Early experience, structural dissociation, and emotional dysregulation in borderline personality disorder: the role of insecure and disorganized attachment

Mosquera, Dolores; González, Anabel; Leeds, Andrew M.

doi:10.1186/2051-6673-1-15

Cited by 46 publications

(42 citation statements)

References 43 publications

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“…For some, the idea that BPD might have an underlying biological and genetic basis came as a surprise. It is our experience from the UK‐service setting that BPD is largely understood within a psychological trauma‐informed paradigm in which it is seen as inherently linked with adverse childhood experiences including childhood sexual abuse (Menon, Chaudhari, Saldanha, Devabhaktuni, & Bhattacharya, ), severe neglect, attachment ruptures, overprotection and invalidating environments (Mosquera, Gonzalez, & Leeds, ). While The Science of BPD in no way diminishes the importance of historical trauma, it also links this with predisposing biological factors.…”

Section: Discussionmentioning

confidence: 99%

“…For some, the idea that BPD might have an underlying biological and genetic basis came as a surprise. It is our experience from the UK-service setting that BPD is largely understood within a psychological trauma-informed paradigm in which it is seen as inherently linked with adverse childhood experiences including childhood sexual abuse (Menon, Chaudhari, Saldanha, Devabhaktuni, & Bhattacharya, 2016), severe neglect, attachment ruptures, overprotection and invalidating environments (Mosquera, Gonzalez, & Leeds, 2014 BPD-diagnosed individuals seem to feel is required actually improve care, or is it an impossible demand whose purpose is largely to shift responsibility for changing practice onto "the system"? Some nurses appeared resistant to change from the outset, maintaining an adverse attitude towards BPD-diagnosed patients which led to frustration when the training did not validate that.…”

Section: Discussionmentioning

confidence: 99%

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Mixed‐methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder

Dickens

Lamont

Mullen³

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To evaluate and explore mental health nurses’ responses to and experience of an educational intervention to improve attitudes towards people with a diagnosis of borderline personality disorder (BPD). Report findings are concordant with relevant EQUATOR guidelines (STROBE and COREQ). Background Attitudes towards people with a diagnosis of BPD are poorer than for people with other diagnoses. There is limited evidence about what might improve this situation. One intervention with reportedly good effect uses an underlying biosocial model of BPD. No previous intervention has been co‐produced with an expert by experience. We developed and delivered a 1‐day intervention comprising these elements. Design A mixed‐methods design was used comprising prospective within‐subjects cohort intervention and qualitative elements. Participants were mental health nursing staff working in inpatient and community settings in one NHS Board in Scotland, UK. Methods Measurement of cognitive and emotional attitudes to people with a diagnosis of BPD at pre‐ and postintervention (N = 28) and at 4‐month follow‐up. Focus groups were used to explore participants’ experiences of the intervention (N = 11). Results Quantitative evaluation revealed some sustained changes consistent with expected attitudinal gains in relation to the perceived treatment characteristics of this group, the perception of their suicidal tendencies and negative attitudes in general. Qualitative findings revealed some hostility towards the underpinning biosocial model and positive appreciation for the involvement of an expert by experience. Conclusions Sustained benefits of an educational intervention for people working with people diagnosed with BPD in some but not all areas. Participants provided contrasting messages about what they think will be useful. Relevance to clinical practice The study provides further evidence for incorporation of a biosocial model into staff training as well as the benefits of expert by experience co‐production. Mental health nurses, however, believe that more well‐resourced services are the key to improving care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mixed‐methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder

Dickens

Lamont

Mullen³

et al. 2019

Journal of Clinical Nursing

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“…Thus, individuals with Borderline Personality Disorder have deficits in accurately attributing mental states to others (cognitive empathy) and having an appropriate emotional response to another person’s emotional state (emotional empathy) (Preissler et al 2010; Roepke et al 2012). These deficits relate to a theory of mind deficit possibly related to insecure and disorganized early attachment (Mosquera et al 2014). …”

Section: The Neuropsychology Of Psychiatric Disorders Vs Alcoholismmentioning

confidence: 99%

Psychiatric Comorbidity in Alcohol Dependence

Fein

2015

Neuropsychol Rev

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We review our clinical studies of psychiatric comorbidity in short-term and long-term abstinent and in treatment naïve alcoholics (STAA, LTAA and TNA). TNA ypically have less severe alcoholism than treated abstinent samples and evidence less severe psychiatric disturbance. Lifetime psychiatric diagnoses are the norm for STAA and LTAA but not for TNA. Individuals with alcohol and drug use disorders show greater antisocial personality disturbance, but do not show differences in the mood or anxiety domains or in borderline personality disorder (BPD) symptoms. The studies show that alcoholics can achieve and maintain abstinence in the face of ongoing mood, anxiety, or BPD problems. By contrast, for ASPD, LTAA essentially stop current antisocial behaviors in all seven domains of antisocial behaviors. We believe that ongoing antisocial behavior is not consistent with maintaining abstinence, and that LTAA modify their antisocial behavior despite continued elevated social deviance proneness and antisocial dispositionality. Abstinent individuals without lifetime psychiatric disorders and TNA show more (subdiagnostic threshold) psychiatric symptoms and abnormal psychological measures than nonalcoholic controls in the mood, anxiety, BPD, and antisocial domains. In summary, our studies show that although LTAA have achieved multi-year abstinence, they still report significant psychological distress compared to NAC. We believe this distress may negatively affect their quality of life. This suggests the importance of developing effective care models to address comorbid mental health problems in LTAA. We also show that antisocial personality disorder symptoms decline to the levels seen in normal controls, and that excluding individuals from research with a psychiatric diagnosis does not control for subdiagnostic psychiatric differences between alcoholics and controls.

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“…Twin studies have indicated that monozygotic twins have significantly higher concordance rates than dizygotic twins for AN, indicating there is a genetic component to the development of AN [1]. Neurologic and hormonal changes associated with malnourishment may also play a role in the maintenance AN [6,7].…”

Section: Issn: 2056-8339mentioning

confidence: 99%

“…The Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition defines anorexia nervosa (AN) as the restriction of energy intake relative to requirements leading to significantly low body weight, in conjunction with an extreme fear of gaining weight and a distorted view of body weight and shape [1]. AN is defined as either restricting type (AN-R) or binge-eating/purging type (AN-BP).…”

Section: Introductionmentioning

confidence: 99%

Practical methods for refeeding patients with anorexia nervosa

A¹,

Em²,

Johnson³

et al. 2017

Integr Food Nutr Metab

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Anorexia nervosa (AN) is a complex mental health disorder that may result in life threatening medical complications if not properly treated. Refeeding and weight restoration are the primary goals of treatment in AN. A multidisciplinary team is essential during this process in order to properly monitor and address complications that can arise during refeeding. There are benefits and drawbacks to different approaches to refeeding and weight restoration, however, recent research supports more aggressive approaches to refeeding and weight restoration. This review explores recommendations for methods of refeeding from various professional organizations, current standards of practice, as well as management of complications that may arise during the refeeding process. Abbreviations and symbols IntroductionThe Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition defines anorexia nervosa (AN) as the restriction of energy intake relative to requirements leading to significantly low body weight, in conjunction with an extreme fear of gaining weight and a distorted view of body weight and shape [1]. AN is defined as either restricting type (AN-R) or binge-eating/purging type (AN-BP). AN-R occurs "when weight loss is accomplished primarily through dieting, fasting and/or excessive exercise". AN-BP is diagnosed "when during the last three months the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or misuse of laxatives, diuretics, or enemas)" The severity of AN is defined by body mass index (BMI): mild: BMI > 17 kg/m 2 , moderate: BMI 16-16.99 kg/ m 2 , severe: BMI 15-15.99 kg/m 2 , and extreme: BMI <15 kg/m 2 .The overall prevalence of AN is estimated to be 1-2% of females between the ages of 15-35. Males have a rate of 0.1% and the overall female to male ratio is 1:20 [2][3][4]. AN has the highest mortality rate of any psychiatric disorder, with a reported mortality rate of 5.6% [5]. Medical complications related to the disorder result in 50% of the deaths in individuals with AN, and at least half of the remainder of the deaths have resulted from suicide. The peak occurrence of AN is during adolescence and early adulthood. Longitudinal studies have identified body dissatisfaction, dieting and picky eating as possible predictors for eating disorders. Additionally, multivariate studies have found obsessive-compulsive personality disorder as well as generalized anxiety indicate to have a strong predictive value for AN [3].

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Early experience, structural dissociation, and emotional dysregulation in borderline personality disorder: the role of insecure and disorganized attachment

Cited by 46 publications

References 43 publications

Mixed‐methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder

Mixed‐methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder

Psychiatric Comorbidity in Alcohol Dependence

Practical methods for refeeding patients with anorexia nervosa

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