Advances in Borderline Personality Disorder: From Early Detection to Treatment

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Psychiatric Diseases".

Deadline for manuscript submissions: 15 August 2024 | Viewed by 6311

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Guest Editor
Centro Psicologia Dinamica, Universitas Mercatorum, 00186 Rome, Italy
Interests: affective neuroscience; emotion regulation; psychotherapy; psychopathology
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Special Issue Information

Dear Colleagues,

Borderline personality disorder (BPD) is a complex disorder with large inter-individual variability in symptom profiles, which may include impaired relatedness (unstable relationships with others, identity disturbance, and chronic emptiness), affective dysregulation (affective liability, excessive anger, and efforts to avoid abandonment), and behavior dysregulation (impulsivity, suicidality, and self-injurious behavior). The problematic nature of BPD is characterized by self-mutilation, suicide attempts, addictions, and episodes of depression, anxiety, and aggression, which produce substantial healthcare-related and social-related costs. Psychotherapy is considered the primary treatment for BPD, and this is effective in reducing overall borderline personality disorder severity. Affective neurosciences have shown functional impairment associated with BPD in the default mode network (DMN), the salience network (SN), and the central executive network (CEN), accounting for disturbances in emotion regulation, social cognition, and all emotion-related functions. Consistently, early evidence has reported effects of treatments in these neural systems. The scope of this Special Issue is to provide a venue for the dissemination of research findings from the study of brain mechanisms in BPD and its treatment, including studies focused on concepts that may have clinical implications for the treatment of BPD (for example, emotion regulation/dysregulation, self-harm, social cognition, and others). We encourage the submission of original articles based on experimental research and neuroimaging studies applying novel techniques, as well as review articles and meta-analyses, which may enhance the understanding of processes and mechanisms underlying and maintaining BPD.

Dr. Irene Messina
Guest Editor

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Keywords

  • borderline
  • psychotherapy
  • neuroimaging
  • treatment
  • early detection

Published Papers (4 papers)

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Research

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20 pages, 2748 KiB  
Article
Short- and Long-Term Outcomes of an Adventure Therapy Programme on Borderline Personality Disorder: A Pragmatic Controlled Clinical Trial
by Alba Gabarda-Blasco, Aina Elias, Mariona Mendo-Cullell, Laura Arenas-Pijoan, Carles Forné, David Fernandez-Oñate, Laura Bossa, Aurora Torrent, Xavier Gallart-Palau and Iolanda Batalla
Brain Sci. 2024, 14(3), 236; https://doi.org/10.3390/brainsci14030236 - 29 Feb 2024
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Abstract
Adventure Therapy (AT) is a therapeutic intervention utilizing the natural environment and adventure activities as tools for psychotherapeutic interventions. It has been demonstrated to be appropriate for the intervention of patients with borderline personality disorder (BPD). This study aims to evaluate the response [...] Read more.
Adventure Therapy (AT) is a therapeutic intervention utilizing the natural environment and adventure activities as tools for psychotherapeutic interventions. It has been demonstrated to be appropriate for the intervention of patients with borderline personality disorder (BPD). This study aims to evaluate the response to AT treatment compared with the response to treatment as usual (TAU), based on cognitive behavioural therapy, in the short and long term, assessing clinical, psychosocial, and functional outcomes; quality of life; and physical health levels. This study extends the sample of and is a follow-up to a pilot study published in 2021, with a sample of 30 patients in the AT group and 10 in the control group. It does not allow us to affirm that AT provides better outcomes than TAU, as the positive effects observed immediately after therapy seem to be attenuated in the long term. Therefore, the effectiveness of long-term psychotherapy did not show differences between AT and TAU therapies in the treatment of BPD patients. However, the effects of intangibles observed during therapy by professionals and patients were not reflected in the measurements collected. Therefore, we believe it is necessary to increase the programme duration, complement treatment with a specific physical health programme, assess results with more specific instruments, and/or move towards a qualitative methodology to measure perceived changes in clinical improvement. New studies are needed to evaluate the results of the proposed changes. Full article
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17 pages, 685 KiB  
Article
“Holding in Anger” as a Mediator in the Relationship between Attachment Orientations and Borderline Personality Features
by Irene Messina, Pietro Spataro, Sara Sorella and Alessandro Grecucci
Brain Sci. 2023, 13(6), 878; https://doi.org/10.3390/brainsci13060878 - 29 May 2023
Cited by 1 | Viewed by 1110
Abstract
Insecure attachment and difficulties in regulating anger have both been put forward as possible explanations for emotional dysfunction in borderline personality (BP). This study aimed to test a model according to which the influence of attachment on BP features in a subclinical population [...] Read more.
Insecure attachment and difficulties in regulating anger have both been put forward as possible explanations for emotional dysfunction in borderline personality (BP). This study aimed to test a model according to which the influence of attachment on BP features in a subclinical population is mediated by anger regulation. In a sample of 302 participants, BP features were assessed with the Borderline features scale of the Personality Assessment Inventory (PAI-BOR), attachment was measured with the Experiences in Close Relationships-12 (ECR-12), and trait anger and anger regulation were assessed with the State and Trait Anger Expression Inventory-2 (STAXI-2). The results indicated that anger suppression emerged as a significant mediator of the associations between both anxious and avoidant attachment and BP traits, while anger control resulted as a marginal mediator in the association between attachment avoidance and BP. Suppressing anger may reflect different forms of cognitive or behavioural avoidance of anger, which may differ on the basis of attachment orientations. We argue that these results may have important clinical implications: the promotion of anger regulation in BP should be considered a critical treatment goal. Full article
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Review

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17 pages, 350 KiB  
Review
Mentalizing in Adolescents with Borderline Personality Disorder
by Magdalena Uzar, Monika Dmitrzak-Węglarz and Agnieszka Słopień
Brain Sci. 2023, 13(10), 1473; https://doi.org/10.3390/brainsci13101473 - 18 Oct 2023
Cited by 1 | Viewed by 1953
Abstract
Mentalizing, recognized as the capacity to understand behaviors in the context of our own mental states and those of other people, is being researched more and more commonly in regard to various mental disorders. The research on mentalization focuses on, among other things, [...] Read more.
Mentalizing, recognized as the capacity to understand behaviors in the context of our own mental states and those of other people, is being researched more and more commonly in regard to various mental disorders. The research on mentalization focuses on, among other things, borderline personality disorder, which is at present perceived as an emerging problem in the population of adolescents. In order to summarize the currently accessible knowledge of mentalizing in adolescents with borderline personality disorder, we thoroughly analyzed relevant publications. Based on the available literature, it can be concluded that the mentalizing ability of adolescents with borderline personality disorder can be impaired. The evidence demonstrates that they are prone to hypermentalizing, defined as an overattribution of mental states to other people. However, this tendency has not been proven to be specific to teenagers with this disorder. Moreover, the existing data suggest that young people with borderline personality exhibit a reduced capacity to mentalize their own inner states. Full article

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15 pages, 299 KiB  
Case Report
May Female Autism Spectrum Be Masked by Eating Disorders, Borderline Personality Disorder, or Complex PTSD Symptoms? A Case Series
by Barbara Carpita, Benedetta Nardi, Cristiana Pronestì, Francesca Parri, Federico Giovannoni, Ivan Mirko Cremone, Stefano Pini and Liliana Dell’Osso
Brain Sci. 2024, 14(1), 37; https://doi.org/10.3390/brainsci14010037 - 30 Dec 2023
Cited by 1 | Viewed by 1844
Abstract
Introduction: The prevalence of Autism Spectrum Disorder (ASD) is four times higher in males than females; however, females are significantly more likely to go undiagnosed due to the existence of a “female autistic phenotype”, a manifestation unique to females that conflicts with conventional, [...] Read more.
Introduction: The prevalence of Autism Spectrum Disorder (ASD) is four times higher in males than females; however, females are significantly more likely to go undiagnosed due to the existence of a “female autistic phenotype”, a manifestation unique to females that conflicts with conventional, masculine conceptualizations of ASD. Furthermore, subthreshold autistic traits, which exert a significantly negative impact on quality of life and represent a vulnerability factor for the development of other psychopathological conditions, may remain even more under-recognized. Subsequently, many women with ASD may never receive a diagnosis or any resulting care, with serious consequences for their health. Aims: We aimed to describe two brief cases in order to confirm the diagnostic difficulties that ASD female undergo during their clinical evaluation and the possible alternative phenotype that they can manifest. Methods: We reported the cases of two young women on the autism spectrum that came to clinical attention only after the development of severe symptomatology attributed to other mental disorders, overlooking the presence of underlying autism spectrum features and a brief résumé of the literature on this topic. Results: These cases confirm the need for a timely and proper identification of females on the autism spectrum in order to prevent complications and improve the outcome. Conclusions: Research on gender differences could lead to a reexamination of the sex ratio in the prevalence of ASD and provide a better understanding of several psychiatric conditions that are frequently diagnosed in women, supporting the neurodevelopmental approach to psychopathology. Full article
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