Because of its high prevalence and implications for quality of life and possibly even disease progression, depression has been intensively studied in multiple sclerosis (MS) over the past 25 years. Despite the publication of numerous excellent empirical research papers on this topic during that time, the publication of theoretical work that attempts to explain depression in a comprehensive way is scarce. In this study, we present a theoretical model that attempts to integrate existing work on depression in MS and provide testable hypotheses for future work. The model suggests that risk for depression begins with the onset of MS. MS results in disease-related changes such as increased lesion burden0brain atrophy and immunological anomalies that are associated with depression in MS, but explain only a relatively limited proportion of the variance. Common sequelae of MS including fatigue, physical disability, cognitive dysfunction, and pain, have all been shown to have an inconsistent or relatively weak relationship to depression in the literature. In the model, we propose that four variables-social support, coping, conceptions of the self and illness, and stress-may moderate the relationship between the above common MS sequelae with depression and help to explain inconsistencies in the literature. (JINS, 2008, 14, 691-724.)
Narcissism has significant interpersonal costs, yet little research has examined behavioral and affective patterns characteristic of narcissism in naturalistic settings. Here we studied the effect of narcissistic features on the dynamic processes of interpersonal behavior and affect in daily life. We used interpersonal theory to generate transactional models of social interaction (i.e., linkages among perceptions of others’ behavior, affect, and one’s own behavior) predicted to be characteristic of narcissism. Psychiatric outpatients (N=102) completed clinical interviews and a 21-day ecological momentary assessment protocol using smartphones. After social interactions (N=5,781), participants reported on perceptions of their interaction partner’s behavior (scored along the dimensions of dominant-submissive and affiliative-quarrelsome), their own affect, and their own behavior. Multilevel structural equation modeling was used to examine dynamic links among behavior and affect across interactions, and the role of narcissism in moderating these links. Results showed that perceptions of others’ dominance did not predict dominant behavior, but did predict quarrelsome behavior, and this link was potentiated by narcissism. Further, the link between others’ dominance and one’s own quarrelsome behavior was mediated by negative affect. Moderated mediation was also found: Narcissism amplified the link between ratings of others’ dominance and one’s own quarrelsomeness and negative affect. Narcissism did not moderate the link between other dominance and own dominance, nor the link between other affiliation and own affiliation. These results suggest that narcissism is associated with specific interpersonal and affective processes, such that sensitivity to others’ dominance triggers antagonistic behavior in daily life.
Individuals with borderline personality disorder (BPD) display an impoverished sense of self and representations of self and others that shift between positive and negative poles. However, little research has investigated the nature of representational disturbance in BPD. The present study takes a multi-modal approach. A card sort task was employed to investigate complexity, integration and valence of self-representation in BPD. Impairment in maintenance of self and other representations was assessed using a personality representational maintenance task. Finally, functional magnetic resonance imaging (fMRI) was used to assess whether individuals with BPD show neural abnormalities related specifically to the self and what brain areas may be related to poor representational maintenance. Individuals with BPD sorted self-aspects suggesting more complexity of self-representation, but also less integration and more negative valence overall. On the representational maintenance task, individuals with BPD showed less consistency in their representations of self and others over the 3-hour period, but only for abstract, personality-based representations. Performance on this measure mediated between-group brain activation in several areas supporting social cognition. We found no evidence for social cognitive disturbance specific to the self. Additionally, the BPD group showed main effects, insensitive to condition, of hyperactivation in the medial prefrontal cortex, temporal parietal junction, several regions of the frontal pole, the precuneus and middle temporal gyrus, all areas crucial social cognition. In contrast, controls evidenced greater activation in visual, sensory, motor and mirror neuron regions. These findings are discussed in relation to research regarding hypermentalization and the overlap between self- and other-disturbance.
Empathy is generally thought of as the ability to share the emotional experiences of others. In scientific terms, this is usually operationalized as an ability to vicariously feel others' mental and emotional experiences. Supporting this account, research demonstrates that watching others experience physical pain activates similar brain regions to the actual experience of pain itself. First-hand experience of social rejection also activates this network. The current work extends these findings by examining whether the "pain" network is similarly implicated in witnessing rejection, and whether emotional closeness modulates this response. We provide evidence for each of these suppositions, demonstrating: (a) that the pain network is activated when watching a friend suffer social rejection, and (b) that interpersonal closeness with that friend modulates this response. Further, we found that the inferior frontal gyrus, critical for representing others' mental and emotional states, mediates the relationship between emotional closeness and neural responses to watching the rejection of a friend.
Theoretical and empirical work suggests that aggression in those with borderline personality disorder (BPD) occurs primarily in the context of emotional reactivity, especially anger and shame, in response to perceived rejection. Using intensive repeated measures, we examined a within-person process model in which perceived rejection predicts increases in aggressive urges and behaviors via increases in negative affect (indirect effect) and in which BPD symptoms exacerbate this process (moderated mediation). Participants were 117 emerging adult women (ages 18–24) with recent histories of aggressive behavior who were recruited from a community-based longitudinal study of at-risk youth. Personality disorder symptoms were assessed by semi-structured clinical interview, and aggressive urges, threats, and behaviors were measured in daily life during a three-week ecological momentary assessment (EMA) protocol. Multilevel path models revealed that within-person increases in perceived rejection predicted increases in negative affect, especially in women with greater BPD symptoms. In turn, increases in negative affect predicted increased likelihood of aggressive urges or behaviors. Further analysis revealed that BPD symptoms predicted greater anger and shame reactivity to perceived rejection, but not to criticism or insult. Additionally, only anger was associated with increases in aggression after controlling for other negative emotions. Whereas BPD symptoms exacerbated the link between perceived rejection and aggression via increases in negative affect (particularly anger), this process was attenuated in women with greater antisocial personality disorder (ASPD) symptoms. These findings suggest that anger reactivity to perceived rejection is one unique pathway, distinct from ASPD, by which BPD symptoms increase risk for aggression.
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