Body self-evaluation and physical scars in patients with borderline personality disorder: an observational study

Background Data from general psychology suggest that body self-evaluation is linked to self-esteem and social emotions. Although these emotions are fragile in individuals with borderline personality disorder (BPD), body self-evaluation is clearly understudied in BPD research. Methods A total of 200 women took part in the study: 80 female BPD patients, and 47 healthy and 73 clinical controls including post-traumatic stress disorder (PTSD) after childhood sexual abuse (CSA). Diagnoses were established through standardised interviews conducted by experienced psychologists. The participants used the Survey of Body Areas to indicate which areas of their own bodies they liked or disliked and to mark the locations of physical scars. Results Compared to healthy controls, both BPD patients and patients with PTSD after CSA had a predominantly negative body self-evaluation (Cohens d=1.42 and 1.38, respectively). As indicated by multilevel analyses, scars were related to a negative evaluation of the affected areas in BPD patients, but not in the control groups. Subgroup analyses revealed that the negative body self-evaluation applies to both BPD patients with and without PTSD or reported CSA. Conclusions BPD patients show a negative body self-evaluation which is associated with the presence of scars but not with CSA

The association of stress and physical activity: Mind the ecological fallacy [Der Zusammenhang zwischen Stress und körperlicher Aktivität: Mind the ecological fallacy]

Psychological stress and physical activity are interrelated, constituting a relevant association to human health, especially in children. However, the association’s nature remains elusive, i.e., why psychological stress predicts both decreased and increased physical activity. To test whether effects vary as a function of the level of analyses, we derived intensive longitudinal data via accelerometers and stress questionnaires from 74 children across 7 days as they went about their daily routines (n = 513 assessments). Multilevel modelling analyses revealed that between children, higher psychological stress predicted decreased physical activity (standardized beta coefficient = −0.14; p = 0.046). Concurrently, within those children, higher psychological stress predicted increased physical activity across days (standardized beta coefficient = 0.09; p = 0.015). Translated to practice, children who experienced more stress than others moved less, but children were more active on days when they experienced heightened stress. This suggests that the analyses level is crucial to the understanding of the association between psychological stress and physical activity and should be considered to receive unequivocal results. If replicated, e.g., including high-frequency sampling and experimental manipulation in everyday life for in-depth insights on underlying mechanisms and causality, our findings may be translated to individually tailored (digital) prevention and intervention strategies which target children’s distress-feelings despite impairing their heightened physical activity in stressful situations and identify tipping points of chronic stress phases. Therefore, we especially call for more intensive longitudinal data approaches to tackle thus far neglected within-subject issues in the field of physical activity, sport and exercise research

Relationships between incidental physical activity, exercise, and sports with subsequent mood in adolescents

Physical activity is beneficial for human physical health and well-being. Accordingly, the association between physical activity and mood in everyday life has been a subject of several Ambulatory Assessment studies. This mechanism has been studied in children, adults, and the elderly, but neglected in adolescents. It is critical to examine this mechanism in adolescents because adolescence plays a key role in human development and adolescents’ physical activity behavior translates into their behavior in adulthood. We investigated adolescents’ mood in relation to distinct physical activities: incidental activity such as climbing stairs; exercise activity, such as skating; and sports, such as playing soccer. We equipped 134 adolescents aged 12-17 years with accelerometers and GPS-triggered electronic diaries to use in their everyday life. Adolescents reported on mood repeatedly in real time across 7 days, and these data were analyzed using multilevel-modeling. After incidental activity, adolescents felt better and more energized. After exercise, adolescents felt better but less calm. After sports, adolescents felt less energized. Analyses of the time course of the effects confirmed our findings. Physical activity influences mood in adolescents’ everyday life, but has distinct effects depending on the kind of physical activity. Our results suggest incidental and exercise activities entail higher post-bout valence compared to sports in competitive settings. These findings may serve as an important empirical basis for the targeted application of distinct physical activities to foster well-being in adolescence

Process Analysis of Visual Search in ADHD, Autism and Healthy Controls - Evidence from Intra-Subject Variability in Gaze Control

Increased Intra subject variability, i.e. moment to moment fluctuations in performance, is a candidate endophenotype of Attention Defecit Hyperactivity Disorder (ADHD. In light of potential etiological overlap between ADHD and Autism Spectrum Disorder (ASD) (Biscaldi et al., 2015; Rommelse et al., 2011), it is important to study ISV, in both aforementioned disorders simultaneously. Here, we broaden the study of ISV from reaction time tasks with manual responses to the ISV of gaze control. Children and adolescents with ADHD, ASD and healthy controls, aged 10-13 years (N = 90; all native German speakers) were invited for an oculomotor testing session. Participants were presented a visual search task. The task required participants to find a Portuguese target word shown above a grid with multiple Portuguese German word pairs and indicate its position by pressing response keys matching the search array. Preliminary analysis have been calculated with moment-to-moment fluctuations in eye movements for the period of search. Preliminary results suggest increased ISV in the ADHD group. Our study extends the ISV finding to the ocular-motor domain, proposes methods to study ISV in gaze movement, and highlights its relationship with ASD

Studying global processing in autism and attention-deficit/hyperactivity disorder with gaze movements: The example of a copying task

Recent discussions in the literature, along with the revision of the Diagnostic and Statistical Manual (DSM) (American Psychiatric Association 2013), suggest aetiological commonalities between the highly comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). Addressing this discussion requires studying these disorders together by comparing constructs typical to each of them. In the present study, we investigate global processing, known to be difficult for participants with ASD, and Intra-Subject Variability (ISV), known to be consistently increased in participants with ADHD, in groups, aged 10–13 years, with ADHD (n = 25), ASD without comorbid ADHD (ASD-) (n = 13) and ASD with ADHD (ASD+) (n = 18) in comparison with a typically developing group (n = 22). A Copying task, typically requiring global processing and in this case particularly designed using equally complex stimuli to also measure ISV across trials, was selected. Oculomotor measures in this task proved to be particularly sensitive to group differences. While increased ISV was not observed in the present task in participants with ADHD, both ASD groups looked longer on the figure to be drawn, indicating that global processing takes longer in ASD. However, the ASD+ group fixated on the figure only between drawing movements, whereas the ASD- group did this throughout the drawing process. The present study provides evidence towards ASD and ADHD being separate, not-overlapping, disorders. Since the pure ASD- group was affected more by central coherence problems than the ASD+ group, it may suggest that neuropsychological constructs interact differently in different clinical groups and sub-groups

Effects of Endurance Exercise Training and Crataegus Extract WS® 1442 in Patients with Heart Failure with Preserved Ejection Fraction - A Randomized Controlled Trial

Impaired exercise capacity is the core symptom of heart failure with preserved ejection fraction (HFpEF). We assessed effects of exercise training and Crataegus extract WS 1442 in HFpEF and aimed to identify mechanisms of action in an exploratory trial (German Clinical Trials Register DRKS00000259). 140 sedentary HFpEF NYHA II patients on standard treatment received eight weeks of aerobic endurance training and half were randomized to WS 1442 900 mg/day. Symptoms, 2 km walking time (T2km), parameters of exercise tolerance, cardiac and vascular function, muscular efficiency and skeletal muscular haemoglobin oxygen saturation (SO2) measured during a treadmill protocol were captured at baseline and after eight weeks. Adverse events were recorded during the trial. Mechanisms of action were explored by correlation and path analyses of changes. Symptoms and exercise capacity improved with training, but correlations between improvements were low and path models were rejected. SO2 increased, decreased or undulated with increasing exercise intensity in individual patients and was not altered by training. WS 1442 improved T2km (-12.7% vs. -8.4%, p = 0.019), tended to improve symptoms and to pronounce SO2-decrease with increasing exercise, an indicator of oxygen utilisation. Endurance training and WS 1442 were safe and well tolerated in combination with standard drug treatment

Digital mental health: challenges and next steps

Digital innovations in mental health offer great potential, but present unique challenges. Using a consensus development panel approach, an expert, international, cross-disciplinary panel met to provide a framework to conceptualise digital mental health innovations, research into mechanisms and effectiveness and approaches for clinical implementation. Key questions and outputs from the group were agreed by consensus, and are presented and discussed in the text and supported by case examples in an accompanying appendix. A number of key themes emerged. (1) Digital approaches may work best across traditional diagnostic systems: we do not have effective ontologies of mental illness and transdiagnostic/symptom-based approaches may be more fruitful. (2) Approaches in clinical implementation of digital tools/interventions need to be creative and require organisational change: not only do clinicians and patients need training and education to be more confident and skilled in using digital technologies to support shared care decision-making, but traditional roles need to be extended, with clinicians working alongside digital navigators and non-clinicians who are delivering protocolised treatments. (3) Designing appropriate studies to measure the effectiveness of implementation is also key: including digital data raises unique ethical issues, and measurement of potential harms is only just beginning. (4) Accessibility and codesign are needed to ensure innovations are long lasting. (5) Standardised guidelines for reporting would ensure effective synthesis of the evidence to inform clinical implementation. COVID-19 and the transition to virtual consultations have shown us the potential for digital innovations to improve access and quality of care in mental health: now is the ideal time to act

Analyzing subcomponents of affective dysregulation in borderline personality disorder in comparison to other clinical groups using multiple e-diary datasets

Background: Affective dysregulation is widely regarded as being the core problem in patients with borderline personality disorder (BPD). Moreover, BPD is the disorder mainly associated with affective dysregulation. However, the empirical confirmation of the specificity of affective dysregulation for BPD is still pending. We used a validated approach from basic affective science that allows for simultaneously analyzing three interdependent components of affective dysregulation that are disturbed in patients with BPD: homebase, variability, and attractor strength (return to baseline). Methods: We applied two types of multilevel models on two e-diary datasets to investigate group differences regarding three subcomponents between BPD patients (n =43; n =51) and patients with posttraumatic stress disorder (PTSD; n= 28) and those with bulimia nervosa (BN; n= 20) as clinical control groups in dataset 1, and patients with panic disorder (PD; n= 26) and those with major depression (MD; n =25) as clinical control groups in dataset 2. In addition, healthy controls (n= 28; n= 40) were included in the analyses. In both studies, e-diaries were used to repeatedly collect data about affective experiences during participants’ daily lives. In study 1 a high-frequency sampling strategy with assessments in 15 min-intervals over 24 h was applied, whereas the assessments occurred every waking hour over 48 h in study 2. The local ethics committees approved both studies, and all participants provided written informed consent. Results: In contradiction to our hypotheses, BPD patients did not consistently show altered affective dysregulation compared to the clinical patient groups. The only differences in affective dynamics in BPD patients emerged with regard to one of three subcomponents, affective homebase. However, these results were not even consistent. Conversely, comparing the patients to healthy controls revealed a pattern of more negative affective homebases, higher levels of affective variability, and (partially) reduced returns to baseline in the patient groups. Conclusions: Our results indicate that affective dysregulation constitutes a transdiagnostic mechanism that manifests in similar ways in several different mental disorders. We point out promising prospects that might help to elucidate the common and distinctive mechanisms that underlie several different disorders and that should be addressed in future studies

Association of Locomotor Activity During Sleep Deprivation Treatment With Response

Disrupted circadian rhythms and sleep patterns are frequently observed features of psychiatric disorders, and especially mood disorders. Sleep deprivation treatment (SD) exerts rapid but transient antidepressant effects in depressed patients and has gained recognition as a model to study quick-acting antidepressant effects. It is of interest how locomotor activity patterns during SD might be associated with and potentially predict treatment response. The present study is an analysis of locomotor activity data, previously collected over a 24 h period, to examine the night of SD (Trautmann et al. 2018) as mood disorder patients suffering from a depressive episode (n = 78; after exclusions n = 59) underwent SD. In this exploratory analysis, the associations between response to SD, locomotor activity, and subjective mood during the 24 h period of SD were explored. Higher levels of activity overall were observed in non-responders (n = 18); in particular, non-responders moved more during the evening of SD until midnight and remained high thereafter. In contrast, activity in responders (n = 41) decreased during the evening and increased in the morning. Subjective mood was not found to be associated with locomotor activity. The window of data available in this analysis being limited, additional data from before and after the intervention are required to fully characterize the results observed. The present results hint at the possible utility of locomotor activity as a predictor and early indicator of treatment response, and suggest that the relationship between SD and locomotor activity patterns should be further investigated