Enhanced Detection of Emotional Facial Expressions in Borderline Personality Disorder

Background: Borderline personality disorder (BPD) is commonly proposed to be characterized by an enhanced sensitivity for emotional stimuli. In the present study, we investigated whether BPD patients show a superior detection of emotional facial expressions relative to healthy controls. The detection of emotional information in the environment represents an important facet of emotional sensitivity. Sampling and Methods: Twenty patients with BPD were compared with 25 healthy controls. The participants were presented a rapid, continuous stream of neutral and randomly inserted emotional facial expressions and were asked to report the presentation of an emotional facial stimulus after each trial. Availability of cognitive resources was manipulated via two different task demands. Results: The participants with BPD performed significantly better in the detection of positive and negative facial expressions compared to the healthy controls. False alarm rates did not differ significantly between the two groups. Conclusions: The BPD participants showed an enhanced detection of emotional expressions that might be related to the emotional disturbances they experience. In particular, we will discuss the role of this superior emotion detection (in combination with previously reported deficits in the labeling of emotional states) for the understanding of emotional instability in BPD

Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder

To provide a comprehensive meta-analysis on the efficacy of psychological and medical treatments for binge-eating disorder (BED), including those targeting weight loss. Method: Through a systematic search before March 2018, 81 published and unpublished randomized-controlled trials (RCTs), totaling 7,515 individuals with BED (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition [DSM–IV] and Fifth Edition [DSM–5]), were retrieved and analyzed using random-effect modeling. Results: In RCTs with inactive control groups, psychotherapy, mostly consisting of cognitive-behavioral therapy, showed large-size effects for the reduction of binge-eating episodes and abstinence from binge eating, followed by structured self-help treatment with medium-to-large effects when compared with wait-list. Pharmacotherapy and pharmacological weight loss treatment mostly outperformed pill placebo conditions with small effects on binge-eating outcome. These results were confirmed for the most common treatments of cognitive-behavioral therapy, self-help treatment based on cognitive-behavioral therapy, and lisdexamfetamine. In RCTs with active control groups, there was limited evidence for the superiority of one treatment category or treatment. In a few studies, psychotherapy outperformed behavioral weight loss treatment in short- and long-term binge-eating outcome and led to lower longer-term abstinence than self-help treatment, while combined treatment revealed no additive effect on binge-eating outcome over time. Overall study quality was heterogeneous and the quality of evidence for binge-eating outcome was generally very low. Conclusions: This comprehensive meta-analysis demonstrated the efficacy of psychotherapy, structured self-help treatment, and pharmacotherapy for patients with BED. More high quality research on treatments for BED is warranted, with a focus on long-term maintenance of therapeutic gains, comparative efficacy, mechanisms through which treatments work, and complex models of care

Human psyche as object of interdisciplinary exploration

The article contains a description and visual representation of the structure of the human psyche considered in the context of systematic studies. The disciplinary levels of study of the phenomenon of the human psyche are described in the article. The scientific concepts of special epistemological value are shown. The author's graphic images (schemes) are presented and illustrate the structure of the human psyche in the context of systematic studies. The ideal structure of the psyche consists of consciousness, personality and cognitive sphere; the material structure of the psyche includes a biological basis. The general system functions of the psyche and the functions of its individual elements are described. The article`s materials complement the existing scientific ideas about the psyche and its structure

Future Challenges in Psychotherapy Research for Personality Disorders.

Individuals with personality disorders are frequently seen in mental health settings. Their symptoms typically reflect a high level of suffering and burden of disease, with potentially harmful societal consequences, including costs related to absenteeism at work, high use of health services, ineffective or harmful parenting, substance use, suicidal and non-suicidal self-harming behavior, and aggressiveness with legal consequences. Psychotherapy is currently the first-line treatment for patients with personality disorders, but the study of psychotherapy in the domain of personality disorders faces specific challenges. Challenges include knowing what works for whom, identifying which putative mechanisms of change explain therapeutic effects, and including the social interaction context of patients with a personality disorder. By following a dimensional approach, psychotherapy research on personality disorders may serve as a model for the development and study of innovative psychotherapeutic interventions. We recommend developing the following: (a) an evidence base to make treatment decisions based on individual features; (b) a data-driven approach to predictors, moderators, and mechanisms of change in psychotherapy; (c) methods for studying the interaction between social context and psychotherapy

Subjektive Krankheitsrepräsentationen sind relevant für Outcomes der Adipositasbehandlung

Adipositas wird von der WHO als chronische Erkrankung beschrieben; Gewichtsreduktionsprogramme sind langfristig häufig nicht erfolgreich. Das Common-Sense-Modell (CSM) der Selbstregulation nach Leventhal nimmt an, dass kognitive und affektive subjektive Repräsentationen von chronischen Gesundheitszuständen das Selbstregulationsverhalten der Betroffenen und darüber den Krankheitsverlauf beeinflussen. Es scheint somit geeignet, um relevante Einflüsse auf Faktoren der Entstehung und Aufrechterhaltung der Adipositas zu identifizieren und neue Ansatzpunkte der Behandlung abzuleiten. Bislang wurden vor allem Ursachenrepräsentationen untersucht. Das CSM postuliert jedoch weitere kognitive (z. B. über Verlauf, Kontrollierbarkeit und Verständnis) sowie emotionale Repräsentationen, die bislang weitestgehend unberücksichtigt blieben

Fat Mass and Obesity-Associated Gene (FTO) in Eating Disorders: Evidence for Association of the rs9939609 Obesity Risk Allele with Bulimia nervosa and Anorexia nervosa

Objective: The common single nucleotide polymorphism (SNP) rs9939609 in the fat mass and obesity-associated gene (FTO) is associated with obesity. As genetic variants associated with weight regulation might also be implicated in the etiology of eating disorders, we evaluated whether SNP rs9939609 is associated with bulimia nervosa (BN) and anorexia nervosa (AN). Methods: Association of rs9939609 with BN and AN was assessed in 689 patients with AN, 477 patients with BN, 984 healthy non-population-based controls, and 3,951 population-based controls (KORA-S4). Based on the familial and premorbid occurrence of obesity in patients with BN, we hypothesized an association of the obesity risk A-allele with BN. Results: In accordance with our hypothesis, we observed evidence for association of the rs9939609 A-allele with BN when compared to the non-population-based controls (unadjusted odds ratio (OR) = 1.142, one-sided 95% confidence interval (CI) 1.001-infinity; one-sided p = 0.049) and a trend in the population-based controls (OR = 1.124, one-sided 95% CI 0.932-infinity; one-sided p = 0.056). Interestingly, compared to both control groups, we further detected a nominal association of the rs9939609 A-allele to AN (OR = 1.181, 95% CI 1.027-1.359, two-sided p = 0.020 or OR = 1.673, 95% CI 1.101-2.541, two-sided p = 0.015,). Conclusion: Our data suggest that the obesity-predisposing FTO allele might be relevant in both AN and BN. Copyright (C) 2012 S. Karger GmbH, Freibur

Invited commentary

P>Background: In double-blind, placebo-controlled food challenges (DBPCFCs), the use of challenge materials in which blinding is validated is a prerequisite for obtaining true blinded conditions during the test procedure. Therefore, the aim of this study was to enlarge the available range of validated recipes for DBPCFCs to facilitate oral challenge tests in all age groups, including young children, while maximizing the top dose in an acceptable volume. Methods: Recipes were developed and subsequently validated by a panel recruited by a matching sensory test. The best 30% of candidates were selected to participate in sensory testing using the paired comparison test. Results: For young children, three recipes with cow's milk and one recipe with peanut could be validated which may be utilized in DBPCFCs. For children older than 4 years and adults, one recipe with egg, two with peanut, one with hazelnut, and one with cashew nut were validated for use in DBPCFCs. Conclusions: All recipes contained larger amounts of allergenic foods than previously validated. These recipes increase the range of validated recipes for use in DBPCFCs in adults and children

Relationship between Borderline Personality Disorder, Emotional Availability, and Cortisol Output in Mother-Child Dyads

Background: Mothers with borderline personality disorder (BPD) often show altered emotional availability toward their own child and heightened stress vulnerability. The aims of the present study were (1) to examine total cortisol output in saliva during mother-child interaction in mothers with BPD and their children and (2) to test whether maternal nonhostility as a subscale of emotional availability mediates the relationship between maternal BPD and child total cortisol output. Methods: We investigated 16 mothers with BPD and 30 healthy control mothers (HC) and 29 children of mothers with BPD and 33 children of HC mothers. Children were between 5 and 12 years old. Salivary cortisol was collected prior to and twice after an episode of a 21-min standardized play situation between mother and child. Nonhostility was rated using the emotional availability scales. Analyses of covariance were computed to test for group differences in total cortisol output (measured with area under the curve with respect to ground). Pearson's correlation was calculated to test the association between maternal and child total cortisol output. To test the second question, a mediation analysis according to Preacher and Hayes was conducted. Results: Mothers with BPD and their children had lower total cortisol output. Maternal and child total cortisol output was significantly correlated. Contrary to our hypothesis, maternal nonhostility did not mediate the relationship between BPD and child total cortisol output. Conclusion: Results imply that the hormonal stress activity of mothers with BPD and their children is altered, which may reflect modified stress regulation and stress vulnerability in mother and child and may impact on mother-child interaction. The finding of a positive association between mother's and child total cortisol output could indicate an intergenerational transmission of these alterations