insula was associated with distancing. Baseline BOLD during distancing in dorsolateral, ventrolateral, and orbital prefrontal cortex (dlPFC, vlPFC, OFC) differentially predicted depression response across treatment groups, with higher activity predicting better response in the SSRI group, and lower activity predicting better response in the DBT group., Limitations: All female samples., Discussion: Findings indicate that greater prefrontal engagement during emotion regulation may predict more antidepressant benefit from SSRIs, whereas lower engagement may predict better response to DBT. These results suggest different mechanisms of action for SSRI and DBT treatment, and this may allow fMRI to guide individualized treatment selection., Competing Interests: Declaration of competing interest JJM and BHS receive royalties from the Research Foundation for Mental Hygiene for commercial use of the C-SSRS. CAM, NS, BSB, and KNO have no conflicts to report. The design, preparation, review, and approval of the manuscript as well as the decision to submit the manuscript for publication was entirely done by the authors CAM, NS, BSB, KNO, JJM, and BHS., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Borderline Personality Disorder (BPD) is a prevalent and debilitating psychiatric condition often accompanied by Post-Traumatic Stress Disorder (PTSD), with a substantial prevalence of trauma history among affected individuals. The clinical, cognitive, and cerebral parallels shared with PTSD suggest a trauma-related etiology for BPD. Studies consistently demonstrate a reduction in hippocampal volume in individuals with BPD, echoing findings in PTSD. However, the interpretation of this shared neurobiological profile remains contentious, with ongoing debates regarding the independence of these pathologies or the potential exacerbation of diminished hippocampal volume in BPD due to concurrent PTSD. Differential impacts on hippocampal subfields across both disorders may further complicate interpretation, suggesting the volume of hippocampal subfields as a potential discriminant biomarker. This study aims to characterize the multidimensional specific and shared profiles of BPD and PTSD-related alterations, with a particular emphasis on hippocampal subfields during adolescence, a crucial period in BPD development., Methods: This study focuses on female adolescents, who are more prevalent in the BPD population. Participants are categorized into three groups: BPD, BPD with comorbid PTSD, and a control group of matched healthy individuals. Data collection encompasses clinical, cognitive, and neuroimaging domains commonly affected in both disorders, utilizing various imaging markers (including gray matter macrostructure, white matter microstructural integrity, and regional functional connectivity)., Discussion: This study examines adolescent BPD with and without comorbid PTSD on clinical, neuroimaging, and cognitive levels. It is the first to use a comprehensive multi-modal approach within the same sample. Additionally, it uniquely explores hippocampal subfield volume differences in adolescents. Analysis of the relationship between the investigated domains and the effects of PTSD comorbidity will elucidate specific and shared alteration profiles in both disorders., Trial Registration: IDRCB number 2019-A00366-51 / clinicaltrials.gov ID: NCT0485274. Registered on 21/04/2021., (© 2024. The Author(s).)

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}., (© 2024. The Author(s).)

Background: Major depressive disorder (MDD) and borderline personality disorder (BPD) often co-occur, with 20 % of adults with MDD meeting criteria for BPD. While MDD is typically diagnosed by symptoms persisting for several weeks, research suggests a dynamic pattern of symptom changes occurring over shorter durations. Given the diagnostic focus on affective states in MDD and BPD, with BPD characterized by instability, we expected heightened instability of MDD symptoms among depressed adults with BPD traits. The current study examined whether BPD symptoms predicted instability in depression symptoms, measured by ecological momentary assessments (EMAs)., Methods: The sample included 207 adults with MDD (76 % White, 82 % women) recruited from across the United States. At the start of the study, participants completed a battery of mental health screens including BPD severity and neuroticism. Participants completed EMAs tracking their depression symptoms three times a day over a 90-day period., Results: Using self-report scores assessing borderline personality disorder (BPD) traits along with neuroticism scores and sociodemographic data, Bayesian and frequentist linear regression models consistently indicated that BPD severity was not associated with depression symptom change through time., Limitations: Diagnostic sensitivity and specificity may be restricted by use of a self-report screening tool for capturing BPD severity. Additionally, this clinical sample of depressed adults lacks a comparison group to determine whether subclinical depressive symptoms present differently among individuals with BPD only., Conclusions: The unexpected findings shed light on the interplay between these disorders, emphasizing the need for further research to understand their association., Competing Interests: Declaration of competing interest NCJ has received a research grant from Boehringer Ingelheim as PI (though there is no salary support or direct payments to NCJ the grant funds his personnel and his ability to collect data). Additionally, NCJ receives speaking fees and royalties related to publishing a book through the Academic Press., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Childhood trauma, including emotional neglect, emotional abuse, physical abuse, and sexual abuse, may contribute to borderline personality features like affective instability, identity problems, negative relationships, and self-harm. This study aims to explore how different types of childhood trauma affect these features in bipolar versus unipolar depressive disorders., Methods: We included 839 participants of the Netherlands Study of Depression and Anxiety (NESDA) with a lifetime diagnosis of major depressive disorder single episode (MDDS; N = 443), recurrent major depressive disorder (MDD-R; N = 331), or bipolar disorder (BD; N = 65). Multivariate regression was used to analyze data from the Childhood Trauma Interview and borderline features (from the self-report Personality Assessment Inventory)., Results: On average, participants were 48.6 years old (SD: 12.6), with 69.2 % being women, and 50.3 % of participants assessed positive for childhood trauma. Adjusted analyses revealed that participants diagnosed with BD, followed by MDD-R, exhibited the highest number of borderline personality features. Additionally, within the entire group, a strong association was found between childhood trauma, especially emotional neglect, and the presence of borderline personality features., Conclusion: Given the high prevalence of childhood trauma and borderline personality features, screening for these factors in individuals with mood disorders is crucial. Identifying these elements can inform and enhance the management of the often fluctuating and complex nature of these comorbid conditions, leading to more effective and tailored treatment strategies., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

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.

Impulsivity, aggression, and suicide are the major clinical symptoms of borderline personality disorder (BPD). Although previous studies indicated poor sleep quality and its relationship with clinical symptoms in patients with BPD, chronotype, an important sleep parameter, was not investigated in these patients. This study aimed to analyze chronotype and its relationship with clinical symptoms in patients with BPD. Participants in this study consisted of 68 BPD patients and 65 healthy controls. Subjective sleep characteristics, impulsivity, aggression, suicide probability, and chronotype were assessed using the Pittsburgh Sleep Quality Index (PSQI), Barratt Impulsivity Scale, Buss-Perry Aggression Scale (BPAQ), Suicide Probability Scale, and Morningness - Eveningness Questionnaire, respectively. PSQI total and subscale scores subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, and daytime drowsiness were significantly higher in the BPD group ( p  < 0.001). There was a positive correlation between the PSQI total score and the BPAQ total score ( r  = 0.268, p  = 0.027). The rate of evening type was significantly higher in the control group ( p  = 0.004). Suicide attempts and the subscale of suicide probability hopelessness, suicidal ideation, and negative self-evaluation scores were significantly higher in evening type BPD patients. ( p  = 0.017, p  = 0.009, p  = 0.001, p  = 0.047). Sleep quality is associated with aggression, and the eveningness chronotype is associated with suicide. It may be useful to focus on sleep problems in treating BPD patients.

Background: Childhood Maltreatment (CM) is linked to adverse outcomes, including Borderline Personality Disorder (BPD) and increased propensity for offending behaviors. However, research on the specific role that BPD plays between the two is limited and highly relevant given the high prevalence of CM in Australia., Objective: The present study aimed to investigate (1) the relationship between CM and subsequent offending behaviors, (2) whether BPD mediates the relation between CM and offending behaviors, and (3) which type of CM (physical, sexual, emotional abuse, neglect, exposure to domestic violence, multitype maltreatment) predicts BPD., Participants: The sample comprised 106 self-identified Australian female survivors of interpersonal violent crimes., Methods: Participants completed an online survey consisting of the Adverse Childhood Events Questionnaire, the McLean Screening Instrument for BPD, and a self-created questionnaire to measure offending behaviors. Regression, mediation analysis, and logistic regression were conducted., Results: CM significantly predicted offending behaviors (path c, B = 1.39, p <. 001) with BPD partially mediating the relationship (path c', B = 1.04, 95 % CI [0.31, 1.77], p = .006; path a, B = 0.47, 95 % CI [0.12, 0.83], p = .009, path b, B = 0.34, 95 % CI [0.07, 0.61], p = .014). Emotional abuse and multitype exposure were identified as predictors of BPD symptom development (OR = 9.42, 95 % CI OR [2.58, 34.40]; OR = 3.81, 95 % CI OR [1.41; 10.28], respectively)., Conclusion: These findings indicate the necessity of early interventions addressing CM, with a particular focus on emotional abuse and exposure to more than one type of maltreatment, to reduce the risk of developing BPD symptomatology and mitigate future offending behaviors., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Previous research on Borderline Personality Disorder (BPD) demonstrated dysfunction across a broad range of cognitive domains. However, the limited number of neuropsychological studies on BPD and their occasionally conflicting results have precluded a clear characterization of the neuropsychological features associated with this personality disorder. Therefore, the main aim of the present study is to provide an updated overview of neuropsychological functions related to BPD. A meta-analysis of 36 studies was performed, comparing the performance of BPD patients and healthy controls (HCs) across several cognitive domains. Significant differences between BPD patients and HCs in multiple cognitive domains were found. The smallest effect size was observed for general executive function, while the largest effect sizes were found in the long-term spatial memory and inhibition domains. In conclusion, the neuropsychological profile of BPD, characterized by deficits in inhibition as well as attention, memory, and executive functions, can result in difficulties in performing everyday activities. Accordingly, assessing neuropsychological functions could assist clinicians in developing more targeted non-pharmacological treatments., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

While many studies have found an association between childhood emotional abuse and alcohol use disorders (AUD) during adulthood, underlying psychological mechanisms linking the two remain inadequately understood. Drawing on the developmental psychopathology perspective, this study examined the relationship between childhood emotional abuse and AUD during adulthood with a national sample of women in Nepal ( N = 1,100, M age = 37.73), focusing on the mediating role of borderline personality traits. Mediation analyses were performed using the Karlson-Holm-Breen (KHB) method and bootstrapping confidence intervals. Results indicated that Nepali women's borderline personality traits significantly mediated the relationship between childhood emotional abuse and AUD. Hence, emotional abuse in childhood increases the risk for AUD during adulthood for Nepali women by increasing the risk of borderline personality traits. Findings underscore the necessity of continued emphasis on developing and implementing early interventions for childhood emotional abuse and therapeutic interventions for borderline personality traits in reducing AUD among vulnerable women in Nepal.