Objective Small-scale studies have shown that the next-of-kin of individuals with Borderline Personality Disorder (BPD) face elevated risk of symptoms of mental illness. Little is known about whether these increased symptoms correspond to psychiatric disorders. The aim of this study was to examine the risk of psychiatric disorders, use of psychotropic medication, and utilization of psychiatric care in the next-of-kin of individuals with BPD. Methods Individuals diagnosed with BPD in Sweden, from 2011‐01-01 to 2022-12-31, were matched (1:3) by age and sex to individuals without BPD. The study and control cohorts comprised the first-degree relatives and spouses of individuals with BPD and matched controls (n = 24,769 vs n = 77,728). Cox proportional hazards and Poisson regression models assessed associations between having a next-of-kin with BPD and outcome measures during five years post index. Results After adjustment for potential confounders, the next-of-kin in the BPD cohort exhibited an increased risk of any of the included disorders (HR 2.08; 95% CI 1.94–2.24), as well as higher rates of psychiatric care utilization (IRR 2.21; 95% CI 2.13–2.29), including inpatient care (IRR 2.23; 95% CI 2.02–2.47), and psychotropic medication use (HR 1.75; 95% CI 1.65–1.85), compared with the next-of-kin in the control cohort. Conclusion In this nationwide study, the next-of-kin of individuals with BPD exhibited increased risk of psychiatric disorders, higher use of psychotropic medication, and greater utilization of psychiatric care. This study highlights the need of adequate care for individuals with BPD and emphasizes the importance of providing support to their next-of-kin.
Background Maladaptive daydreaming refers to excessive, immersive, and difficult-to-control fantasy that may interfere with functioning. It can be conceptualized as a maladaptive form of affect regulation with addictive features that vary in severity, including impaired control, increasing prioritization, and persistence despite harm. This preregistered study examined the population distribution, functional impact, provisional screening thresholds, and correlates of severity of addictive features of maladaptive daydreaming in a nationally representative Polish adult sample. Methods A quota-based online sample (N = 1072) completed the Addictive Daydreaming Scale (ADS) and the Difficulties in Emotion Regulation Scale. Single items assessed life satisfaction and daydreaming-related functional impact; sociodemographic, health care, and medication data were collected. Results Approximately 3% of participants reported that daydreaming negatively affected their professional or private life to a large or very large extent. ADS scores were positively associated with self-reported functional impact and emotion dysregulation, and negatively associated with age and life satisfaction. In hierarchical regressions, the final models explained 33.2% and 29.9% of the variance in ADS-20 and ADS-5 scores, respectively. Emotion dysregulation was the strongest independent correlate in both models, with younger age and poorer subjective financial situation also consistently associated with higher scores. Conclusions Addictive features of maladaptive daydreaming are detectable in the general population and vary dimensionally. The 3% estimate should be interpreted as a provisional self-report indicator of problematic daydreaming rather than diagnostic prevalence. Future two-stage studies should combine ADS screening with structured clinical interviews and assessment of functional impairment and psychiatric comorbidity.
Background and aims Previous studies suggest that altered implicit and explicit cognitive processes in individuals with substance-related and behavioral addictions influence the development and maintenance of these disorders. Based on the Interaction of Person-Affect-Cognition-Execution model, the present research project investigates how disorder-specific implicit cognitions contribute to the development and persistence of addictive behaviors. Methods The study involved 103 treatment-seeking patients with Internet Gaming Disorder, Gambling Disorder, or Alcohol Use Disorder. In addition, 40 healthy participants served as a control group. Implicit addiction-related cognitions were assessed using a modified Implicit Association Test. Decision-making processes in response to addiction-related imagery were assessed using a modified Iowa Gambling Task, which was supplemented by addiction-specific and addiction-unspecific stimuli. Results Patients with Internet Gaming Disorder showed significantly stronger positive implicit associations with gaming-related cues than patients with Gambling Disorder, Alcohol Use Disorder, and healthy controls in the Implicit Association Test. In the Iowa Gambling Task, patients with Gambling Disorder achieved the lowest total profits and selected significantly fewer advantageous decks than healthy controls and patients with Alcohol Use Disorder. Conclusions The findings indicate disorder-specific cognitive patterns in both substance-related and behavioral addictions. Internet Gaming Disorder was characterized by stronger positive implicit associations, whereas Gambling Disorder showed significantly poorer decision-making performance. These results suggest distinct underlying cognitive mechanisms and highlight the relevance of tailored therapeutic interventions.
Background The US Veterans Health Administration (VHA) has almost twenty years of experience implementing trauma-focused psychotherapies (TFPs) for posttraumatic stress disorder (PTSD). Yet, the potential of TFPs to alleviate the burden of PTSD has not been fully realized. Previous reviews focused primarily on clinician uptake and patient perceptions of TFPs with limited examination of service delivery challenges. Methods This narrative review summarizes the evidence describing practice gaps specific to TFPs within VHA, factors that contribute to these evidence gaps, and recommends strategies and research to address modifiable contributing factors. Results TFP practice gaps include limited or variable reach to patients, high dropout, and reduced effectiveness compared to randomized clinical trials. Contributing factors span patient, clinician, and healthcare organizational levels. To bridge these practice gaps, we recommend: (1) Taking patient preference and heuristic approaches to treatment decisions into account; (2) Testing novel strategies to augment patient sustained engagement through treatment completion; (3) Developing empirically adapted clinician training and consultation programs; (4) Designing clinics to facilitate delivery of these proven interventions; (5) Developing scheduling and other organizational strategies to facilitate an adequately intensive treatment course; (6) Enhancing local leadership support and the implementation climate for TFPs; and (7) Evaluating how clinician burnout symptoms impact treatment delivery and outcomes. Conclusions Narrowing the research-to-practice gap for TFPs within VHA requires addressing multi-level determinants to maximize patient engagement and facilitate effective intervention delivery. Without optimizing the conditions for intervention delivery, TFPs will remain limited in their capacity to reduce the systemic burden of PTSD.
