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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: Borderline personality disorder (BPD) is associated with heightened impulsivity, evidenced by increased substance abuse, self-harm, and suicide attempts. Addressing impulsivity in individuals with BPD is a therapeutic objective, but its underlying neural basis in this clinical population remains unclear, partly due to its frequent comorbidity with attention-deficit/hyperactivity disorder (ADHD)., Methods: We used a response inhibition paradigm-the interleaved pro-/antisaccade task-among adolescents diagnosed with BPD with and without comorbid ADHD (n = 25 and n = 24, respectively) during concomitant video-based eye tracking. We quantified various eye movement response parameters reflective of impulsive action during the task, including delay to fixation acquisition, fixation breaks, anticipatory saccades, and direction errors with express saccade (saccade reaction time: 90-140 ms) and regular saccade latencies (saccade reaction time > 140 ms)., Results: Individuals with BPD exhibited deficient response preparation, as evidenced by reduced visual fixation on task cues and greater variability of saccade responses (i.e., saccade reaction time and peak velocity). The ADHD/BPD group shared these traits and made more anticipatory responses and direction errors with express saccade latencies and reduced error correction., Conclusions: Saccadic deficits in BPD and ADHD/BPD stemmed not from an inability to execute antisaccades but rather from inadequate preparation for the upcoming task set. These distinctions may arise due to abnormal signaling in cortical areas like the frontal eye fields, posterior parietal cortex, and anterior cingulate cortex. Understanding these mechanisms could provide insights into targeted interventions focusing on task set preparation to manage response inhibition deficits in BPD and ADHD/BPD., (Crown Copyright © 2024. Published by Elsevier Inc. 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).)

Psychosis can be considered a dimension that in its most severe extreme can be expressed with alterations in sensory perception, mainly hallucinations. Their presence is a fact that is frequently observed in severe psychiatric pathologies such as schizophrenia (EZQ) and bipolar disorder (BD) where they can be markers of severity. However, sensory-perceptual disturbances are not pathognomonic of these disorders, nor do they signal any of these illnesses as an isolated event. Such symptomatology can be described in a variety of situations both within and outside psychopathology. In this sense, proposing a direct line between hallucinations and diseases such as CZS or TB disregards their occurrence in other pathologies, as is the case of Borderline Personality Disorder (BPD). It is feasible that we may find the expression of pseudo hallucinations or hallucinations in patients with this disorder and their presence may have etiological, clinical and therapeutic connotations that should be reviewed and taken into account in our clinical practice., (CC BY NC ND)

Background: Those with cooccurring antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are reported to be highly psychopathic and to represent a severe challenge to treatment efforts. In a sample of such individuals, the effects of two treatments, mentalization-based therapy (MBT) and the unified protocol (UP), were investigated on three outcomes: (i) the psychopathy trait domains of meanness, boldness and disinhibition proposed by the triarchic psychopathy model (TPM); (ii) antisocial and borderline symptom severity; and (iii) the severity of their common features including impulsivity, anger expression and self-harm., Methods: Of 163 individuals with BPD + ASPD screened for eligibility, 55 were randomized to MBT treatment and 53 to UP treatment. Outcomes of treatment were assessed at 6-month intervals to 36 months., Results: Short-term reductions were seen following both treatments in traits of psychopathy, antisocial and borderline personality symptom severity, anger dysregulation, impulsivity and self-harm, but both treatment groups showed almost complete relapse of symptoms at the 36-month follow-up. UP had more durable effects than MBT., Conclusions: Despite being a considerably shorter treatment, UP was at least as effective as MBT and in some respects superior. Remission of symptoms was not achieved by either treatment in the long term. Psychopathy and borderline/antisocial comorbidity with which it is associated are to some extent remediable through psychotherapy, but only in the short term., Clinical Implications: Patients with high levels of impulsivity and disinhibition are likely to relapse following psychotherapy and should be closely monitored after treatment., (© 2024 John Wiley & Sons Ltd.)

This article describes the 1-year follow-up of a study into the effectiveness of Schema Therapy (ST) for borderline personality disorder (BPD) and comorbid alcohol use disorder (AUD). In the original study, 20 of these patients participated in a multiple baseline case series design study. The results of the original study were promising (a significant decrease of BPD and AUD symptoms). The present study is aimed at examining the longer term benefits of ST for BPD and comorbid AUD. One year after the cessation of the investigational therapy, 17 of the original participants agreed to participate in this follow-up study. T- or Wilcoxon signed rank tests were performed to compare 1-year follow-up to start of therapy (baseline). The results suggest that the main therapeutic improvements were generally preserved at 1-year follow-up. These findings add to the idea that integrated ST for BPD and comorbid AUD might be effective, also in the long term. A randomized clinical trial is indicated to substantiate this idea., (© 2024 The Author(s). Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Introduction: Cognitive impairment associated with borderline personality disorder (BPD) has been consistently demonstrated. However, a specific neuropsychological profile has not yet been established for this disorder, maybe due to the heterogeneity of BPD. The aim of this work is the search for distinct neuropsychological subtypes among patients with BPD and for the association of neuropsychological subgroups with specific clinical characteristics., Methodology: One hundred fifteen patients with BPD diagnosis received an extensive neuropsychological evaluation assessing attentional, memory and executive functions indexes. For subtyping strategies, a cluster analysis of neuropsychological BPD distribution was performed. Central clinical dimensions of BPD were measured and analysed in relation with the obtained neuropsychological clusters., Results: Two clusters were found: Cluster 1 showed a significantly lower score on the working memory index, and Cluster 2 had significantly worse overall executive performance, response inhibition and planning abilities. Patients in the neurocognitive Cluster 2 showed significantly higher clinical deficits of attention as measured with subscales of the CAARS attention deficit hyperactivity disorder (ADHD) index (F = 2.549, p < 0.005, d = 11.49)., Conclusions: Two neuropsychological clusters of patients were found in the BPD sample: Cluster 1 patients showed greater impairment in working memory, while Cluster 2 patients had greater deficits of executive functioning, particularly for response inhibition and planning. In addition, BPD patients with greater executive deficits presented greater levels of ADHD clinical features. These findings might also facilitate earlier diagnosis of severe BPD patient profiles and to establish more personalized treatment based on neurocognitive stimulation., (© 2024 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Increased schizotypal traits have previously been associated with atypical semantic cognition in community samples. However, no study has yet examined whether adults diagnosed with schizotypal personality disorder (SPD) display atypical semantic fluency and memory. We hypothesized that 24 adults diagnosed with SPD would name more idiosyncratic words on the semantic fluency task and show decreased semantic recall for animal and fruit category words compared with 29 participants with borderline personality disorder (BPD) and a community sample of 96 age-matched controls. We examined whether atypical semantic cognition was specifically associated with disorganized and eccentric speech and thinking, or more broadly with pathological personality traits and personality functioning. Our main hypothesis was confirmed, as the SPD participants named more idiosyncratic words and recalled fewer semantically related words compared with controls. Surprisingly, participants with BPD likewise named more atypical words compared with controls. More idiosyncratic semantic fluency was associated with more eccentric speech and thinking. Increased idiosyncratic semantic fluency and reduced semantic recall were both coupled to increased detachment and lowered personality functioning, while reduced semantic recall further was related to increased interpersonal problems. Our findings suggest that persons with SPD, and to a lesser degree BPD, show atypical semantic cognition, which is associated with eccentric speech and thinking, and more broadly with impaired personality function, social withdrawal, and emotional flatness. The idiosyncratic semantic cognition may worsen difficulties with social reciprocity seen in SPD and BPD.

Individuals with borderline personality disorder (BPD) often report chronic, severe self-hatred. It is frequently experienced as immutable, seen as a barrier to recovery, and is associated with risk for self-injury and suicide attempts. Yet self-hatred remains a poorly understood, underdiagnosed, and undertreated presentation of BPD. In this concept article and review, we describe the nature of self-hatred in BPD and related disorders, propose a theory as to the development of self-hatred in BPD, review the assessments of and interventions for self-hatred, and consider next steps in the research, assessment, and treatment of self-hatred in BPD. Through increased awareness, understanding, and measures of self-hatred in BPD, new treatment paradigms can be developed to ensure more comprehensive recovery.

Background: One in five young people with first-episode psychosis (FEP) also presents with borderline personality disorder (BPD) features. Among people diagnosed with BPD, auditory verbal hallucinations occur in 29-50 % and delusions in 10-100 %. Co-occurrence of psychotic symptoms and BPD is associated with greater clinical severity and greater difficulty accessing evidence based FEP care. This study aimed to investigate psychotic symptoms and psychosocial functioning among young people presenting to an early intervention mental health service., Method: According to the presence or absence of either FEP or BPD, 141 participants, aged 15-25 years, were assigned to one of four groups: FEP, BPD, combined FEP + BPD, or clinical comparison (CC) participants with neither FEP nor BPD. Participants completed semi-structured diagnostic interviews and interviewer and self-report measures of psychopathology and psychosocial functioning., Results: The FEP + BPD group had significantly more severe psychopathology and poorer psychosocial functioning than the FEP group on every measure, apart from intensity of hallucinations. Comparing the FEP or BPD groups, the BPD group had greater psychopathology, apart from intensity of psychotic symptoms, which was significantly greater in the FEP group. These two groups did not significantly differ in their overall psychosocial functioning. Compared with CC young people, both the FEP + BPD and BPD groups differed significantly on every measure, with medium to large effect sizes., Conclusions: Young people with co-occurring FEP and BPD experience more severe difficulties than young people with either diagnosis alone. This combination of psychosis and severe personality pathology has been longitudinally associated with poorer outcomes among adults and requires specific clinical attention., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Bipolar disorder and borderline personality disorder commonly co-occur. Each disorder is associated with substantial morbidity and mortality, which are worsened by co-occurrence of the disorders. Emotional dysregulation, suicidality, and disrupted circadian rhythm are key aspects of psychopathology associated with both conditions. A novel psychotherapy combining elements of two evidence-based treatments (i.e., dialectical behavior therapy [DBT] for borderline personality disorder and social rhythm therapy [SRT] for bipolar disorder) is described. Unlike either treatment alone, the new therapy, called dialectical behavior and social rhythm therapy (DBSRT), targets all three disease-relevant processes and therefore may represent a promising new approach to treatment for individuals with these two conditions. DBSRT may also have utility for individuals with overlapping characteristics of bipolar disorder and borderline personality disorder or for those whose illness manifestation includes a mix of bipolar and borderline personality disorder traits. Strategies associated with DBSRT are described, and a brief case vignette illustrates its application., Competing Interests: Dr. Swartz is Editor of the journal; she reports receiving royalties from UpToDate (Wolters Kluwer) and the American Psychiatric Association and has served as a consultant to the Clinical Education Alliance, Intra-Cellular Therapies, Mediflix, Medscape (Internet Brands/WebMD), and Physicians Postgraduate Press. The other authors report no financial relationships with commercial interests. Lisa O’Donnell served as decision editor during peer review of the manuscript.

Existing literature on the effects of borderline personality disorder (BPD) and eating disorder (ED) comorbidity in terms of clinical presentation and treatment outcome has been limited and inconclusive. The present study examined whether clients with EDs and varying levels of BPD symptoms presented with more severe ED symptoms at admission, and whether they responded to dialectical behavior therapy (DBT)-based treatment. Participants ( N = 176) were adults in a DBT-based partial hospitalization program for EDs at an academic medical center. Participants completed self-report measures at admission, 1-month postadmission, discharge, and 6-month follow-up. Results suggested that patients with elevated BPD symptoms at admission had greater ED symptoms during treatment, evidenced by small to moderate effect sizes. However, patients with high BPD symptoms demonstrated steeper declines in binge eating, fasting, and parasuicidal behavior early during treatment compared to patients with low BPD symptoms. Individuals with high BPD symptoms at admission (i.e., probable BPD diagnosis) were as likely to meet remission criteria and relapse as individuals with low BPD symptoms, though this null finding may be influenced by small cell sizes. Our findings also suggest that DBT skills use does not predict changes in symptoms. In sum, our findings suggest that while clients with higher BPD symptoms may improve during DBT-based partial hospitalization, their ED symptoms may remain more severe. Future studies are needed to determine whether adjunctive treatments improve outcomes for clients with EDs and comorbid BPD symptoms in DBT programs and whether skills use quality is a better predictor of ED symptom changes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Results of studies concerning a possible beneficial effect of Intranasal-Oxytocin (IN-OT) as an add-on treatment for patients with major depression (MDD) have been inconsistent. One possible explanation to account for the difference in the effect of IN-OT is comorbid borderline personality disorder (BPD). This randomized controlled study was aimed to explore the differential effect of IN-OT administration among depressive patients with or without comorbid borderline personality disorder., Methods: A secondary analysis was conducted on a specific subset of patients who participated in an RCT evaluating the impact of IN-OT as add-on treatment for patients with severe mental illness. Patients treated in inpatient settings (N = 58) were randomized and double-blindly allocated to receive twice daily IN-OT (32 IU) or placebo for a period of four weeks. The effect of IN-OT on therapy process and outcome was examined among patients with (n = 35) and without (n = 23) comorbid BPD., Results: An interaction effect between diagnosis and group was observed on the Outcome Questionnaire-45 (B = 8.93, p = .007). Further analysis revealed that patients without BPD demonstrated significantly greater improvements following OT administration (B = -8.32, p = .001), whereas patients with BPD did not show significant improvement (B = 0.61, p = .76). The interactive pattern was also observed in the Hopkins Symptom Checklist (B = 0.25, p = .02), where patients without BPD demonstrated significantly larger improvements following OT administration (B = -0.29, p = .0009) as compared to placebo, while patients with BPD demonstrated no significant improvement (B = -0.04, p = .55). We did not find a harmful effect of IN-OT administration among patients with MDD and comorbid BPD., Conclusions: Patients with MDD and comorbid BPD benefit less from IN-OT administration as compared to depressed patients without BPD. Future studies should aim to identify patients who are more likely to benefit from IN-OT administration., Competing Interests: Declaration of competing interest The study was supported by a research grant from the American Psychological Foundation. Sponsors had no role in the in the preparation of data or the manuscript. The authors of this manuscript have no conflict of interest to declare regarding this manuscript. Prof. Dana Tzur Bitan received a research grant from Pfizer and from the American Psychological Foundation., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objectives: Co-occurrence of Anorexia Nervosa (AN) and borderline personality disorder (BPD) is frequent (8%-40%) and associated with specificities that impact the treatment process. Lifetime history of suicide attempt (HAS), substance use disorder (SUD) and the binge-purging subtype (B-P) might be good markers of such comorbidity. We made the hypothesis that in patients with AN, the presence of HAS, SUD and B-P have sufficient predictive power to efficiently detect an associated BPD comorbidity., Methods: After a case report analysis on a pilot sample of 119 patients with AN, we performed a cross-sectional analysis on a confirmatory sample of 84 patients with AN in a single center specialized in eating disorders systematically assessing HAS, SUD, B-P and BPD using the Mini International Neuropsychiatric Interview for DSM-5 and the Diagnostic Interview for Borderline (DIB-R)., Results: B-P had a 100% negative predictive value, and the combination of SUD plus HAS had a 100% positive predictive value. On a quantitative level, B-P, HAS and SUD were independent explanatory factors of the DIB-R total score., Conclusions: The main limitations were the low number of patients, the single center analyses, the potential overlapping of assessments and the fact that data were exclusively declarative. In this study, every patient with B-P, SUD and HAS had been diagnosed with BPD., (Copyright © 2022 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objective: To investigate associations between patients with borderline personality disorder (BPD)-related symptoms and their hospital presentations as well as the effect of inpatient length of stay (LOS) on time to hospital re-presentation., Methods: A retrospective cohort design was used to investigate mental health emergency department (ED) visits and inpatient admissions. The cohort comprised 13,320 men and 12,290 women with a follow-up period between January 1, 2014, and December 31, 2019., Results: Across all presentations in the study period, approximately 4% of mental health patients were discharged from ED or inpatient admission with primary diagnosis of BPD. Both male and female patients with BPD were at higher risk of hospital re-presentation when compared to patients with any other type of mental disorder ( P  < .01). Patients with BPD who had LOS > 14 days in their first inpatient admission were, on average, more likely to experience a repeat ED or inpatient presentation 58 days sooner than patients who had LOS < 2 days ( P  = .036)., Conclusions: Findings suggest the need for ( a ) more accurate recording of BPD and related presentations, ( b ) more in-depth investigations of BPD care pathways, and ( c ) identifications of subpopulations who may benefit from a specific inpatient length of stay., Prim Care Companion CNS Disord 2024;26(1):23m03559 ., Author affiliations are listed at the end of this article., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

Objective: Borderline personality disorder (BPD) with auditory hallucinations (AHs) may inadvertently be misdiagnosed with a primary psychotic disorder, such as schizophrenia (SZ). This misidentification can lead to challenges in providing effective psychological treatment. This review therefore aims to identify the phenomenological characteristics of AHs in BPD in comparison to SZ, as well as psychological interventions that explicitly target AHs in BPD., Methods: A systematic review was conducted to summarise the existing evidence base regarding the phenomenological similarities and differences of AHs in BPD and SZ, along with the identification of psychological interventions for AHs in BPD., Results: Eighteen studies were eligible for inclusion. Compared to the SZ group, BPD clients were characterised by more persistent and repetitive AHs, significantly more voice-related distress and appraisals of omnipotence, and an earlier age of onset of AHs. The BPD group also reported more severe depression and anxiety, a higher incidence of childhood trauma, and more negative self-schema. Cognitive Behaviour Therapy Coping Strategy Enhancement (CBT-CSE) might be a promising intervention to reduce AH-related distress in BPD, although further studies are required to determine its effectiveness., Conclusion: In order to prevent misdiagnosis of AHs in BPD, the DSM-5 may need to acknowledge the broader and more frequent occurrence of psychosis symptoms in BPD clients. Such clarification may enhance diagnostic practices and facilitate more timely access to treatment. There is also a need to develop and trial psychological interventions that explicitly target AHs in BPD., (© 2024 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Objective: To estimate the prevalence of alexithymia and self-harm in patients with borderline personality disorder (BPD). To assess the role of alexithymia in the emergence of self-harm in patients with BPD., Material and Methods: We studied 104 patients (85 women, 19 men aged 21 to 25 years (64.4%)), including 54 patients with and 50 patients without BPD. Most of them had incomplete higher education (55%). We used the Russian version of the 20-item Toronto Alexithymia Scale (TAS-20) to reveal alexithymia and SCID - II to diagnose BPD. The presence of self-harm behavior was confirmed by the subjects' anamnesis data., Results: The prevalence of alexithymia in patients with BPD was 83.3%, in the control group it was 52% ( p =0.001). The prevalence of self-aggression was 70.3% ( n =38) in patients with BPD, and 12% ( n =6) in people without BPD. Self-harm among persons with alexithymia was noted in 62.5% ( n =45). During the analysis, a connection between auto-aggression and alexithymia was found at the level of a statistical trend ( p =0.051)., Conclusion: Alexithymia and self-harm are more common in patients with BPD than in healthy people. This type of emotional dysregulation mediates self-harm in patients with BPD.

Treating chronic illness requires ongoing patient-provider cooperation, but individual differences in patients' negative perceptions of care can undermine this cooperation. Research suggests people high on borderline personality disorder (BPD) features may react negatively to and comply less with mental health and medical treatment. This might be particularly problematic in chronic pain treatment, where BPD features are over-represented and the dysregulation typifying BPD likely undermines consistent care. In a sample of 147 chronic pain patients, we investigated whether higher levels of BPD features - both in general and by specific facets - predicted worse perceptions of treatment and lower patient-reported compliance with treatment recommendations. Participants higher (vs. lower) on borderline features viewed treatment more negatively but did not report complying less with recommendations. We found evidence that this may reflect the unstable relationships facet of BPD. Our results indicate that, consistent with other treatment settings, BPD features may undermine care for chronic pain. Furthermore, our results highlight the importance of collaborative provider-patient relationships and patient agreement with the treatment of chronic pain, particularly among individuals higher on BPD features.

Interpersonal difficulties in borderline personality disorder (BDP) have been suggested to be related to impairments in Social Cognition (SC), mainly due to deficits in Theory of Mind (ToM). However, literature is scarce and ambiguous. This work aims to study the SC impairments in BPD patients, by the specific assessment of ToM deficits, and to investigate the relationship between these SC impairments and clinical variables. 82 BPD patients with BPD and 47 control subjects were assessed with the Movie for the Assessment of Social Cognition (MASC). Clinical variables of severity, chronicity, functionality and anxious-depressive symptomatology were recorded. BPD patients had fewer correct mentalization responses and more overmentalization, undermentalization, and absence of mentalization errors than controls. Chronicity was negatively correlated with overmentalization and positively correlated with undermentalization and absence of mentalization errors. Functionality was indirectly correlated with absence of mentalization. These results confirm previous reports of alterations in SC in BPD patients. Furthermore, this study shows that SC impairments in patients with BPD are dependent on characteristics such as chronicity or degree of functionality. The different ToM profiles in patients with BPD indicate the necessity of developing variants of mentalization therapy depending on the deficits of each patient., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jose L. Carrasco reports financial support provided by Carlos III Health Institute. Alejandra Galvez-Merlin reports a relationship with Universidad Complutense de Madrid, Department of Psychiatry, Faculty of Medicine that includes predoctoral grant. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Non-suicidal self-injurious behavior (NSSI) is the core characteristic of adolescent borderline personality disorder (BPD) and visual working memory is involved in the pathological processes of BPD. This study aimed to investigate alterations in white matter microstructure and their association with NSSI and visual working memory in adolescents with BPD., Methods: 53 adolescents diagnosed with BPD and 39 healthy controls (HCs) were enrolled. White matter microstructure was assessed with the fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor imaging (DTI). Correlation analysis was performed to assess the association between FA/MD and core features of BPD. A mediation analysis was performed to test whether the effects of white matter alterations on NSSI could be mediated by visual working memory., Results: Adolescents with BPD showed a reduced FA and an increased MD in the cortical-limbic and cortical-thalamus circuit when compared to the HCs (p < 0.05). Increased MD was positively correlated with NSSI, impulse control and identity disturbance (p < 0.05), and was negatively correlated with the score of visual reproduction. Reserved visual working memory masked the effects of white matter microstructural alterations on NSSI behavior., Conclusions: White matter microstructural deficits in the cortical-limbic and cortical-thalamus circuits may be associated with NSSI and visual working memory in adolescents with BPD. Reserved visual working memory may protect against NSSI., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Emotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), whose aetiology has been attributed to biosocial factors. In autism spectrum condition (ASC), although ED is prevalent and is associated with decreased well-being (e.g. self-harm, suicidality), it has been understudied, especially in adults. It is therefore crucial to further understand ED in autistic adults to improve its treatment. Our study investigates ED, its behavioural correlates (e.g. self-harm, suicidality) and biosocial predictors in autistic adults relative to BPD and nonclinical controls (NC)., Methods: A total of 724 participants (ASC = 154; BPD = 111; NC = 459) completed 11 self-reported questionnaires assessing ED, ASC and BPD traits, co-occurring disorders, alexithymia, emotional vulnerability and invalidating experiences (e.g. bullying, autistic camouflaging). The occurrence of ED behavioural correlates (i.e. self-harm, history of suicide attempts, and psychiatric hospitalizations) was collected. In addition, between-groups analyses, linear regressions and machine learning (ML) models were used to identify ED predictors in each group., Results: ED and its behavioural correlates were higher in ASC compared to NC, but milder than in BPD. While gender did not predict ED scores, autistic women had increased risk factors to ED, including sexual abuse and camouflaging. Interestingly, BPD traits, emotional vulnerability and alexithymia strongly predicted ED scores across the groups. Using ML models, sensory sensitivity and autistic camouflaging were associated with ED in ASC, and ADHD symptoms with ED in BPD., Limitations: ASC and BPD diagnoses were self-reported, which did not allow us to check their accuracy. Additionally, we did not explore the transactional and the moderating/mediating relationships between the different variables. Moreover, our research is cross-sectional and cannot draw conclusions regarding the direction and causality of relationships between ED and other clinical dimensions., Conclusions: ED and its behavioural correlates are heightened in BPD compared to ASC and nonclinical controls. In the ASC group, there were no gender differences in ED, despite the heightened exposure of autistic women to ED risk factors. BPD traits, emotional vulnerability, and alexithymia are core to ED regardless of diagnosis. Although less central, sensory sensitivity and autistic camouflaging seem to be specific predictors of ED in autistic adults., (© 2023. The Author(s).)

The present study examines the 8-year course of physical pain and its interference with functioning in patients with borderline personality disorder (BPD) and a comparison group of patients with other personality disorders (other-PD). Participants completed the Brief Pain Inventory (BPI) at five assessments, each separated by 2 years. Results showed that across all 13 domains assessed, participants with BPD reported significantly higher levels of acute physical pain and its functional interference than other-PD comparison subjects. The severity of physical pain and its interference with multiple domains of functioning were relatively stable over 8 years of assessment for both study groups. Within the BPD group, pain was significantly associated with older age, comorbid major depressive disorder (MDD), and history of a physically violent partner. Taken together, these results suggest that physical pain is a serious health issue for individuals with BPD that interferes with functioning across a wide spectrum of areas.

Objectives: Borderline personality disorder (BPD) and bipolar disorder (BD) often co-occur and frequently do not respond adequately to traditional antidepressant treatments. Ketamine has shown rapid antidepressant and anti-suicidal effects. However, there is limited literature on the safety and tolerance of using ketamine to treat patients with comorbid BD and BPD., Methods: This case presents a female patient diagnosed with both Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) who received intravenous ketamine treatment to alleviate acute depressive symptoms., Results: Initially, ketamine ameliorated depressed symptoms. However, as the ketamine treatment continued, the patient showed an increase in nonsuicidal self-injury (NSSIs) and impulsive conduct with a aggravation of dissociative symptoms. As a result, intravenous ketamine was discontinued, and the patient received the medication, which proved helpful., Conclusions: Although ketamine presents antidepressant properties, reports on its impact on emotional dysregulation and impulsive conduct are unclear and not alike to its antidepressant effect. Therefore, there is a need for more studies investigating the effectiveness and safety of this rapid-acting medicine in this patient population.

Introduction: This work aims to demonstrate, through the International Affective Picture System (IAPS) responses, an altered emotional pattern in borderline personality disorder (BPD) patients and to find a specific emotional response pattern by understanding their relationship with traumatic experiences and attachment bonds towards their primary caregivers., Method: A total of 50 BPD patients and 39 control patients were evaluated using the IAPS, and its assessment was carried out through the Self-Assessment Manikin (SAM). Paternal and maternal attachment bonds as well as traumatic experiences in BPD patients were evaluated. Statistical associations were analysed in the different variables., Results: Significant differences between BPD and control patients were found in all emotional response components for pleasant, unpleasant and neutral images (p < .01), with one exception, the arousal in pleasant images. Patients' experience of traumatic experiences was positively related to scores on the happiness component of pleasant imagery (p = .057) and on the arousal component of unpleasant imagery (p = .058). Poorer maternal bonding in BPD patients was significantly related to lower scores on happiness (p < .01) and dominance (p < .05) components of pleasant imagery and all emotional response components for unpleasant imagery (p < .01)., Conclusions: The results of the study confirm an impaired emotional response pattern in patients with borderline personality disorder (BPD), showing an emotional response to pleasant images similar to that of depression, while the pattern found to unpleasant images could be related to the complex trauma observed in these patients, which includes PTSD experiences such as sexual abuse and attachment trauma experiences., (© 2023 John Wiley & Sons Ltd.)

Introduction: In this study, we introduce the concept of comorbidity between factitious disorder (FD), borderline personality disorder (BPD), dysthymia (DY), medically unexplained physical symptoms (MUPS) and functional neurological disorder (FND) characterising patients who may tend to exaggerate physical or psychiatric symptoms of presentation to a general or psychiatric hospital with a constellation of signs that do not receive confirmation from further clinical and instrumental assessments. The similarities between these syndromes and the constant presence of borderline personality in the psychopathology make it the possible link between all these syndromes., Materials and Methods: The authors captured the typical appearance and characterisation of FD-BPD-DY-MUPS-FND (Com-1) syndrome in adult and non-forensic acute psychiatric hospitals in the United Kingdom (UK) and adjacent liaison psychiatric teams through case vignettes. Each case vignette merged similar clinical cases and was cross-analysed using information from various mental health and medical professionals and bridging primary and secondary carers' records., Results: The findings suggest striking similarities between the syndromes making borderline personality the bridge pathology for FD, MUPS and FND. The complexity of the diagnosis of these cases is discussed in the study, together with prototypical presentations., Conclusions: Improving the management of these often-occurring diseases requires multidisciplinary coordination across psychiatry, general care, neurology and surgery departments.

Schizophrenia-spectrum psychopathology appears best understood as being expressed across a continuum of clinical and subclinical symptoms and impairment referred to as schizotypy. This brief report describes a comprehensive replication study examining the associations of positive, negative, and disorganized schizotypy with interview ratings of impairment, psychopathology, and personality pathology in a sample of 161 young adults. Consistent with past studies, positive, negative, and disorganized schizotypy had distinct and hypothesized associations with symptoms and impairment. Positive schizotypy was associated with prodromal symptoms and schizotypal, paranoid, and borderline personality traits. Negative schizotypy was associated with impaired functioning, negative symptoms, and schizoid, schizotypal, and paranoid traits, as well as any broad personality disorder diagnosis; it was also associated with never having dated. Disorganized schizotypy was associated with impaired functioning, disorganized schizotypic experiences, attentional deficits, and schizotypal, paranoid, borderline, and avoidant personality traits, as well as depression. Overall, we successfully replicated findings from five previous schizotypy interview studies, supporting the construct validity of the multidimensional model of schizotypy and the Multidimensional Schizotypy Scale. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The objective of this work is the creation of specific indices of the different executive functions (EF).

Moral injury (MI) has received increased research attention in the past decades. However, despite its detrimental mental health consequences, MI has not been studied in psychiatric patients. We aimed to establish the relationship between childhood trauma, MI, and borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and disturbances in self-organization symptoms (DSO), a core diagnostic criterion of complex PTSD besides PTSD symptoms, and shame as a moral emotion in an inpatient psychiatric sample ( N = 240). We found that the impact of childhood trauma on present BPD, PTSD, and DSO symptoms was mediated by MI and shame; the models accounted for up to 31% of variance in symptomatology. To our knowledge, this study is the first to investigate MI in a psychiatric sample, and our results highlight the importance of considering MI as a critical factor of patient experiences in relation to childhood trauma that potentially contributes to the development of psychiatric symptoms.

Emotion dysregulation is central to borderline personality disorder (BPD) and exacerbated by sleep disruptions. This study investigated whether homeostatic (i.e., sleep efficiency), circadian (i.e., chronotype), and subjective (i.e., sleep quality) sleep elements predict emotion dysregulation in BPD, healthy controls (HCs), and a generalized anxiety disorder (GAD) group. Participants (N = 120) with BPD, GAD, and HCs completed daily sleep measures for seven days prior to an experiment wherein baseline emotion, emotional reactions to stressors (i.e., reactivity), and the extent to which they can decrease their emotion using mindfulness and distraction (i.e., emotion regulation) were measured across self-reported, sympathetic, and parasympathetic emotion. Across groups, earlier chronotypes and higher sleep quality predicted less self-reported baseline negative emotion, and higher sleep quality predicted better parasympathetic emotion regulation. For HCs, higher sleep efficiency and lower sleep quality predicted higher parasympathetic baseline emotion, and higher sleep efficiency predicted more self-reported baseline negative emotion. Also in HCs, earlier chronotype predicted better sympathetic emotion regulation, and there was a quadratic relationship between sleep efficiency and self-reported emotion regulation. Optimizing sleep quality and improving alignment between chronotype and daily living may improve baseline emotion and emotion regulation. Healthy individuals may be particularly vulnerable to high or low sleep efficiency., Competing Interests: Declaration of Competing Interest We have no known conflicts of interest to disclose. The Toronto Metropolitan University research ethics board approved study procedures (insert #REB number 2015-001)., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Rationale: Refeeding syndrome (RS) is a fatal condition caused by rapid calorie intake during starvation. Self-neglected fasting in psychiatric disorders is associated with RS. However, overeating resulting from circumventing the clinician's instructions does not have a reportedly high risk of RS., Patient Concerns: A 47-year-old undernourished woman with borderline personality disorder was hospitalized for nausea, vomiting, and diarrhea., Clinical Findings: She had not eaten much for 10 days and had lost weight (56.5-51.1 kg) over 3 weeks. No abnormalities were indicated on physical examination and imaging examinations., Diagnoses, Interventions, and Outcomes: Infectious diseases and malignancies were excluded from the differential diagnosis. On the third day of admission, the patient's serum phosphorus level significantly decreased to 0.7 mg/dL, and additional sodium phosphate was administered intravenously. On the fourth day, despite our instructions, the patient was found to be eating nonhospital food from the first day of admission. In conjunction with her history, a final diagnosis of RS was made. After appropriate treatments, the patient was discharged on the 15th day of hospitalization. The patient's nausea, vomiting, and diarrhea were improved., Lessons: When undernourished patients have psychiatric disorders, including borderline personality disorder or schizophrenia, the occurrence of RS should be considered based on the patients' poor adherence to physicians' instructions., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Borderline personality disorder (BPD) is common among people diagnosed with first episode of psychosis (FEP), but is often under-recognized and under-researched. This study aimed to determine: (i) the prevalence of borderline personality pathology (subthreshold features and categorical disorder) in a FEP cohort (termed FEP + BPP); (ii) demographic and clinical factors associated with FEP + BPP; (iii) the symptomatic and functional outcomes., Methods: This study was conducted within the Early Psychosis Prevention and Intervention Centre (EPPIC) at Orygen over the 30-month period between 2014 and 2016. BPP was evaluated by using the Structured Clinical Interview for DSM-IV Axis II Personality Questionnaire BPD criteria., Results: In a cohort of 457 young people with a FEP (mean age 19.5 years, 56% male), 18.4% had borderline personality pathology (BPP). Compared with FEP alone, young people with FEP + BPP were more likely to be female, younger, Australian-born. In addition, young people with FEP + BPP were more likely to be diagnosed with Psychosis NOS, present with more severe hallucinations, and have alcohol abuse. Young people with FEP + BPP had more relationship difficulties at presentation and they were more likely to suffer of depression and to engage in self-harm throughout the follow-up. In relation to outcome, FEP + BPP was not associated with different rates of remission or relapse, however they were less likely to be admitted to hospital at presentation or involuntarily during their episode of care., Conclusion: BPP is a common occurrence in psychotic disorders and is associated with more severe hallucinations and depression with higher risks of self-harm. Specific interventions need to be developed., (© 2022 John Wiley & Sons Australia, Ltd.)

Abstract: Major depressive disorder (MDD) commonly coincides with borderline personality disorder (BPD), aggravating depressive symptom severity and reducing the odds of responding to antidepressant treatments. In this systematic review, we summarize the available evidence assessing the question whether the presence of BPD reduces the response to electroconvulsive therapy (ECT) in individuals with MDD.We conducted a systematic literature search (up to December 2021) without language restriction, using the PubMed/MEDLINE, Web of Science (Core Collection), Embase, and Cochrane Library databases, for prospective and retrospective studies, which assessed the efficacy of ECT in patients with MDD and comorbid BPD.Of the 2548 records screened, 6 articles were selected, 2 of which were based on the same population, leading to 5 included articles. The included studies are reporting on 3465 patients with MDD, of which 1206 had a comorbid BPD. Five of the 6 studies found a less robust response to ECT in patients with MDD and BPD compared with those without BPD.Our results suggest that, in patients with MDD, the presence of BPD is associated with a less robust acute response to ECT. Patients with BPD, however, showed a significant response to ECT in all of the included studies. More longitudinal studies with higher accuracy in BPD diagnosis are needed. Although a comorbid BPD seems to decrease the efficacy of ECT for MDD, ECT remains an effective treatment option in this severely ill patient group., Competing Interests: The authors have no conflicts of interest or financial disclosures to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives : Gender differences are poorly investigated in patients with borderline personality disorder (BPD), although they could be useful in determining the most appropriate pharmacological and non-pharmacological treatment. The aim of the present study was to compare sociodemographic and clinical characteristics and the emotional and behavioral dimensions (such as coping, alexithymia, and sensory profile) between males and females with BPD. Material and Methods : Two hundred seven participants were recruited. Sociodemographic and clinical variables were collected through a self-administered questionnaire. The Adolescent/Adult Sensory Profile (AASP), Beck Hopelessness Scale (BHS), Coping Orientation to Problems Experienced (COPE), and Toronto Alexithymia Scale (TAS-20) were administered. Results : Male patients with BPD showed more involuntary hospitalizations and greater use of alcohol and illicit substances compared to females. Conversely, females with BPD reported more frequent medication abuse than males. Furthermore, females had high levels of alexithymia and hopelessness. Regarding coping strategies, females with BPD reported higher levels of "restraint coping" and "use of instrumental social support" at COPE. Finally, females with BPD had higher scores in the Sensory Sensitivity and Sensation Avoiding categories at the AASP. Conclusions : Our study highlights gender differences in substance use, emotion expression, future vision, sensory perception, and coping strategies in patients with BPD. Further gender studies may clarify these differences and guide the development of specific and differential treatments in males and females with BPD.

High comorbidity between borderline personality disorder (BPD) and eating disorders (ED) shows the necessity of developing transdiagnostic models, where impulsivity could play a relevant role in the manifestations of self-injurious behaviour.

Borderline personality disorder (BPD) has high rates of comorbidity with mood disorders, including treatment-resistant depression (TRD). Comorbidity of BPD with depression is associated with poorer response to antidepressants. Intravenous ketamine is a novel treatment for TRD that has not been specifically evaluated in patients with comorbid BPD. In this retrospective analysis of data collected from participants who received care at the Canadian Rapid Treatment Centre of Excellence (CRTCE; Braxia Health; ClinicalTrials.gov: NCT04209296), we evaluated the effectiveness of intravenous ketamine in a TRD population with comorbid BPD (N=100; n=50 BPD-positive compared with n=50 BPD-negative). Participants were administered four doses of intravenous ketamine (0.5-0.75mg/kg over 40 minutes) over two weeks. The primary outcome measures were changes in depressive symptom severity (as measured by Quick Inventory of Depressive Symptomatology-Self Report 16-item (QIDS-SR 16 )) and borderline symptom severity (as measured by Borderline Symptom List 23-item (BSL-23)). Both BPD-positive and BPD-negative groups improved significantly on the QIDS-SR 16 , QIDS-SR 16 suicide ideation item, anxiety, and functionality scales with large effect sizes. There was no significant difference between groups. The BPD-positive group exhibited significant reduction of 0.64 on BSL-23 scores and a significant reduction of 5.95 on QIDS-SR 16 scores. Patients with TRD and comorbid BPD receiving ketamine exhibited a significant reduction in symptoms of depression, borderline personality, suicidality, and anxiety., Competing Interests: Declaration of Competing Interest Dr. Joshua D Rosenblat has received research grant support from the Canadian Institute of Health Research (CIHR), Physician Services Inc (PSI) Foundation, Labatt Brain Health Network, Brain and Cognition Discovery Foundation (BCDF), Canadian Cancer Society, Canadian Psychiatric Association, Academic Scholars Award, American Psychiatric Association, American Society of Psychopharmacology, University of Toronto, University Health Network Centre for Mental Health, Joseph M. West Family Memorial Fund and Timeposters Fellowship and industry funding for speaker/consultation/research fees from iGan, Boehringer Ingelheim, Janssen, Allergan, Lundbeck, Sunovion and COMPASS. He is the Chief Medical and Scientific Officer of Braxia Scientific and the medical director of the Canadian Rapid Treatment Centre of Excellence (Braxia Health). Kevin Kratiuk is the Vice President of Operations at Braxia Health and is a shareholder of Braxia Scientific Corp. Dr. Roger McIntyre has received research grant support from Global Alliance for Chronic Diseases/Canadian Institutes of Health Research (CIHR)/National Natural Science Foundation of China's Mental Health Team Grant; speaker/consultation fees from Lundbeck, Janssen, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Abbvie. Dr. Roger McIntyre is a CEO of Braxia Scientific Corp. Kayla M. Teopiz has received personal fees from Braxia Scientific Corp. All other authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: Non-suicidal self-injury (NSSI) is common among adolescents and has been linked to mental disorders and suicide in addition to physical injuries. According to the empirical avoidance model, adolescents with NSSI have stronger emotional affect and poorer emotional regulation than those without NSSI, and these constitute core features of borderline personality disorder (BPD). The relationship between borderline personality features, emotional regulation, and NSSI in the population is unclear. This study explored these associations to provide a theoretical basis for the treatment of NSSI in the future., Methods: Depressed adolescents (n = 1192) were evaluated using Chinese versions of the Function Assessment of Self-mutilation Scale, Emotional Regulation Questionnaire for Children and Adolescents, and Borderline Personality Features Scale for Children., Results: The majority of depressed adolescents (71.3%, 850/1192) had demonstrated NSSI in the past year, with cutting or scratching being the most common form (57.4%). Pearson correlation analysis with NSSI as a fixed factor (NSSI = 1, no NSSI = 2) revealed a negative correlation between NSSI and borderline personality features (r = -0.314, P < 0.01) but a positive correlation between NSSI and emotional regulation capacity (r = 0.159, P < 0.01), which was positively correlated with the expression suppression dimension (r = 0.079, p < 0.01); however, there was no significant correlation between the cognitive reappraisal dimension and expression suppression (r = 0.022, p > 0.05). The occurrence of NSSI was also positively correlated with borderline personality features in general (r = 0.314, p < 0.01). These results were statistically significant. Emotional regulation played a mediating role between borderline personality traits and NSSI in adolescents with depression (effect value = 0.151)., Conclusion: Borderline personality features and emotional regulation ability were significantly correlated with NSSI in depressed adolescents. Borderline personality symptoms not only directly influenced NSSI risk in adolescents with depression, but also indirectly influenced NSSI risk through emotional regulation., (© 2023. The Author(s).)

Importance: Borderline personality disorder (BPD) affects approximately 0.7% to 2.7% of adults in the US. The disorder is associated with considerable social and vocational impairments and greater use of medical services., Observations: Borderline personality disorder is characterized by sudden shifts in identity, interpersonal relationships, and affect, as well as by impulsive behavior, periodic intense anger, feelings of emptiness, suicidal behavior, self-mutilation, transient, stress-related paranoid ideation, and severe dissociative symptoms (eg, experience of unreality of one's self or surroundings). Borderline personality disorder is typically diagnosed by a mental health specialist using semistructured interviews. Most people with BPD have coexisting mental disorders such as mood disorders (ie, major depression or bipolar disorder) (83%), anxiety disorders (85%), or substance use disorders (78%). The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse. Psychotherapy is the treatment of choice for BPD. Psychotherapy such as dialectical behavior therapy and psychodynamic therapy reduce symptom severity more than usual care, with medium effect sizes (standardized mean difference) between -0.60 and -0.65. There is no evidence that any psychoactive medication consistently improves core symptoms of BPD. For discrete and severe comorbid mental disorders, eg, major depression, pharmacotherapy such as the selective serotonin reuptake inhibitors escitalopram, sertraline, or fluoxetine may be prescribed. For short-term treatment of acute crisis in BPD, consisting of suicidal behavior or ideation, extreme anxiety, psychotic episodes, or other extreme behavior likely to endanger a patient or others, crisis management is required, which may include prescription of low-potency antipsychotics (eg, quetiapine) or off-label use of sedative antihistamines (eg, promethazine). These drugs are preferred over benzodiazepines such as diazepam or lorazepam., Conclusions and Relevance: Borderline personality disorder affects approximately 0.7% to 2.7% of adults and is associated with functional impairment and greater use of medical services. Psychotherapy with dialectical behavior therapy and psychodynamic therapy are first-line therapies for BPD, while psychoactive medications do not improve the primary symptoms of BPD.

Patients with co-occurring substance use disorders and borderline personality disorder have high rates of morbidity, mortality, and utilization of medical services. Their acute symptoms present complex challenges to clinical staff in the medical emergency department related to both logistics and management of countertransference. This article examines patterns in countertransference and proposes application of psychodynamically informed principles and strategies to facilitate safety and enhance communication during fraught clinical encounters., Competing Interests: The authors report no financial relationships with commercial interests.

Aim: This exploratory study reports on borderline symptomatology within a sample of individuals at clinical high risk for psychosis (CHR-P) through a validated, self-report instrument, the short version of the Borderline Symptom List (BSL-23)., Methods: The sample consisted of 44 help-seeking CHR-P youth (ages 14-29 years) who completed an initial evaluation at a specialized clinic for psychosis-risk., Results: The mean BSL-23 score was 1.5 (SD = 1.0, range 0.1-4.0). Higher scores were strongly associated with greater reported depressive symptoms (r = 0.84, p < 0.001). Additionally, borderline symptoms associated with attenuated positive symptoms (r = 0.32, p = 0.034) and social anxiety (r = 0.34, p = 0.027). Borderline symptomatology was not associated with role or social functioning., Conclusions: This study is one of the first examinations of borderline symptomatology within a CHR-P sample through a validated self-report measure. Future research replicating these results is required to determine their robustness., (© 2022 John Wiley & Sons Australia, Ltd.)

Background: Dialectical Behaviour Therapy for Posttraumatic Stress Disorder (DBT-PTSD) is a phase-based treatment for PTSD. The DBT-PTSD treatment programme's efficacy has not been tested during standard operation, outside of laboratory outcome studies. Objective: The present pilot study investigated the transportability of the DBT-PTSD treatment to a real word clinical setting in a residential mental health centre. Methods: The DBT-PTSD treatment was compared to a treatment as usual (TAU) condition in a non-randomized study. Overall, 156 patients from a residential mental health centre were included. Propensity score matching was used to match participants in the two treatment arms based on baseline characteristics. Primary and secondary outcomes (PTSD and other symptoms) were assessed at the time of admission and at the time of discharge. Results: The DBT-PTSD treatment outperformed the TAU condition in the improvement of all primary outcomes, as indicated by a significant time and group interaction. There were notable differences in the effect sizes between the unmatched and matched sample as well as between the available and the intent-to-treat (ITT) data analyses. The effect sizes in the ITT data analyses were much lower. Both treatment groups showed similar improvements in secondary outcomes. Conclusions: This study provides initial evidence for the transportability of the DBT-PTSD treatment to a naturalistic clinical care setting, but with considerably lower effect sizes than in previously published laboratory RCTs. The higher efficacy of DBT-PTSD compared to TAU may largely depend on patient's adherence to treatment.

Background: Borderline personality disorder (BPD) is one of the most common personality disorders among persons with substance use disorders (SUDs) and is characterized by severe clinical symptoms. The aim of this study was to investigate if the effect of dialectical behavior therapy for substance use disorders (DBT-S) inpatient treatment on psychopathological symptom load in patients suffering from both BPD and SUD can be augmented by weekly 60-min "Trauma Informed Hatha Yoga" sessions., Materials and Methods: Thirty-nine patients suffering from comorbid BPD and SUD were consecutively in time included in this quasi-experimental pilot study (first intervention then control group). In the intervention group, weekly Trauma Informed Hatha Yoga sessions were added to standard DBT-S for 8 weeks. The participants of the control group received standard DBT-S. All participants completed several self-report questionnaires to assess symptoms of depression, anxiety, symptoms of BPD, and their subjective stress perception at three points in time during the study course., Results: A repeated measures analysis of variance with patients' psychopharmacological medication as covariate revealed a significant main effect of time for each of the psychometric scales (State and Trait Anxiety Inventory subscale for state anxiety [STAI-S] p = 0.001, Beck Depression Inventory [BDI] p < 0.001; Borderline Symptom List 23 [BSL] p = 0.036) indicating that the psychopathological symptom load of the patients was significantly lower at the end of the DBT-S therapy compared to the beginning in both study groups. Moreover, there was a significant interaction effect of group*time on the psychometric scales STAI-T (subscale for trait anxiety) sum score (p = 0.010) and the sum score of the Perceived Stress Scale (PSS) (p = 0.043). This was expressed by the fact that the participants of the intervention group showed a significant reduction of the STAI-T sum score as well as the sum score of the Perceived Stress Scale (PSS), while the control group did not. Due to the exploratory nature of this study, correction for multiple testing was omitted., Conclusion: Although they are very preliminary, our results suggest that practicing Trauma Informed Hatha Yoga on a regular basis in addition to DBT-S inpatient treatment seems to reduce the level of trait anxiety and perceived stress significantly more than DBT-S inpatient treatment alone. Nevertheless, the effectiveness of Trauma Informed Hatha Yoga in reducing trait anxiety and perceived stress in patients suffering from SUD und BPD must be tested in large randomized controlled trials., (© 2022 S. Karger AG, Basel.)

Introduction: Auditory verbal hallucinations (AVH) are transdiagnostic phenomena that can occur in several mental disorders, including borderline personality disorder (BPD). Despite the transdiagnostic relevance of these symptoms, very little is known about neural signatures of AVH in BPD., Methods: We used structural magnetic resonance imaging to investigate multiple markers of brain morphology in BPD patients presenting with a lifetime history of AVH (AVH, n = 6) versus BPD patients without AVH (nAVH, n = 10) and healthy controls (HC, n = 12). The Computational Anatomy Toolbox (CAT12) was used for surface-based morphometric analyses that considered cortical thickness (CTh), gyrification (CG), and complexity of cortical folding (CCF). Factorial models were used to explore differences between AVH patients and HC, as well as between the patient groups., Results: Compared to HC, AVH patients showed distinct abnormalities in key regions of the language network, i.e., aberrant CTh and CG in right superior temporal gyrus and abnormal CCF in left inferior frontal gyrus. Further abnormalities were found in right prefrontal cortex (CTh) and left orbitofrontal cortex (CCF). Compared to nAVH patients, individuals with AVH showed abnormal CTh in right prefrontal cortex, along with CCF differences in right transverse temporal, superior parietal, and parahippocampal gyri. CG differences between the patient groups were found in left orbitofrontal cortex., Conclusion: The data suggest a transdiagnostic neural signature of voice-hearing that converges on key regions involved in speech generation and perception, memory and executive control. It is possible that cortical features of distinct evolutionary and genetic origin, i.e., CTh and CG/CCF, differently contribute to AVH vulnerability in BPD., (© 2023 S. Karger AG, Basel.)

Background: Emotion dysregulation is increasingly recognized as highly prevalent and impairing in autistic individuals. Yet, a large majority of studies have considered emotion dysregulation in youth only, and most of them did not consider sex differences in emotion dysregulation manifestation., Objectives: In the present study, we aim to investigate sex differences relative to emotion dysregulation in autistic adults without intellectual disability as well as its relationship with different factors potentially involved in emotion dysregulation (e.g. camouflaging, alexithymia, suicidality, quality of life). Self-reported emotion dysregulation will be assessed in autistic adults but also in females with borderline personality disorder, given that emotion dysregulation is particularly enhanced in this population., Design: Cross-sectional, prospective, controlled., Methods: Twenty-eight autistic females, 22 autistic males and 24 females with borderline personality disorder were recruited from a dialectical behavior therapy program waiting list. They completed several self-report questionnaires measuring emotion dysregulation, alexithymia, suicidality, quality of life, camouflaging borderline symptoms and autism severity., Results: Most emotion dysregulation subscale scores and alexithymia scores were heightened in autistic females compared to females with borderline personality disorder and, to a lesser extent, compared to autistic males. Independently of borderline personality disorder symptoms, emotion dysregulation was related to alexithymia and poorer psychological health in autistic females, whereas it was mostly related to autism severity, poorer physical health and living conditions in autistic males., Conclusion: Our results suggest that emotion dysregulation is a major difficulty of autistic adults without intellectual disability eligible for dialectical behavior therapy, and this is especially the case for autistic females. There seem to be different sex-specific factors involved in emotion dysregulation found in autistic adults, which highlight the need to target-specific domains (e.g. alexithymia) in the treatment of emotion dysregulation in autistic females. ClinicalTrials.gov Identifier: NCT04737707 https://clinicaltrials.gov/ct2/show/NCT04737707.

Personality disorders are characterized by "ego-syntonic" maladaptive behaviors that impair functioning. This contribution outlines the relevant characteristics and approach to patients with personality disorders pertaining to the dermatology setting. For patients with Cluster A personality disorders (paranoid, schizoid, and schizotypal), it is crucial to avoid being overly contradictory of eccentric beliefs and to take a straightforward, unemotional approach. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Promoting safety and boundaries is paramount when interacting with patients with an antisocial personality disorder. Patients with borderline personality disorder have higher rates of various psychodermatologic conditions and benefit from an empathetic approach and frequent followup. Patients with borderline, histrionic, and narcissistic personality disorders all have higher rates of body dysmorphia, and the cosmetic dermatologist needs to avoid unnecessary cosmetic procedures. Patients with Cluster C personality disorders (avoidant, dependent, and obsessive-compulsive) often have significant anxiety associated with their illness and may benefit from extensive and clear explanations of their condition and management plan. Due to the challenges posed by these patients' personality disorders, they are often undertreated or receive poorer quality care. Although it is essential to acknowledge and address challenging behaviors, their dermatologic concerns should not be dismissed., (Copyright © 2023 Elsevier Inc. All rights reserved.)

We present a case illustrating common challenges in the hospital management and treatment of comorbid borderline personality disorder and substance use disorders. Experts in the field of personality disorders and substance use disorders discuss various topics and strategies for patient-centered management. Key learning points include evaluation and diagnosis of borderline personality disorder, good psychiatric management, withdrawal and pharmacologic management, harm reduction, team dynamics, and behavior planning all in the hospital setting. This paper provides actionable considerations with elements common to many clinical encounters that present challenges to the consultation-liaison psychiatrist in the general hospital setting., (Copyright © 2022 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of the present study was to investigate the risk of nonremission following electroconvulsive therapy (ECT), as associated with borderline personality disorder, in individuals with major depression in the context of the contradictory data available in the literature., Methods: We analyzed demographic and clinical data from 210 individuals with major depression who were treated with ECT. Study participants were recruited from the medical records database of the Psychiatry Department at Erasme Hospital. Only individuals with major depression who were in remission, as demonstrated during the systematic psychiatric interview performed at the end of ECT (ie, with a >60% reduction in their 24-item Hamilton Depression Rating Scale score, combined with a score of <10), were included in the "remission" group. Logistic regression analyses were used to determine the risk of nonremission following ECT., Results: Nonremission following ECT occurred frequently (42.9%) in our sample. Moreover, after adjusting for major confounding factors, multivariate logistic regression analyses demonstrated that borderline personality disorder was a risk factor for nonremission following ECT in individuals with major depression., Conclusions: We demonstrated that borderline personality disorder was associated with a higher risk of nonremission following ECT in individuals with major depression. This finding seems to justify more systematic screening as well as more adequate management of this personality disorder in individuals with major depression who are treated with ECT to allow for attaining better remission rates in this subpopulation., Competing Interests: The authors have no conflicts of interest or financial disclosures to report., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)