Borderline personality disorder: patterns of self-harm, reported childhood trauma and clinical outcome.

SUMMARY: Consecutive admissions of 214 women with borderline personality disorder were investigated for patterns of specific forms of self-harm and reported developmental experiences. Systematic examination of clinical notes found that 75% had previously reported a history of childhood sexual abuse. These women were more likely to self-harm, and in specific ways that may reflect their past experiences. Despite this, treatment within a dialectical behaviour therapy-informed therapeutic community leads to relatively greater clinical gains than for those without a reported sexual abuse trauma history. Notably, greater behavioural and self-reported distress and dissociation were not found to predict poor clinical outcome

Developmental changes in the cortical sources of spontaneous alpha throughout adolescence

This study investigated age-, gender-, and puberty-related changes in two cortical sources of spontaneous alpha during eyes-open and eyes-closed conditions in a cohort of adolescents aged 9-23 years. In total, 29 preadolescents (9-12 years, 14 females), 29 mid-adolescents (13-17 years, 14 females), and 33 late adolescents (18-23 years, 17 females) had their resting brain activity measured using electroencephalography (EEG) during eyes-open and eyes-closed conditions. Standardised Low Resolution Brain Electromagnetic Tomography (sLORETA) was used to estimate the cortical sources of spontaneous alpha. Two cortical sources were chosen as regions of interest (ROIs): prefrontal cortex and occipital cortex. Significant age-related changes in the cortical sources of alpha were found, particularly in prefrontal regions; prefrontal alpha power was greater during the eyes-open condition compared to the eyes-closed condition for late adolescents, but equivalent across the eyes-open and eyes-closed conditions for both pre- and mid-adolescents. In addition, more advanced pubertal stage predicted reduced alpha power in male, but not female, adolescents aged 9-17 years. This study provides an important initial step towards understanding developmental changes in the cortical sources of spontaneous alpha in the typically developing brain. Moreover, the results from this study underscore the need to tease out the effects of age, gender, and puberty when examining the cortical sources of alpha during the adolescent period

A reduction in the implicit sense of agency during adolescence compared to childhood and adulthood

Sense of agency (SoA), the fundamental feeling of control over our actions and their consequences, may show key developmental changes during adolescence. We examined SoA in childhood (9–10), mid-adolescence (13–14), late-adolescence (18–20) and adulthood (25-28) using two tasks (Libet Clock and Stream of Letters). SoA was implicitly indexed by intentional binding that reflects the agency effect on action-outcome temporal association. We found age effects on the sub-processes in both tasks. In the Libet Clock task, where performance was more reliable, we observed a U-shaped developmental trajectory of intentional binding suggesting an adolescent-specific reduction in the experience of control. This study provides evidence for the developmental effects on the implicit agency experience and suggests adolescence as a critical period. We discuss the possible implications of these findings

Cognitive control across adolescence : dynamic adjustments and mind-wandering

Models of cognitive development suggest that cognitive control, a complex construct that ensures goal-directedness even in the face of distractions, is still maturing across adolescence. In the present study, we investigated how the ability to dynamically adjust cognitive control develops in this period of life, as indexed by the magnitude of the congruency sequence effect (CSE) in conflict tasks, and how this ability might relate to lapses of attention (mind-wandering [MW]). To these ends, participants from four age groups (12–13, 14–15, 18–20 and 25–27 years old) completed confound-minimized variants of the flanker and Simon tasks, along with a Go/No-Go task with thought probes to assess their frequency of mind-wandering. The CSE was present in both tasks, but was not affected by age in either of them. In addition, the size of the CSE in the flanker, but not in the Simon task was negatively associated with the frequency of MW with awareness. Trait MW and the probability of reporting MW during the task was found to increase with age in accordance with cognitive resource views of MW. Our findings suggest that at the behavioral level there are no substantial developmental changes through the adolescent period in control adjustment ability as measured by the CSE. Response inhibition performance in the Go/No-Go task, however, improved significantly with age. The implications of the present results for the conflict monitoring account of the CSE and extant theories of MW are discussed

Evaluation of LiNES : a new measure of trauma, negative affect, and relationship insecurity over the life span in persons with FND

Objective: The authors evaluated potential predisposing vulnerabilities and perpetuating factors among individuals with functional neurological disorder (FND) by using the novel Lifespan Negative Experiences Scale (LiNES), which assesses retrospective self-report of interpersonal trauma, negative affect, and relationship insecurity at three developmental stages: childhood, adolescence, and adulthood. Methods: The LiNES, Childhood Abuse and Trauma Scale (CATS), Relationship Scales Questionnaire (RSQ), and Positive and Negative Affect Schedule (PANAS) were administered to 71 individuals with FND. The reliability and validity of LiNES were examined by correlation with the other measures. FND patients’ responses on LiNES were compared with those of 170 healthy control subjects. Results: LiNES scores in the FND group were internally consistent and correlated highly with CATS, RSQ, and PANAS scores. At each developmental stage, LiNES trauma scores were higher among patients with FND, compared with control subjects. The FND subgroup, which comprised patients who also had nonepileptic attack disorder, had higher trauma scores, compared with the FND-only subgroup. Compared with control subjects, patients with FND reported greater negative affect and relationship insecurity in adulthood. Lifetime LiNES scores for interpersonal trauma and relationship insecurity predicted FND group classification with >80% accuracy. Conclusions: This study provides further support for the links between FND and trauma, negative affect, and insecure attachment. Recognition of these factors is likely to be important for treatment and stratification of important subpopulations in research. These findings provide new insights into the association between the timing of negative experiences and their effect, with LiNES emerging as a potentially useful measure for patients presenting with FND

Subjective versus objective measures of distress, arousal and symptom burden in patients with functional seizures and other functional neurological symptom disorder presentations : a systematic review

Symptoms and functioning can be measured subjectively using self-report measures or objectively, based on physiological changes. This raises the question whether subjective and objective measures are closely correlated and – if not – whether one is more accurate or meaningful than the other, especially in patients with Functional Seizures (FS) or other Functional Neurological Symptom Disorders (FND), where subjective and objective observations may be thought particularly likely to deviate. This systematic review explores these questions focussing on measures of distress, arousal and symptom burden. Eighteen studies (12 FS, 6 other FND) capturing 396 FND patients were included. Eleven reported no correlation between subjective and objective measures. Only four studies reported significant correlations (r’s = −0.74–0.59, p’s < 0.05). The small number of studies and diverse methodologies do not provide conclusive answers to the questions posed. Given that subjective and objective measures capture different aspects of current state or function, a combination of measurement approaches is likely to provide optimal information about patients’ health state. In view of the attentional and perceptual alterations implicated in FND, the difference between objective and subjective measures may represent an interesting observation in its own right

Cortical thickness and gyrification patterns in patients with psychogenic non-epileptic seizures

Psychogenic non-epileptic seizures (PNES) are often viewed as manifestations of altered motor and sensory function resulting from psychological responses to adverse experiences. Yet many patients and non-expert healthcare professionals find it difficult to understand how severe disturbances in normal neurological functioning can solely result from underlying psychological mechanisms to the exclusion of other physical causes. Perhaps importantly, recent advances using neuroimaging techniques point to possible structural and functional correlates in PNES. In an attempt to further our understanding of the neurobiological correlates of this condition, we compared the brain scans of 20 patients with PNES (14 females, mean age 41.05, range 19-62) and 20 age- and gender-matched healthy controls (14 females, mean age 40.65, range 21-61) to investigate group differences for cortical thickness and gyrification patterns using FreeSurfer. Compared to controls, patients with PNES showed cortical thickness increases in motor, sensory and occipital areas as well as cortical thickness decreases in temporal and frontal brain regions. In addition, we observed age-related changes in cortical thickness in the right lateral occipital area in PNES. However, contrary to our prediction that atypical gyrification may be present, we did not find any evidence of abnormalities on a measure thought to reflect prenatal and early childhood cortical development and organization. Nor did we find significant correlations between cortical thickness results and clinical features. These findings partly corroborate, but also differ from previous morphometric studies in PNES. These inconsistencies likely reflect the aetiology and phenomenological heterogeneity of PNES

Cortical Surface Area Differentiates Familial High Risk Individuals Who Go on to Develop Schizophrenia

BACKGROUND: Schizophrenia is associated with structural brain abnormalities that may be present before disease onset. It remains unclear whether these represent general vulnerability indicators or are associated with the clinical state itself. METHODS: To investigate this, structural brain scans were acquired at two time points (mean scan interval 1.87 years) in a cohort of individuals at high familial risk of schizophrenia (n 5 142) and control subjects (n 5 36). Cortical reconstructions were generated using FreeSurfer. The high-risk cohort was subdivided into individuals that remained well during the study, individuals that had transient psychotic symptoms, and individuals that subsequently became ill. Baseline measures and longitudinal change in global estimates of thickness and surface area and lobar values were compared, focusing on overall differences between high-risk individuals and control subjects and then on group differences within the high-risk cohort. RESULTS: Longitudinally, control subjects showed a significantly greater reduction in cortical surface area compared with the high-risk group. Within the high-risk group, differences in surface area at baseline predicted clinical course, with individuals that subsequently became ill having significantly larger surface area than individuals that remained well during the study. For thickness, longitudinal reductions were most prominent in the frontal, cingulate, and occipital lobes in all high-risk individuals compared with control subjects. CONCLUSIONS: Our results suggest that larger surface areas at baseline may be associated with mechanisms that go above and beyond a general familial disposition. A relative preservation over time of surface area, coupled with a thinning of the cortex compared with control subjects, may serve as vulnerability markers of schizophrenia

Updating beliefs under perceived threat

Humans are better at integrating desirable information into their beliefs than undesirable. This asymmetry poses an evolutionary puzzle, as it can lead to an underestimation of risk and thus failure to take precautionary action. Here, we suggest a mechanism that can speak to this conundrum. In particular, we show that the bias vanishes in response to perceived threat in the environment. We report that an improvement in participants' tendency to incorporate bad news into their beliefs is associated with physiological arousal in response to threat indexed by galvanic skin response and self-reported anxiety. This pattern of results was observed in a controlled laboratory setting (Experiment I), where perceived threat was manipulated, and in firefighters on duty (Experiment II), where it naturally varied. Such flexibility in how individuals integrate information may enhance the likelihood of responding to warnings with caution in environments rife with threat, while maintaining a positivity bias otherwise, a strategy that can increase well-being.SIGNIFICANCE STATEMENTThe human tendency to be overly optimistic has mystified scholars and lay people for decades: how could biased beliefs have been selected for over unbiased beliefs? Scholars have suggested that while the optimism bias can lead to negative outcomes, including financial collapse and war, it can also facilitate health and productivity. Here, we demonstrate that a mechanism generating the optimism bias, namely asymmetric information integration, evaporates under threat. Such flexibility could result in enhanced caution in dangerous environments while supporting an optimism bias otherwise, potentially increasing well-being