Psychosocial functioning in adolescents with non-suicidal self-injury: the roles of childhood maltreatment, borderline personality disorder and depression

Background: There is a lack of studies examining psychosocial functioning in patients with non-suicidal self-injury (NSSI), especially in adolescents, and rates of impaired functioning in existing literature vary considerably. These variations may be attributable to further risk factors that influence psychosocial functioning. Thus, the aim of the study was to examine whether adolescent NSSI patients with childhood maltreatment (CM), a known risk factor for lower psychosocial functioning, may differ from adolescent NSSI patients without CM, and whether these differences may be explained by the severity of comorbid disorders. Specifically, we examined whether severity of borderline personality disorder (BPD), depression and posttraumatic stress disorder may explain differences in psychosocial functioning in NSSI patients with and without CM. Methods: Data of 368 adolescents with NSSI disorder from an outpatient clinic were analyzed using structural equation modeling. Clinicans' rating of the Global Assessment of Functioning Scale (GAF) was collected, in addition to clinical interviews. Results: Results indicate that GAF scores were lower among NSSI patients with CM and that the difference in psychosocial functioning between these groups was explained by BPD and depression severity. Conclusions: Psychosocial functioning in NSSI patients varies depending on whether they have experienced CM or not. Specifically, these differences seem to be attributable to higher BPD and depression severity in adolescent NSSI patients with CM. Clinicians should ensure to assess CM and focus on BPD and depression severity in this population. Treatment of BPD and depression may notably reduce psychosocial impairment in NSSI patients with CM

Self-rated risk as a predictor of suicide attempts among high-risk adolescents

Background: Predicting suicide attempts is a challenging task for clinicians and researchers, particularly among high-risk individuals (i.e. adolescents with lifetime suicide attempts). In this study, we examined whether adolescents were able to predict their own risk of attempting suicide in the future and whether borderline personality disorder (BPD) or depressive symptoms impacted the predictive value of self-ratings. Methods: Structured clinical assessments were conducted at baseline and after 12 months in a high-risk sample of treatment-seeking adolescents (n = 134; 12-17y.; 90% female) with at least one lifetime suicide attempt. Results: During the follow-up period, n = 51 participants (38%) attempted suicide at least once. Self-rated risk was a significant predictor for the recurrence of a suicide attempt, whereas BPD and depression were not. While there was no significant interaction between self-rated risk and BPD, a negative interaction emerged between self-rated risk and depression in the prediction of a suicide attempt. Greater depression severity diminished the predictive value of self-ratings. Limitations: Depression severity was measured using a questionnaire, not a clinical interview. The findings may not be applicable to less burdened samples. Conclusions: Asking high-risk adolescents to rate their own risk of attempting suicide appears to be an easy to apply method in improving the prediction of future suicide attempts in the clinical context

Associative memory impairments are associated with functional alterations within the memory network in schizophrenia patients and their unaffected first-degree relatives: an fMRI study

Memory impairments are a major characteristic of schizophrenia (SZ). In the current study, we used an associative memory task to test the hypothesis that SZ patients and first-degree relatives have altered functional patterns in comparison to healthy controls. We analyzed the fMRI activation pattern during the presentation of a face-name task in 27 SZ patients, 23 first-degree relatives, and 27 healthy controls. In addition, we performed correlation analyses between individual psychopathology, accuracy and reaction time of the task and the beta scores of the functional brain activations. We observed a lower response accuracy and increased reaction time during the retrieval of face-name pairs in SZ patients compared with controls. Deficient performance was accompanied by abnormal functional activation patterns predominantly in DMN regions during encoding and retrieval. No significant correlation between individual psychopathology and neuronal activation during encoding or retrieval of face-name pairs was observed. Findings of first-degree relatives indicated slightly different functional pattern within brain networks in contrast to controls without significant differences in the behavioral task. Both the accuracy of memory performance as well as the functional activation pattern during retrieval revealed alterations in SZ patients, and, to a lesser degree, in relatives. The results are of potential relevance for integration within a comprehensive model of memory function in SZ. The development of a neurophysiological model of cognition in psychosis may help to clarify and improve therapeutic options to improve memory and functioning in the illness

Associative Memory Impairments Are Associated With Functional Alterations Within the Memory Network in Schizophrenia Patients and Their Unaffected First-Degree Relatives: An fMRI Study

Memory impairments are a major characteristic of schizophrenia (SZ). In the current study, we used an associative memory task to test the hypothesis that SZ patients and first-degree relatives have altered functional patterns in comparison to healthy controls. We analyzed the fMRI activation pattern during the presentation of a face-name task in 27 SZ patients, 23 first-degree relatives, and 27 healthy controls. In addition, we performed correlation analyses between individual psychopathology, accuracy and reaction time of the task and the beta scores of the functional brain activations. We observed a lower response accuracy and increased reaction time during the retrieval of face-name pairs in SZ patients compared with controls. Deficient performance was accompanied by abnormal functional activation patterns predominantly in DMN regions during encoding and retrieval. No significant correlation between individual psychopathology and neuronal activation during encoding or retrieval of face-name pairs was observed. Findings of first-degree relatives indicated slightly different functional pattern within brain networks in contrast to controls without significant differences in the behavioral task. Both the accuracy of memory performance as well as the functional activation pattern during retrieval revealed alterations in SZ patients, and, to a lesser degree, in relatives. The results are of potential relevance for integration within a comprehensive model of memory function in SZ. The development of a neurophysiological model of cognition in psychosis may help to clarify and improve therapeutic options to improve memory and functioning in the illness

Non-suicidal self-injury disorder as a stand-alone diagnosis in a consecutive help-seeking sample of adolescents

Background: With inclusion of non-suicidal self-injury disorder (NSSID) in the DSM-5, empirical data are crucial to gather information regarding its clinical validity and relevance. Until now, research focused mostly on single diagnostic criteria of NSSID. The present study aimed to characterize NSSID with and without comorbid diagnoses in a large help-seeking adolescent sample, investigating the clinical validity and selectivity of NSSID within the theoretical framework of Robins and Guze. Methods: Interview and self-report data of n = 464 adolescents (mean age = 14.95 years, SD = 1.43, 89.17% female) with NSSID according to DSM-5 from a German outpatient clinic were analysed with descriptive statistics. Group differences were calculated with χ2 tests or t-tests respectively. Stability of NSSID without comorbidity was investigated after 12 months. Results: Within a consecutive help-seeking sample, NSSID as a stand-alone diagnosis (without comorbidity) was rare (only 3.7%), associated with low illness severity and psychopathological distress, and prospectively rather unstable. Limitation: Selection bias due to the help-seeking population and female preponderance. Conclusion: Based on the theoretical framework applied, NSSI should be considered as an unspecific precursor for psychopathological development generally and suicide specifically but it may be of limited significance as a 'pure and sole' diagnostic entity. Results add to existing claims to re-propose classification criteria to better picture the clinical group of affected adolescents

Heterogeneity of borderline personality disorder symptoms in help-seeking adolescents

Background: The heterogeneous presentation of borderline personality disorder (BPD) represents a clinical challenge. There is an ongoing scientific debate whether the heterogeneity can best be understood in terms of qualitative (categorical) or quantitative (dimensional) differences between individuals. The present study examined the latent structure of BPD in adolescents. Methods: Five-hundred and six outpatients aged 12 to 17 years with risk-taking and/or self-harming behavior were assessed at baseline and one-year follow-up. Latent class analysis (corresponding with the categorical approach), factor analysis (corresponding with the dimensional approach), and factor mixture models (allowing for both categorical and dimensional aspects) were applied to the DSM-IV BPD criteria. Results: The best fitting model distinguished between a majority class with high probabilities for all BPD criteria ("borderline group") and a minority class with high probabilities for the impulsivity and anger criteria only ("impulsive group"). Sex significantly affected latent class membership, and both a latent factor and age explained within-class variability. The borderline group primarily consisted of females, frequently reported adverse childhood experiences, scored high on the emotion dysregulation and inhibitedness personality traits, and was associated with internalizing psychopathology. In contrast, the impulsive group primarily consisted of males, scored high on the dissocial behavior personality trait, and was associated with externalizing psychopathology. After one year, the two groups showed similar clinical improvement. Conclusions: The study provides evidence for two distinct subgroups of adolescents with BPD features that resemble the subtypes of the ICD-10 emotionally unstable personality disorder. More research is needed to further investigate the diagnostic stability of the two groups over time and potential differential treatment indications

Die Ambulanz für Risikoverhalten und Selbstschädigung (AtR!Sk) – ein Pionierkonzept der ambulanten Früherkennung und Frühintervention von Borderline-Persönlichkeitsstörungen

Riskantes und selbstschädigendes Verhalten ist ein häufiges Problem im Alltag von Jugendlichen und stellt das Gesundheitssystem mehr und mehr vor neue Herausforderungen. Solche riskanten und selbstschädigenden Verhaltensweisen sind besonders typisch bei Jugendlichen mit einer Borderline-Persönlichkeitsstörung (BPS). Nach Jahrzehnten der Kontroverse gilt die Diagnose der adoleszenten BPS inzwischen als valide und reliabel. Sie ist mit einem großen Leidensdruck, erhöhter Mortalität und einer massiven psychosozialen Beeinträchtigung der betroffenen Jugendlichen verbunden. Lange Wartezeiten für ambulante Therapien und hohe Kosten bei unnötig langen stationären Aufenthalten kennzeichnen leider das aktuelle Bild in der medizinischen Versorgungslandschaft bei Kinder- und Jugendlichen mit BPS in Deutschland. Modelle, die gezielt auf Früherkennung und Frühintervention der Borderline-Symptomatik ausgerichtet sind und bereits bei Patienten mit Risikokonstellationen ansetzen, können als Alternativkonzepte dienen. Die Spezialambulanz AtR!Sk der Klinik für Kinder- und Jugendpsychiatrie der Universitätsklinik Heidelberg sichert eine niederschwellige, schnelle und auf die Problematik der Jugendlichen „zugeschnittene“ Behandlung durch eine umfassende und akkurate Diagnostik und leistet seit 2013 Pionierarbeit auf dem Gebiet der evidenzbasierten Früherkennung und Frühintervention der BPS im Jugendalter.The Outpatient Clinic for Adolescent Risk-taking and Self-harm behaviors (AtR!Sk) – A Pioneering Approach of Outpatient Early Detection and Intervention of Borderline Personality Disorder. Self-harm and risk-taking behaviors are frequently occurring problems in adolescents’ everyday life and commonly challenge the present child and adolescent health-care system. Those behaviors are typical features of borderline-personality disorder (BPD), a severe mental disorder that is associated with immense psychological strain, increased risk of mortality and poor psychosocial functioning. Despite controversy in the past, recent evidence shows that BPD is a valid and reliable diagnosis in adolescence. Consequently, specified and effective intervention programs for this age group are necessary. Instead, present health-care services for children and adolescents in Germany are usually characterized by long waiting periods for specialized outpatient treatments and unnecessary expanses of unnecessary long inpatient stays. Alternatively, and in order to prevent serious long-term consequences, new concepts – integrated in an ambulatory setting and close to patients’ daily routines – should focus on early detection and treatment of adolescents at-risk presenting with borderline personality features. The specialist outpatient clinic AtR!Sk at the University Hospital Heidelberg ensures a low-threshold initial contact service, comprehensive and accurate diagnosis of BPD features, and rapidly “tailored” therapy for young people presenting with any types of risk-taking and self-harm behavior. AtR!Sk – as a pioneering approach in south Germany – provides evidence-based early detection and intervention for adolescent BPD

Zusammenhänge von Drogenkonsum und der Borderline-Persönlichkeitsstörung sowie Depressivität in einer klinischen Stichprobe an Jugendlichen

The Association Between Illicit Drug Use, Borderline Personality Disorder and Depression in a Help-Seeking Sample of Adolescents Risk-taking behavior is a common phenomenon in adolescence. Even prevalence rates for illicit drug use are considerably high in youth and associated with a range of psychiatric disorders, especially depression and Borderline Personality Disorder (BPD). However, there is a lack of data investigating differences in psychopathology between different substance user groups. Therefore, aim of the study was to investigate occurrence of depression and BPD symptoms in different drug risk groups (no use vs. occasional use vs. frequent use). Further aim of the study was to examine risk profiles regarding single BPD criteria. Data of n = 347 adolescents (81.7 % female, mean age 14.95, SD = 1.50) presenting at the specialized outpatient clinic for risk-taking and self-harming behavior (AtR!Sk) in Heidelberg were analyzed. Results show that BPD is clearly associated with illicit drug use in adolescence. There is no difference between occasional and frequent users in terms of mean number of BPD criteria. However, frequent users differ from occasional users regarding greater number of impulsivity and anger criteria. After adjusting for sociodemographic variables there was no association between drug use and depression. Since even single events of illicit drug use are associated with higher levels of BPD, clinicians should rapidly target to stop consumption. Further, psychotherapeutic interventions for BPD in high-risk consumers should especially focus on facilitating adaptive emotion regulation skills in regards to impulsivity and anger

Longitudinal development of risk-taking and self-injurious behavior in association with late adolescent borderline personality disorder symptoms

Self-injurious behavior and risk-taking behaviors are associated with adolescent borderline personality disorder (BPD). Developmental trajectories of self-injurious and risk-taking behavior in predicting BPD have not been fully understood. The aim of the present study was to examine self-injurious and risk-taking behavior development and their prospective influence on BPD symptoms in adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the German Saving and Empowering Young Lives in Europe cohort were analyzed. Self-injurious and risk-taking behaviors were assessed at baseline and one-year follow-up. BPD symptoms were assessed at two-year follow-up. In fully adjusted stepwise binominal regression analyses, recent onset, termination and maintenance of risky alcohol use and self-injurious behavior remained as significant predictors of BPD. Highest ORs were found for alcohol termination and maintenance of self-injurious behavior. Other facets of risk-taking behavior were not associated with increased ORs of BPD symptoms at two-year follow-up. These findings highlight the importance of self-injurious behavior and specific facets of risk-taking behavior in the development of adolescent BPD. Clinicians should focus on efforts in preventing adolescents from risk-taking and self-injurious behavior, since engaging in young age and therefore in potentially longer periods of these behaviors is associated with the highest risk of BPD