Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses.

Obese persons suffer from an increased mortality risk supposedly due to cardiovascular disorders related to either continuously lowered parasympathetic or altered sympathetic activation. Our cross-sectional correlation study establishes the relationship between obesity and autonomic regulation as well as salivary cortisol levels. Three patient cohorts were sampled, covering ranges of body mass index (BMI) of 27-32 (n=17), 33-39 (n=13) and above 40 kg/m 2 (n=12), and stratified for age, sex and menopausal status. Autonomic cardiovascular regulation was assessed by use of heart rate variability and continuous blood pressure recordings. Spectral analytical calculation (discrete Fourier transformation) yields indices of sympathetic and parasympathetic activation and baroreflex sensitivity. Morning salivary cortisol was concurrently collected. Contrary to expectation, BMI and waist/hip ratio (WHR) were inversely correlated with sympathetic activity. This was true for resting conditions (r= 0·48, P<0·001; r= 0·33, P<0·05 for BMI and WHR respectively) and for mental challenge (r= 0·42, P<0·01 for BMI). Resting baroreflex sensitivity was strongly related to the degree of obesity at rest (BMI: r= 0·35, P<0·05) and for mental challenge (r= 0·53, P<0·001). Salivary cortisol correlated significantly with waist circumference (r= 0·34, P=0·05). With increasing weight, no overstimulation was found but a depression in sympathetic and parasympathetic activity together with a significant reduction in baroreflex functioning and in salivary cortisol levels.

According to current concepts of functional psychosomatic disorders, disturbed interoceptive processes are considered relevant causal factors especially in relation to panic disorders and functional cardiac complaints. In our study, heart beat perception was assessed for subgroups of psychosomatic disorders and in comparison to healthy controls. A further issue was the distribution of performance scores across diagnostic subgroups. Special consideration was given to the question of panic patients forming two extreme groups with either better or worse perception than other patient groups. Additionally, a subsample of patients was tested twice in order to establish test-retest-reliability of heart beat perception. Within the whole group of 546 patients, marginally significant differences in heart beat perception scores in the Schandry Mental Tracking Task between subgroups became evident. The detection score of patients with personality disorders was lower compared to patients with functional disorders and healthy controls. Patients with functional heart disorder and panic patients did not have higher perception scores than controls. Effects of medication were taken into account. Only medicated panic patients showed better heart beat perception than unmedicated ones. The distribution of heart beat perception was similar in all groups studied, patients with panic disorders did not differ from the general picture. Time stability after a 4 week interval in 42 patients was sufficiently high to show trait characteristics reaching r = .58. In general, psychosomatic patients are characterized by a tendency towards lower perception scores compared to healthy subjects. Better than normal interoceptive functioning, in contrast to some literature reports, does not seem to play a decisive role in the establishment of functional psychosomatic disorders.

The significance of training programmes was assessed in reducing cognitive deficits in schizophrenics. In a controlled clinical trial, which included 15 experimental and 15 comparison subjects, training was shown to be effective with regard to more complex cognitive functions rather than on an elementary level. Results are discussed with regard to theoretical and practical implications.