Statistical outcomes cannot be equated with clinical relevance. The "MID" may be used for pinpointing the cutoff for clinical relevance, but more work in this area is needed.
Psychotherapy may be effective in the treatment of subclinical depression and reduce the incidence of major depression, but more high-quality research is needed.
Although affect dysregulation is considered a core component of borderline personality disorder (BPD) and somatoform disorders (SoD), remarkably little research has focused on prevalence and nature of affect dysregulation in these disorders. BPD and SoD diagnoses were confirmed or ruled out in 472 psychiatric inpatients using clinical interviews. Three qualitatively different forms of affect dysregulation were identified: under-regulation, over-regulation of affect and combined under- and over-regulation of affect. BPD was associated with under-regulation of affect, and SoD was associated with over-regulation of affect. However, one in five patients with BPD also reported substantial over-regulation, and one in six patients with SoD reported clinically significant under-regulation, and the comorbid BPD and SoD group reported more frequently both over- and under-regulation than patients diagnosed with BPD or SoD alone or those with other psychiatric disorders.
Affect dysregulation and dissociation may be associated with borderline personality disorder (BPD) and somatoform disorder (SoD). In this study, both under-regulation and over-regulation of affect and positive and negative somatoform and psychoform dissociative experiences were assessed. BPD and SoD diagnoses were confirmed or ruled out in 472 psychiatric inpatients using clinical interviews and clinical multidisciplinary consensus. Affect dysregulation and dissociation were measured using self-reports. Under-regulation (but not over-regulation) of affect was moderately related to positive and negative psychoform and somatoform dissociative experiences. Although both BPD and SoD can involve dissociation, there is a wide range of intensity of both somatoform and psychoform dissociative phenomena in patients with these diagnoses. Compared with other groups, SoD patients more often reported low levels of dissociative experiences and reported fewer psychoform (with or without somatoform) dissociative experiences. Compared with the other groups, patients with both BPD and SoD reported more psychoform (with or without somatoform) dissociative experiences. Evidence was found for the existence of 3 qualitatively different forms of experiencing states. Over-regulation of affect and negative psychoform dissociation, commonly occurring in SoD, can be understood as inhibitory experiencing states. Under-regulation of affect and positive psychoform dissociation, commonly occurring in BPD, can be understood as excitatory experiencing states. The combination of inhibitory and excitatory experiencing states commonly occurred in comorbid BPD + SoD. Distinguishing inhibitory versus excitatory states of experiencing may help to clarify differences in dissociation and affect dysregulation between and within BPD and SoD patients.
Objective: Complex posttraumatic stress disorder (CPTSD) as defined by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) formulation is associated with childhood relational trauma and involves relational impairment, affect dysregulation, and identity alterations. However, the distinct contributions of relational impairment (operationalized in the form fears of closeness or abandonment), affect dysregulation (operationalized in the form of overregulation and under-regulation of affect), and identity alterations (operationalized in the form of positive or negative psychoform or somatoform dissociation) to the relationship between childhood trauma and CPTSD/DESNOS have not been systematically tested.
Method and Results: In a clinical sample of adults diagnosed with severe and chronic psychiatric and personality disorders (n = 472; M = 34.7 years, SD = 10.1), structural equation modelling with bootstrap 95% confidence intervals demonstrated that the association between childhood trauma and CPTSD/DESNOS symptoms in adulthood was partially mediated by under-regulation of affect, negative psychoform dissociation, and adult relational fears of closeness and of abandonment. These results also were independent of the effects of borderline personality disorder (BPD) symptoms.
Conclusions: Some, but not all, hypothesized components of the DESNOS formulation of CPTSD statistically mediate the relationship between childhood trauma and adult CPTSD/DESNOS. These relationships appear specific to CPTSD/DESNOS and not to the effects of another potential sequelae of childhood trauma BPD. Replication with prospective longitudinal studies is needed.
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