Recent developments in psychosocial interventions for borderline personality disorder [version 1; peer review: 3 approved]

Borderline personality disorder (BPD) is a serious psychiatric disorder that affects multiple symptomatic domains and is associated with an increased risk of suicidality. Several empirically supported treatments for BPD have been developed in recent years for adults with BPD. More recent work has focused on tailoring or applying (or both) these existing treatments to specific patient populations, including patients with certain types of comorbidity (for example, BPD and post-traumatic stress disorder or antisocial personality disorder) and younger patients. Other work has involved developing treatments and models of treatment delivery that address concerns related to access of care. Relatedly, new adjunctive and technology-assisted interventions have been developed, adding to the growing repertoire of treatment options for these patients. Advances in the last several years address specific treatment needs and offer cost-efficient options for this diverse patient population

Apego como marco teórico para entender los trastornos de personalidad: Consideraciones psicoterapéuticas, neurocientíficas y de desarrollo

In this paper we propose that John Bowlby\u27s attachment theory provides a theoretically coherent, empirically based, and clinically useful model for understanding personality pathology. This theoretical framework brings parsimony and breadth to the conceptualization of the etiology, maintenance, and treatment of personality disorders (PDs). Attachment theory can explain both the intrapersonal and interpersonal difficulties common in those with PDs and is consistent with findings from studies across multiple domains of knowledge, including evolutionary biology, ethology/comparative psychology, developmental psychology, experimental social-personality psychology, and neuroscience.PDs are characterized by significant interpersonal challenges. Recently, these challenges have been hypothesized to stem from underlying maladaptive attachment schemas. Our goal is to outline and elaborate on attachment theory as a foundation for the etiology and pathology of PDs and to highlight the implications of this theory for treatment. We begin with a brief review of attachment, describing its conceptualization and assessment in both children and adults in order to examine PD development. This theoretical foundation is supported by a body of empirical research, from which we present findings from neurobiological and developmental literatures linking attachment and PDs. We then examine the role of attachment in the psychotherapy process and in treatment outcome. Further, we outline research reporting changes in attachment patterns as a result of treatment. Finally, we summarize the implications of attachment theory for understanding PDs and present possible directions for future research.En este trabajo proponemos que la teoría de apego de John Bowlby ofrece un modelo teoréticamente coherente, empíricamente basado y clínicamente útil para entender la patología de personalidad. Este marco teorético trae parquedad y anchura a la conceptualización de la etiología, mantenimiento y tratamiento de trastornos de personalidad. La teoría de apego puede explicar las dificultades tanto intrapersonales como interpersonales comunes a las personas con trastornos de personalidad y es consistente con los descubrimientos de estudios de varios dominios del saber, incluyendo biología evolutiva, etiología/psicología comparada, psicología de desarrollo, psicología de personalidad y psicología social-personalidad experimental, y neurociencia. Trastornos de personalidad son caracterizados por los retos interpersonales significativos. Últimamente, se han hecho hipótesis que estos retos son el resultado de esquemas de apego mal adaptivos. Nuestro objetivo es explicar y elaborar la teoría de apego como la base para la etiología y patología de trastornos de personalidad y acentuar las implicaciones de esta teoría para el tratamiento. Empezamos con un pequeño análisis del apego, describiendo sus conceptualizaciones y evaluación tanto en niños como adultos para examinar el desarrollo de trastornos de personalidad. Este fundamento teórico está apoyado por la investigación empírica, de la que presentamos resultados de la literatura neurobiológica y de desarrollo relacionados con el apego y los trastornos de personalidad. Luego investigamos el papel que tiene el apego en los procesos de psicoterapia y en los resultados del tratamiento. Finalmente, resumimos las implicaciones de la teoría de apego para entender trastornos de personalidad y presentamos unas posibles direcciones para las futuras investigaciones

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

An Attachment Theoretical Framework for Personality Disorders

Personality disorders are highly prevalent, associated with considerable morbidity, and difficult to treat. Intrapersonal and interpersonal difficulties are central to the pathology observed in personality disorders. Attachment theory provides a broad yet parsimonious explanatory framework for understanding the development, maintenance, and treatment of personality pathology. Attachment theory conceptualizes human behaviour in ways consistent with multiple scientific traditions, including evolutionary, developmental, and neuropsychological domains. The relevant literature has focused predominately on borderline personality disorder, although a few studies have examined attachment associations with other personality disorders, such as narcissistic and avoidant personality disorders. The authors first outline attachment theory and discuss assessment of attachment patterns from both developmental and social psychological viewpoints. Next, the authors present empirical support for attachment theory and its associations with personality, including studies of developmental, physiological, neurobiological, and genetic correlates of personality pathology. They then look at psychotherapy research relevant to (a) underlying components of current psychotherapies, (b) the relation between attachment and both therapy process and treatment outcome, and (c) changes in attachment styles as a result of personality disorder treatment. Finally, the authors call for future research to delve deeper into specific relationships between attachment constructs and personality pathology, as well as to address personality disorders more broadly. Keywords: attachment theory, personality disorder, psychopathology, psychotherapy In this article, we propose that John Bowlby and Mary Ainsworth&apos;s attachment theory provides a cogent, empirically based, clinically useful, and theoretically coherent model for understanding many of the intrapsychic and interpersonal aspects that are central to personality disorders (PDs). This theoretical framework brings both parsimony and breadth to the conceptualisation of the etiology, maintenance, and treatment of PDs. Further, attachment theory is consistent with research findings from a host of studies across multiple domains of knowledge, including evolutionary biology, ethology/comparative psychology, developmental psychology, experimental social-personality psychology, and neuroscience Difficulties with attachment are often at the heart of most PDs Attachment Theory Early interactions between child and caregiver are at the core of attachment theory. The affective bond that develops between caregiver and infant is the developmental nucleus of identity formation, intrapersonal regulation, and interpersonal attitudes Although this adaptive form of attachment is perhaps ideal, Bowlby suggested that other modes of attachment exist. He hypothesised that security of attachment derives from a caregiver&apos;

An Attachment Theoretical Framework for Understanding Personality Disorders: Developmental, Neuroscience, and Psychotherapeutic Considerations

In this paper we propose that John Bowlby's attachment theory provides a theoretically coherent, empirically based, and clinically useful model for understanding personality pathology. This theoretical framework brings parsimony and breadth to the conceptualization of the etiology, maintenance, and treatment of personality disorders (PDs). Attachment theory can explain both the intrapersonal and interpersonal difficulties common in those with PDs and is consistent with findings from studies across multiple domains of knowledge, including evolutionary biology, ethology/comparative psychology, developmental psychology, experimental social-personality psychology, and neuroscience.<br />PDs are characterized by significant interpersonal challenges. Recently, these challenges have been hypothesized to stem from underlying maladaptive attachment schemas. Our goal is to outline and elaborate on attachment theory as a foundation for the etiology and pathology of PDs and to highlight the implications of this theory for treatment. We begin with a brief review of attachment, describing its conceptualization and assessment in both children and adults in order to examine PD development. This theoretical foundation is supported by a body of empirical research, from which we present findings from neurobiological and developmental literatures linking attachment and PDs. We then examine the role of attachment in the psychotherapy process and in treatment outcome. Further, we outline research reporting changes in attachment patterns as a result of treatment. Finally, we summarize the implications of attachment theory for understanding PDs and present possible directions for future research