Developmental and Momentary Dynamics in the Onset and Maintenance of Nonsuicidal Self-Injurious Behavior and Borderline Personality Disorder

Selby, Edward A.; Harnedy, Lauren E.; Hiner, Michelle; Kim, Joanne S.

doi:10.1007/s11920-022-01396-3

Cited by 5 publications

(3 citation statements)

References 69 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study altogether illustrates the added value of in-depth case-study research [9] and the utility of complex systems principles to guide such an inquiry. Our three-step approach adheres to recent calls for holistic and dynamic accounts of challenging behaviors in BPD [49]. Over time, few (if any) if-then relationships could be said to possibly explain the participant's challenging behavior, substantiating it as a complex phenomenon that is di cult to grasp.…”

Section: Discussion Conclusionmentioning

confidence: 99%

A complex systems perspective on chronic aggression and self-injury: Case study of a woman with mild intellectual disability and borderline personality disorder

Hulsmans,

Otten,

Poelen

et al. 2023

Preprint

View full text Add to dashboard Cite

Background Challenging behaviors like aggression and self-injury are dangerous for clients and staff in residential care. These behaviors are not well understood and therefore often labeled as “complex”. Yet it remains vague what this supposed complexity exactly entails at the individual level. The current case-study used a mixed-methods analytical strategy, inspired by complex systems theory, that consisted of three steps. First, we construed a holistic summary of the client’s relevant factors in her daily life. Second, we described her challenging behavioral trajectory by identifying stable phases. Third, instability and extraordinary events in her environment were evaluated as potential mechanisms for changes between different phases. Case presentation A woman, living at a residential facility, with mild intellectual disability and borderline personality disorder with a chronic pattern of aggressive and self-injurious incidents. She used ecological momentary assessments to daily self-rate challenging behaviors for 560 days. Conclusions A qualitative summary of caretaker records revealed many internal and environmental factors relevant to her daily life. Her clinician narrowed these down to 11 staff hypothesized risk- and protective factors, such as reliving trauma, experiencing pain, receiving medical care, compliments or psychological therapy. The vast multitude of bivariate associations between these 11 factors and self-reported challenging behaviors were non-significant. These null-results indicate that challenging behaviors are not governed by mono-causal if-then relations, speaking to its complex nature. Despite this complexity there were patterns in the temporal ordering of incidents. Aggression and self-injury occurred on respectively 13% and 50% of the 560 days. On this timeline, we identified 11 distinct stable phases, that were alternating between four unique states: high levels of aggression and self-injury, average levels of aggression and self-injury, low levels of aggression and self-injury, and low aggression with high self-injury. Eight out of ten transitions between phases were either triggered by extraordinary events in her environment (event-induced) or preceded by increased fluctuations in her self-ratings (instability-induced), or a combination of these two. Desirable patterns emerged more often and were less easily malleable, indicating that when the participant experiences bad times, keeping in mind better times are ahead is as hopeful as it is realistic.

show abstract

Section: Discussion Conclusionmentioning

confidence: 99%

A complex systems perspective on chronic aggression and self-injury: Case study of a woman with mild intellectual disability and borderline personality disorder

Hulsmans,

Otten,

Poelen

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The study altogether illustrates the added value of in-depth case-study research [ 9 ] and the utility of complex systems principles to guide such an inquiry. Our three-step approach adheres to recent calls for holistic and dynamic accounts of challenging behaviors in BPD [ 52 ]. Over time, few (if any) if-then relationships could be said to possibly explain the participant’s challenging behavior, substantiating it as a complex phenomenon that is difficult to grasp.…”

Section: Discussionmentioning

confidence: 99%

A complex systems perspective on chronic aggression and self-injury: case study of a woman with mild intellectual disability and borderline personality disorder

Hulsmans,

Otten,

Poelen

et al. 2024

BMC Psychiatry

View full text Add to dashboard Cite

Background Challenging behaviors like aggression and self-injury are dangerous for clients and staff in residential care. These behaviors are not well understood and therefore often labeled as “complex”. Yet it remains vague what this supposed complexity entails at the individual level. This case-study used a three-step mixed-methods analytical strategy, inspired by complex systems theory. First, we construed a holistic summary of relevant factors in her daily life. Second, we described her challenging behavioral trajectory by identifying stable phases. Third, instability and extraordinary events in her environment were evaluated as potential change-inducing mechanisms between different phases. Case presentation A woman, living at a residential facility, diagnosed with mild intellectual disability and borderline personality disorder, who shows a chronic pattern of aggressive and self-injurious incidents. She used ecological momentary assessments to self-rate challenging behaviors daily for 560 days. Conclusions A qualitative summary of caretaker records revealed many internal and environmental factors relevant to her daily life. Her clinician narrowed these down to 11 staff hypothesized risk- and protective factors, such as reliving trauma, experiencing pain, receiving medical care or compliments. Coercive measures increased the chance of challenging behavior the day after and psychological therapy sessions decreased the chance of self-injury the day after. The majority of contemporaneous and lagged associations between these 11 factors and self-reported challenging behaviors were non-significant, indicating that challenging behaviors are not governed by mono-causal if-then relations, speaking to its complex nature. Despite this complexity there were patterns in the temporal ordering of incidents. Aggression and self-injury occurred on respectively 13% and 50% of the 560 days. On this timeline 11 distinct stable phases were identified that alternated between four unique states: high levels of aggression and self-injury, average aggression and self-injury, low aggression and self-injury, and low aggression with high self-injury. Eight out of ten transitions between phases were triggered by extraordinary events in her environment, or preceded by increased fluctuations in her self-ratings, or a combination of these two. Desirable patterns emerged more often and were less easily malleable, indicating that when she experiences bad times, keeping in mind that better times lie ahead is hopeful and realistic.

show abstract

“…Preliminary evidence from animal models suggests that glial cells may be involved in regulating behaviours like self-injurious behaviours, which are a frequently seen clinical sign of BPD (385). In one study examining self-injurious macaques, results showed increased vimentin expression on astrocytes and activation of pathways involved in neuroinflammation, tissue remodelling, and cyclic adenosine monophosphate (cAMP) signalling, indicating that glial cells are potential therapeutic targets (386).…”

Section: Linking Inflammation and Ed Via Neuroimaging And Behaviour I...mentioning

confidence: 99%

Inflammation and emotional regulation: a narrative review of evidence and mechanisms in emotional dysregulation disorders

Petruso¹,

Giff²,

Milano³

et al. 2023

Preprint

View full text Add to dashboard Cite

Emotion dysregulation (ED) describes a difficulty with the modulation of which emotions are felt, as well as when and how these emotions are experienced or expressed. It is a focal overarching symptom in many severe and prevalent neuropsychiatric diseases, including bipolar disorders (BD), attention deficit and hyperactivity disorder (ADHD), and borderline personality disorder (BPD). In all these disorders, ED can manifest through symptoms of depression, anxiety, or affective lability. Considering the many similarities in symptoms between BD, ADHD, and BPD, a transdiagnostic approach is a promising lens of investigation. Mounting evidence supports the role of peripheral inflammatory markers and stress in the multifactorial aetiology and physiopathology of BD, ADHD, and BPD. Of note, neural circuits that regulate emotions appear particularly vulnerable to inflammatory insults and peripheral inflammation, which can impact the neuroimmune milieu of the central nervous system. Thus far, few studies have examined the link between ED and inflammation in BD, ADHD, and BPD. To our knowledge, no specific work has provided a critical comparison of the results from these disorders. To fill this gap in the literature, we review the known associations and mechanisms linking ED and inflammation in general, and clinically, in BD, ADHD, and BD. Our narrative review begins with an examination of the routes linking ED and inflammation, followed by a discussion of disorder-specific results accounting for methodological limitations and relevant confounding factors. Finally, we critically discuss both correspondences and discrepancies in the results and comment on potential vulnerability markers and promising therapeutic interventions.

show abstract

Developmental and Momentary Dynamics in the Onset and Maintenance of Nonsuicidal Self-Injurious Behavior and Borderline Personality Disorder

Cited by 5 publications

References 69 publications

A complex systems perspective on chronic aggression and self-injury: Case study of a woman with mild intellectual disability and borderline personality disorder

A complex systems perspective on chronic aggression and self-injury: Case study of a woman with mild intellectual disability and borderline personality disorder

A complex systems perspective on chronic aggression and self-injury: case study of a woman with mild intellectual disability and borderline personality disorder

Inflammation and emotional regulation: a narrative review of evidence and mechanisms in emotional dysregulation disorders

Contact Info

Product

Resources

About