Borderline Personality Features and Integration of Positive and Negative Thoughts About Significant Others

Taking the bad with the good is a necessity of life, and people who readily integrate thoughts of their loved one’s flaws with thoughts of their more positive attributes maintain more stable, satisfying relationships. Borderline personality disorder, however, is often characterized by interpersonal perceptions that fluctuate between extremes of good and bad. We used a timed judgment task to examine information processing about significant others in individuals high in borderline personality features relative to healthy individuals and those high in avoidant personality features. In Study 1, when judging traits of a liked significant other, same-valence facilitation by negative primes (judging negative traits faster than positive traits after a negative prime) was significantly stronger in the borderline features group than the other two groups, and was inversely associated with self-reports of integrated thoughts about significant others. In contrast, same-valence facilitation by positive primes (judging positive traits faster than negative traits after a positive prime) was significantly stronger in the avoidant features group than the other two groups, and inversely associated with self-esteem. No between-group differences in same-valence facilitation were statistically significant when participants judged traits of disliked significant others, liked foods, and disliked foods. In Study 2, same-valence facilitation by negative primes when judging traits of a liked significant other was significantly associated with less integrated positive/negative thoughts about that person in a 12-day diary. These results identify an implicit information-processing pattern relevant to interpersonal difficulties in borderline personality disorder

Attributions for Rejection and Acceptance in Young Adults with Borderline and Avoidant Personality Features

Individuals with borderline and avoidant personality disorders show interpersonal dysfunction that includes maladaptive responses to rejection and reduced emotional benefits from acceptance. To identify the attributional styles that may underlie these difficulties, we examined causal attributions for rejection and acceptance among undergraduates high in features of each disorder and a healthy comparison group. In Study 1, participants rated how likely they were to attribute hypothetical rejection and acceptance experiences to positive and negative qualities of the self and others, as well as external circumstances. In Study 2, we examined these same attributions in daily diary assessments of real rejection and acceptance experiences. Although the two studies showed some differences in results, they both linked borderline personality features with suspicious, selfbolstering responses and avoidant personality features with perceived inferiority. Distinct attributional styles may contribute to the distinct interpersonal problems characteristic of these conditions

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes