Despite increased interest in clients’ subjective experiences of recovery from borderline personality disorder (BPD), qualitative research exploring how Dialectical Behavior Therapy (DBT) therapists conceptualize recovery and its relationship to DBT’s overarching treatment goal, “a life worth living,” remains scarce. The aim of the present study was to explore DBT therapists’ descriptions of recovery sufficient for treatment termination in clients with BPD, as well as to examine its relation to the concept of a life worth living. Eight semi-structured interviews with DBT therapists were conducted and analyzed using reflexive thematic analysis. Therapists described recovery as a transition from suffering to a life of normal freedom, viewed as an individual process in which clients at treatment termination had ceased self-destructive behaviors and acquired skills, leading to changes in self-image and self-acceptance and enabling the creation of a stable and viable way of life. Therapists perceived recovery and a life worth living as mutually reinforcing processes. The results emphasize early integration of clients’ goals and values in DBT and clarify recovery at treatment termination as a clinically sufficient foundation for a life worth living, contributing to a practice-informed operationalization of recovery within DBT. Not applicable.
Individuals with Borderline Personality Disorder (BPD) and Complex Post-Traumatic Stress Disorder (C-PTSD) often face significant challenges in treatment due to the severity and complexity of their symptoms. Dialectical Behavior Therapy for PTSD (DBT-PTSD) is a phase-based, multicomponent psychotherapy developed to address the needs of this population. While its efficacy has been demonstrated in clinical trials, little is known about how patients and clinicians experience this treatment. This qualitative study explored the perspectives of six patients and five clinicians involved in DBT-PTSD at a university-affiliated mental health institute. Data were collected through individual interviews and focus groups at multiple time points and were analyzed inductively using Reflexive Thematic Analysis. Five themes were generated, including trauma-focused exposure as a main mechanism of change, the role of the therapeutic alliance in supporting engagement and treatment outcomes, the demanding nature of trauma-focused exposure, the tension between fidelity and flexibility within the protocol, and the influence of individual resources on patients’ experiences with at-home assignments. This is the first study to qualitatively examine DBT-PTSD, providing insights into its perceived relevance, challenges, and potential impact. These findings may contribute to clinical training, guide adaptations of the protocol, and contribute to refining trauma interventions for individuals with BPD and C-PTSD. This trial was retrospectively registered on 14 August 2025, ClinicalTrials.gov, TRN: NCT07123974
This study evaluated whether Obsessive-Compulsive Personality Disorder (OCPD) is associated with impairments across multiple domains of psychosocial functioning, and whether such impairments vary as a function of treatment-seeking status, specific psychopathological features, and social-cognitive response patterns. Global, social-occupational, relational and empathic functioning, perceived quality of life, rigidity and perfectionism were compared among 39 outpatients with OCPD, 36 non-clinical OCPD individuals (NC-OCPD) and 80 healthy controls (HC). Participants then completed two virtual ball-toss paradigms: Cyberball, assessing distress following excessive social closeness (overinclusion) relative to fair inclusion and exclusion, and Cybershape, assessing distress in response to rule-violation scenarios relative to fair play. OCPD showed greater psychosocial impairment and worse quality of life compared to the other groups, as well as lower perspective taking and higher personal distress than HC. Both OCPD and NC-OCPD reported higher rigidity and perfectionism than HC, but OCPD also had higher rigidity than NC-OCPD. Rigidity had stronger correlations with functional impairment than perfectionism and correlated with decreased perspective taking. Following Cyberball, both OCPD and NC-OCPD showed higher negative emotions than HC after the overinclusion condition, but only OCPD reacted more negatively than HC to standard social inclusion, and this difference was associated with increased personal distress. Following Cybershape, OCPD reported that even the fair-play condition violated their expectations. Conversely, NC-OCPD reported greater distress in response to rule violations than HC throughout the task. Treatment-seeking OCPD individuals show greater psychosocial impairment and rigidity than both NC-OCPD and HC, along with heightened sensitivity to both excessive and normal interpersonal closeness and a tendency to perceive even normative social contexts as violating their expectations. Conversely, NC-OCPD individuals maintain levels of functioning comparable to HC but remain distressed by excessive interpersonal closeness and by situations requiring adherence to explicit behavioral rules. Overall, these findings indicate that the severity of OCPD pathology modulates functional outcomes, with rigidity playing a central role in psychosocial impairment, and point to specific social-cognitive patterns associated with psychosocial difficulties in OCPD.
Aggression is a key factor in various mental health problems including personality disorders, underscoring the importance of effective interventions for regulating or preventing aggression. Positive psychology suggests that promoting prosocial emotions such as joy and compassion may help to buffer against aggression. This experimental study examined (1) whether joy- or compassion-based writing exercises can buffer against anger and aggression in response to provocation, (2) whether trait prevention focus (a self-regulation style focused on avoiding negative outcomes) influences these effects, and (3) how positive and negative affect evolve over time. A total of N = 148 university students were randomly assigned to one of three writing interventions: joy, compassion, or a procedural control. After the writing task, participants were provoked by exposing them to unsolvable anagrams and a standardized provocation by a condescending confederate. Measures of anger, positive affect (PA), and negative affect (NA) were collected at baseline, post-intervention, and post-provocation. Behavioral aggression was assessed post-provocation, using the competitive reaction time task (CRTT). Controlling for baseline levels, neither joy or compassion significantly buffered against increased anger, NA, and behavioral aggression, or against decreased PA after provocation, compared to the control condition. However, affective trajectories differed by condition: In the joy condition, post-intervention PA was significantly higher (compared to the control condition) and NA significantly lower (compared to compassion and control). However, following provocation, PA dropped and NA rose significantly more sharply in the joy condition compared to the other conditions. Prevention focus did not moderate any outcomes. These findings suggest that brief joy and compassion interventions do not buffer against aggression. Compared to inducing compassion, inducing joy does lead to more immediate improved affect, though this impact is only short-lived, potentially illustrating an affective contrast effect. More research is needed to further explore timing, contrast, and longer-term mood effects of prosocial interventions as antidotes to aggression.
Mentalization-Based Treatment Introduction (MBT-I) is a psychoeducational group module preceding long-term Mentalization-Based Treatment (MBT) for patients with borderline personality disorder (BPD). MBT-I aims to increase knowledge of mentalizing and BPD, prepare patients for treatment, clarify diagnosis, and assess mentalizing capacities. However, empirical evidence remains limited. This study examined whether MBT-I was associated with improved mentalizing capacity and attainment of its clinical goals. A naturalistic, non-randomized one-group pre-post study was conducted in a Dutch mental health care institute. Patients attended ten weekly MBT-I group sessions. Of 60 patients included, 51 were analyzed. Most had a primary BPD diagnosis; others had personality disorders with comparable difficulties in relational functioning, self-image, and mentalizing. Mentalizing capacity was assessed using the Reflective Functioning Questionnaire, Interpersonal Reactivity Index, and Toronto Alexithymia Scale. MBT-I goals were measured using visual analogue scales. A trend was found for the TAS-20 subscale ‘Difficulty Identifying Feelings’. No significant differences were found between pre- and posttest on the RFQ, IRI, and the remaining subscales of the TAS-20. Significant differences were found comparing pre- and post-VAS scores with regard to the goals of MBT-I. MBT-I was not associated with statistically significant improvements across the outcome scales on mentalizing, but a promising trend emerged toward improved emotional awareness. The brief module appears to strengthen early prerequisites for mentalizing and offers clear psychoeducational value by increasing patient knowledge, rather than inducing changes in mentalizing. Future controlled studies are needed to clarify its incremental clinical benefit.
Abstract Background Borderline personality disorder (BPD) is characterized by severe emotional vulnerability, including heightened sensitivity, exaggerated reactivity, and delayed recovery from emotional arousal. Altered interoceptive-affective processing may contribute to these features. Transcutaneous auricular vagus nerve stimulation (taVNS) provides a non-invasive method for modulating vagal-afferent pathways involved in interoception and emotion regulation. This study examined whether active taVNS, relative to sham stimulation, was associated with lower self-reported negative affect during a video-based mood-induction paradigm in women with BPD. Methods Thirty-four female psychiatric outpatients with DSM-5 BPD were randomized to receive active taVNS or sham stimulation during a single-session experimental paradigm. Self-reported negative affect was assessed repeatedly using the Positive and Negative Affect Schedule (PANAS) Negative Affect scale. The primary analysis modeled PANAS Negative Affect across four collapsed task phases: Pre-Induction, Post-Neutral, Post-Negative, and Recovery-Negative, adjusting for baseline negative affect and stimulation intensity. Exploratory physiological analyses examined heart rate, lnRMSSD, phasic electrodermal activity (EDA) response frequency, and tonic skin conductance level. Results Active taVNS was associated with lower PANAS Negative Affect across the mood-induction paradigm compared with sham stimulation, Treatment Group: F(1, 36.44) = 5.74, p = 0.022. Negative affect varied significantly across task phases, F(3, 94.12) = 22.60, p < 0.001, confirming successful mood induction. The Treatment Group × Phase interaction was not significant, F(3, 94.12) = 0.75, p = 0.525. Exploratory physiological analyses showed no treatment-related effects on heart rate, lnRMSSD, or phasic EDA response frequency. Tonic skin conductance level showed no main effect of Treatment Group, but an exploratory Treatment Group × Epoch interaction. Conclusions In this preliminary single-session randomized sham-controlled study, active taVNS was associated with lower self-reported negative affect during a mood-induction paradigm in women with BPD. This subjective effect was not accompanied by treatment-related effects on heart rate, lnRMSSD, or phasic EDA response frequency, while the tonic skin conductance interaction should be interpreted cautiously as exploratory. These findings support further investigation of taVNS as a mechanistic probe of acute affective responding in BPD. Trial registration ClinicalTrials.gov NCT05892900. Retrospectively registered 7 June 2023.
Ostracism on social media is a common and emotionally salient stressor. However, its moment-to-moment psychological and behavioral consequences, remain poorly understood in individuals with Non-Suicidal Self-Injury (NSSI) and Borderline Personality Disorder (BPD). Using an Instagram-mimicking smartphone platform (Socializapp) coupled with Ecological Momentary Assessment (EMA), we examined responses to experimentally manipulated peer feedback across 7 days in three groups: healthy Controls (HC; n = 20), NSSI without BPD (NSSI; n = 18), and comorbid BPD+NSSI (n = 17). Participants were exposed to Inclusion, Partial Exclusion, and Exclusion conditions. Linear and generalized linear mixed-effects models tested within-person effects on perceived exclusion and approval, affective reactivity, objective engagement (Likes and Comments) and NSSI urges, with borderline traits (BPQ) modeled dimensionally. Compliance was high, supporting feasibility. The manipulation was perceived as intended, with perceived exclusion increasing and perceived approval decreasing stepwise from Inclusion to Partial and Full Exclusion across participants. Exclusion also increased negative affect, reduced positive affect, and suppressed effortful interaction (fewer comments). In exploratory analyses, Exclusion was associated with more than a threefold increase in the odds of reporting an NSSI urge, after adjusting for borderline severity. While the data more clearly supported a baseline negative appraisal bias associated with borderline severity (even under objectively favorable feedback) evidence for cross-level moderation effects remained inconclusive. Social media ostracism emerges as a relevant interpersonal stressor for individuals with NSSI, producing detectable shifts in online engagement and, in exploratory analysis, increases in self-harm urges and changes. Borderline severity tracked a sustained negative interpretation of social feedback, although potential moderation effects regarding exclusion reactivity remained inconclusive. These findings establish Socializapp as a feasible paradigm and highlight everyday digital social experiences as meaningful targets for understanding short-term fluctuations in NSSI vulnerability.
Borderline personality disorder (BPD) is among the most frequent, debilitating, and lethal mental conditions. Treatment for patients with BPD involves structured psychotherapy, but such treatment is often not readily available due to imbalances in supply and demand for care. Brief treatments that are available as first-line interventions may address this delay in care. No controlled study has assessed the effectiveness of brief psychiatric interventions, such as 10 sessions of Good Psychiatric Management (GPM) over 12 months follow-up, in comparison with treatment as usual. Whereas most psychotherapy studies in patients with BPD focus on symptom reduction at the end of treatment, more research is needed on the patients’ symptom levels after one year. The present study compares brief psychiatric treatment (4 months of GPM) with treatment as usual (4 months of TAU). Participants (N = 76 patients with BPD) undergo assessments at intake, after two months, at discharge (4 months) and 1 year follow-up (16 months after intake). At these four time-points, each patient was assessed using the clinician rated Zanarini BPD (ZAN-BPD) scale. The study found brief GPM to show significantly greater symptom reduction in ZAN-BPD scores between intake of 4-month treatment and 12-month follow-up (16 months later), compared to treatment as usual. This study shows that after one year, the effects of a brief psychiatric treatment are strengthened in both groups. Additionally, brief GPM presents an advantage in helping BPD patients make further progress after the intervention has ended, which potentially helps diminish the societal burden of disease related to BPD symptomatology.
This paper is a narrative review of the implementation trajectories Dialectical Behaviour Therapy in five countries, the UK, Germany Norway, Poland, and the Czech Republic in Europe over the past 30 years. The aim of this comparison is to identify common and divergent systems levels facilitators and hindrances of DBT implementation. DBT experts in each respective country were asked to provide a narrative account of their country’s implementation journey. Histories were then considered in accordance with existing DBT implementation frameworks. Common themes emerged such as the importance national guidelines on evidence-based treatment shape implementation, university affiliations promote dissemination, implementation and research activities, national societies help to create standards. There are common DBT implementation trajectories that exist across geography and nationally specific mental health care systems. The discussion of the refining of national DBT practices based on emerging literature and the importance of outcomes of implementation such as therapists’ behaviour or client related outcome data adds to existing information.
Borderline Personality Disorder (BPD) has been associated with a range of adverse experiences, including emotional, physical, and sexual abuse, neglect, invalidation, bullying, and unpredictable environments during childhood and adolescence (ACE). While these different forms of ACE often co-occur, most research has examined them in isolation, leaving unclear their interrelations and specific significance for BPD psychopathology. This study investigates the level of different forms of ACE exposure in BPD and clinical controls, whether they are differentially related to the severity of BPD symptoms and how they are inter-related with each other. Cross-sectional data were collected from individuals diagnosed with BPD (n = 171), clinical controls (CC; n = 93), and non-clinical controls (NC; n = 73). BPD symptoms were measured using the BSL-23, while different types of ACE were assessed using the CTQ (abuse/neglect), ICES (invalidation), QUIC (unpredictability), and BSA (bullying). Graph-theoretical network analyses were conducted across groups to investigate associations between BPD symptom severity and ACE types, as well as interrelationships among ACEs. Data-driven community detection was applied to identify clusters of closely connected ACE types. The BPD group showed higher ACE severity across all forms of ACE compared to CC and NC groups. Network analysis revealed unique associations between BPD symptom severity and emotional abuse, peer bullying, parental unpredictability, and lack of safety and security. Examination of interrelationships among ACE types resulted in a five-cluster solution demonstrating a complex pattern of unique associations. This study advances our understanding of how different forms of ACE relate to BPD psychopathology and how they are interrelated with each other. The findings suggest that the impact of ACE extends beyond physical and sexual abuse to include relational and environmental adversities with relevance for BPD symptom severity in adulthood.
Abstract Background Staff education may improve clinicians’ attitudes toward self-harm, but whether this translates into reduced coercion is unclear. We evaluated a regional strategy to improve care for self-harming patients and its impact on staff attitudes and coercive interventions across services. Methods Quasi-experimental dual design: (a) interrupted time-series of registry data on coercive interventions (Jan 2021–Dec 2024) and (b) three-wave pre–post surveys using the revised 17-item Self-Harm Antipathy Scale (SHAS-DR) at baseline, 2 months, and 8 months post-training. Change points: June 2022 (strategy announcement) and June 2023 (training implementation). Results In registry data, coercive interventions declined after the strategy announcement (level IRR 0.39, 95% CI 0.21–0.73) with no subsequent trend change. A temporary increase occurred at the training point (level IRR 2.58, 95% CI 1.57–4.25), consistent with implementation disruption. Reductions were largest for mechanical restraints, particularly among self-harming patients, while rapid tranquillization remained most frequent. Annual coercive episodes fell from 1,280 (2021) to 409 (2024). Staff attitudes improved and were sustained. Mean SHAS-DR decreased from 40.0 (SD 10.8) at baseline to 34.8 (SD 7.4) at 2 months and 35.4 (SD 8.2) at 8 months; baseline-to-follow-up changes were significant ( p ≤ 0.001). Conclusions The strategy coincided with an immediate reduction in coercion and a transient rise during training, while staff attitudes reflected reduced antipathy toward people who self-harm. Sensitivity analyses suggested changes were not driven by high-frequency patients. Sustained reductions likely require continued organizational and relational supports. Trial registration Not applicable.
Abstract Background Borderline personality disorder (BPD) frequently co-occurs with eating disorders (EDs). Despite this clinical relevance, the dimensional structure of commonly used assessment instruments, such as the Eating Disorder Examination Questionnaire (EDE-Q), has not been sufficiently examined in BPD populations. Previous research suggests that the original four-factor structure of the EDE-Q may not be stable across different populations. Methods This study examined the structure of the EDE-Q in a clinical sample of individuals with BPD (N = 73) using Exploratory Graph Analysis (EGA), a network-based approach to dimensionality assessment. Dimensionality and item stability were evaluated using nonparametric bootstrapping. Robustness was assessed via sensitivity analyses, including median imputation, variation of the regularization parameter, comparison of community detection algorithms, and leave-one-item-out procedures. Results After iterative item reduction, a three-dimensional solution emerged, comprising 13 items. The identified dimensions reflected (1) Restraint, (2) Cognitive–Interpersonal Eating Concerns, and (3) Body Dissatisfaction. The final solution demonstrated high robustness across all sensitivity analyses, with identical dimensional structures and item assignments under multiple conditions. Conclusions The findings suggest that the original four-factor structure of the EDE-Q may not fully generalize to individuals with BPD. Several aspects of the identified structure are consistent with previous research reporting deviations from the original EDE-Q model. These findings underscore the importance of validating assessment instruments within specific clinical populations and support a cautious interpretation of standard EDE-Q subscale scores in individuals with BPD.
Background Parenting and substance use recovery often intersect, as many adults accessing substance use disorder (SUD) treatment are also parents. Critically, parental SUDs are a risk factor for poorer parenting behaviors, with downstream impacts on child mental health. However, extant evidence-based interventions do not target proximal, parent-specific relapse risk factors (e.g., parental emotion dysregulation [ED], parenting stress), and relapse risk remains high. We sought to address this by integrating best practices in SUD, ED, and parenting interventions to expand reach and improve outcomes. Methods This pilot study assessed feasibility, acceptability, and preliminary efficacy of a 20-week Dialectical Behavior Therapy Skills + Parent Training (DBT Skills + PT) telehealth group intervention for parents in SUD remission with elevated ED. Participants were 12 parents (11 mothers) of preschool-aged children (5 female). Results Intervention feasibility (i.e., attendance, attrition, diary card compliance) and acceptability (i.e., satisfaction, skills use) were high. All treatment-completers maintained their SUD remission and reported large reductions in ED, child behavior problems, negative parenting behaviors, and parenting stress. Quantitative results were corroborated by qualitative feedback provided at an exit interview. Conclusions The present findings support further larger scale testing of DBT Skills + PT as a promising intervention for parents in SUD remission with elevated ED, with prospective intergenerational impacts.
Family members of individuals who have attempted suicide may experience feelings of guilt, depression, hopelessness, and burnout. Previous studies suggest that Psychoeducational Interventions (PI) for caregivers of people with suicide attempts improve their feelings of caregiver burden and that Dialectical Behavioral Therapy (DBT) helps to reduce caregivers’ burden, depression, and validating behaviors. However, no studies have analyzed whether DBT is more effective than PI for caregivers of people who have made suicide attempts. The aim of the study was to analyze the differential efficacy of the DBT vs. PI. The study was a superiority trial with a two-arm randomized controlled design. The intention-to-treat principle was employed using mixed-effects models. In all, 108 caregivers of patients diagnosed with Suicide Behavior Disorder were randomized. DBT was equally effective as PI in alleviating caregivers’ burden. DBT was more effective than PI in increasing caregivers´ family empowerment and validation behaviors and reducing stress. This study suggests that DBT could be an effective intervention for caregivers of people with suicide attempts. The study was registered on December 15, 2021 in https://www.clinicaltrials.gov/ ID: NCT05157607.
Comorbid borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) predict poorer treatment outcomes. Available treatments for BPD and psychological trauma are often phase-based, first ensuring stabilization of dysregulated behaviors and emotions and later focusing on treating trauma. This study investigates the feasibility, acceptability, and preliminary efficacy of combining dialectical behavioral therapy group skills training (DBT-ST), consisting of mindfulness, emotion regulation, distress tolerance, and interpersonal-effectiveness skills, with eye movement desensitization and reprocessing (EMDR) individual therapy for patients with BPD and psychological trauma. Forty-two participants with BPD and psychological trauma (40 females, mean age = 28.5, SD = 9.2) participated in the study. All participants underwent an initial 6-month DBT-ST group (phase 1), then those randomized to the experimental group received EMDR, and those in the control condition continued DBT-ST (phase 2). Feasibility and acceptability were assessed through qualitative interviews. Additionally, borderline personality disorder symptoms and trauma-related symptoms were measured as secondary clinical outcomes. Assessments were conducted at baseline, post phase 1, and post phase 2. Overall retention from baseline to post phase 2 was 62
The construct of borderline personality disorder (BPD) remains contentious, with some arguing that it embraces too much pathology to be of any real value as a clinical diagnosis. Examining BPD’s comorbidity is key to understanding its heterogeneous vs. homogeneous nature. This study aimed to uncover differences in patterns of symptoms and their severity between 3 groups of patients a with a DSM-5 diagnosis of BPD: (i) those with a single borderline diagnosis; (ii) those with a dual diagnosis of BPD and antisocial personality disorder (ASPD); those with a dual diagnosis of BPD and narcissistic personality disorder (NPD). Groups were compared in terms of: (i) borderline symptom severity; (ii) self-report measures of emotional dysregulation, suicidality, and identity disturbance; (iii) DSM-defined borderline symptom profiles. Network analysis assessed whether a stable and reproducible structure of symptoms could be seen across all three groups and whether groups differed in symptom prevalence. Results of network analyses showed that the three groups shared the same symptom structure but differed systematically in which symptoms were most strongly endorsed: identity/interpersonal dysfunction in BPD, affective/behavioural dysregulation in BPD+ASPD, and a mixed/intermediate profile in BPD + NPD. BPD+ASPD showed the greatest severity of borderline symptoms, greatest emotional dysregulation, and highest impulsiveness and anger. The BPD group showed the highest identity disturbance and suicidality, BPD + NPD the lowest. In their symptom profiles, BPD were more likely to meet criteria for fear of abandonment, unstable relationships, identity disturbance and suicidality, while BPD+ASPD were more likely to meet criteria for impulsivity, affective instability, and anger control difficulty. The three groups differed on measures of identity and interpersonal relationships, supporting the idea that PD reflects disturbances of relationality. Results highlight that BPD can manifest in different ways that depend on its comorbidity. These differences require treatment to be tailored to the individual patient, with a focus on identity/interpersonal dysfunction when BPD presents alone, and on affective/behavioural dysregulation when BPD co-occurs with ASPD.
Borderline Personality Disorder (BPD) is a common condition with significant negative impacts on relatives due to its interpersonal instability and suicidal behaviors. Family Connections (FC) is currently the most empirically supported intervention for family members of individuals with BPD. However, access to FC remains limited. Online delivery could overcome geographic barriers, as digital formats have shown efficacy in psychotherapies for patients, though little is known about their effectiveness for family-oriented interventions. During the COVID-19 crisis, rapid adaptations of psychotherapeutic programs such as FC to online formats created an opportunity to collect data. This study aimed to compare the effectiveness of the online FC with face-to-face format. This multicenter naturalistic study extended a previous project involving French-speaking FC participants. The program was first delivered face-to-face (n = 141) and then online (n = 27). FC is a 12-week group intervention providing psychoeducation about BPD and teaching coping skills derived from Dialectical Behavior Therapy. Groups were comparable at baseline, except for certain variables. Controlling for baseline scores, multiple linear regressions showed no significant group differences for post-intervention burden (b=-0.59, p = 0.825) or depression (b = 1.37, p = 0.398). However, the online group improved more in emotion dysregulation (b=-9.05, p = 0.003) but less in coping (b=-0.79, p < 0.000). Findings support the online FC format as comparably effective to the face-to-face version, suggesting its potential to enhance accessibility without compromising outcomes. Replication in randomized designs is warranted. This study supports the online Family Connections as comparably effective to the face-to-face version. Online Family Connections showed similar improvements in caregiver burden compared to face-to-face groups. Online format allowed Family Connections to continue during the COVID-19 crisis. Online Family Connections could improve access across wider geographic regions.
Intimacy, feeling close to others, and mutual trust and regard are important aspects of a secure attachment style that contributes to stable relationships. Difficulties experiencing intimacy have been linked to traumatic childhood experiences, such as abuse and neglect, rejection sensitivity (RS), and borderline personality disorder (BPD). In experimental studies, patients with BPD perceived unfamiliar faces as less trustworthy and detected less positive cues of happiness, social affirmation, and inclusion. However, it remains unclear whether social-cognitive judgments of unfamiliar faces predict attachment-related intimacy beyond BPD features, childhood trauma, and RS. This study aimed to simultaneously investigate the predictive effects of BPD features, childhood trauma, RS, and first-impression social-cognitive judgments of trustworthiness and happiness on intimacy in close relationships, beyond romantic relationships. Additionally, we investigated whether the association between BPD features and attachment-related intimacy is moderated by childhood trauma, RS, and first-impression social judgments. In an online study, 509 women completed questionnaires on intimacy in close relationships (subscales of the Adult Attachment Scale Revised), BPD features (Personality Assessment Inventory Borderline Features Scale), childhood trauma (Childhood Trauma Questionnaire Short Form), and RS (Adult Rejection Sensitivity Questionnaire). Additionally, they evaluated happiness and trustworthiness in unfamiliar female faces. Hierarchical linear regression analysis with intimacy as outcome tested the predictive strengths of all variables including interactions with BPD features. Higher BPD features, childhood trauma, particularly emotional neglect, and RS, as well as lower trustworthiness impressions predicted less intimacy in close relationships. Despite their interrelations, all predictors except happiness ratings showed unique predictive effects on intimacy. Interaction effects were not significant. Findings support the importance of BPD features, childhood trauma, and RS for experiences of closeness and connection in adult attachment relationships. Additionally, findings provide first evidence for a small direct link between trustworthiness evaluations of unfamiliar faces and lower experiences of intimacy. Future research should investigate these associations in clinical samples including both women and men to further understand whether trustworthiness impressions could be an important socio-cognitive mechanism and potential treatment target.
Abstract Background Mentalization plays a key role in borderline personality disorder (BPD), yet its moment-to-moment fluctuations remain understudied. This study is the first to use established self-report items within an Ecological Momentary Assessment (EMA) to explore the links between aspects of mentalizing in daily life and BPD traits in a community sample. Methods The non-clinical sample consisted of 86 participants (86% female) aged between 18 and 51 years (M = 22.93, SD = 5.36). As part of a baseline survey in the laboratory, the participants completed self-report questionnaires to assess borderline accentuation and mentalizing in the form of subjective certainty regarding their own and others’ mental states (self-certainty and other-certainty). In addition, in a subsequent one-week EMA, they reported momentary self-certainty and other-certainty at six randomized times during the day. Results Using multiple regression (enter method), self-certainty proved to be a negative predictor of borderline accentuation, with intraindividual variations correlating positively with borderline personality style. Contrary to expectations, however, neither the level of other-certainty in the EMA nor the corresponding intraindividual fluctuations were related to borderline accentuation. Conclusion Future studies should consider the high intraindividual variability of self- and other-certainty in order to obtain ecologically valid insights into mentalizing processes in the context of BPD. Promoting self-certainty may be a valuable target in BPD treatment. However, other-certainty might not be as important.
Parenting and substance use recovery often intersect, as many adults accessing substance use disorder (SUD) treatment are also parents. Critically, parental SUDs are a risk factor for poorer parenting behaviors, with downstream impacts on child mental health. However, extant evidence-based interventions do not target proximal, parent-specific relapse risk factors (e.g., parental emotion dysregulation [ED], parenting stress), and relapse risk remains high. We sought to address this by integrating best practices in SUD, ED, and parenting interventions to expand reach and improve outcomes. This pilot study assessed feasibility, acceptability, and preliminary efficacy of a 20-week Dialectical Behavior Therapy Skills + Parent Training (DBT Skills + PT) telehealth group intervention for parents in SUD remission with elevated ED. Participants were 12 parents (11 mothers) of preschool-aged children (5 female). Intervention feasibility (i.e., attendance, attrition, diary card compliance) and acceptability (i.e., satisfaction, skills use) were high. All treatment-completers maintained their SUD remission and reported large reductions in ED, child behavior problems, negative parenting behaviors, and parenting stress. Quantitative results were corroborated by qualitative feedback provided at an exit interview. The present findings support further larger scale testing of DBT Skills + PT as a promising intervention for parents in SUD remission with elevated ED, with prospective intergenerational impacts.
