The longitudinal relation between personality disorder symptoms and depression in adolescence: the mediating role of interpersonal stress.

The relation between personality disorder (PD) symptoms, depression, and interpersonal stress were examined over 6 months in a sample of 143 adolescents from a low-income urban high school. Both self report questionnaires in the full sample and structured interviews in a subset of 54 girls indicated the following: PD symptoms predicted greater depressive symptoms and interpersonal stress over time; PD symptoms were highly stable; depressive symptoms did not predict change in PD symptoms over time. Moreover, an integrative model was supported, wherein the route by which PD symptoms led to greater depression was via the generation of interpersonal stress. These results suggest that adolescents' PD symptoms play a destructive role in the construction of interpersonal circumstances during a key period for depression onset.

The stress sensitization hypothesis: understanding the course of bipolar disorder.

BACKGROUND: The influence of psychosocial stress on the course of bipolar disorder has been increasingly recognized. The authors tested hypotheses about both stress and early adversity "sensitization" on the course of bipolar disorder over a one-year period. METHODS: The participants were 58 adults (29 male and 29 female) with a diagnosis of bipolar I disorder. They were evaluated every three months for one year. Stressful life events and the presence of early adversity were assessed by structured interview. RESULTS: There was no significant interaction between stress and episode number in the prediction of bipolar recurrence. The interaction of early adversity severity and stressful life events significantly predicted recurrence in a manner consistent with the sensitization hypothesis. Participants with early adversity reported lower levels of stress prior to recurrence than those without early adversity. Individuals with early adversity also had a significantly younger age of bipolar onset. LIMITATIONS: The sample size was small and the number of past episodes was determined retrospectively, mainly through self-report. CONCLUSIONS: Severe early adversity may result in a greater effect of stress on bipolar recurrence and earlier onset of bipolar disorder, suggesting the need for further studies of stress mechanisms in bipolar disorder and of treatments designed to intervene early among those at risk.

Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients.

BACKGROUND: The expressed emotion (EE) construct has predicted clinical outcomes in schizophrenia and depression, but few studies have been conducted with bipolar patients. Moreover, there is a particular dearth of information regarding the prediction of depressive versus manic episodes in bipolar patients. Questions also remain about the utility of EE compared to other variables (perceived criticism, relationship negativity, and chronic strain in close relationships) that more directly evaluate interpersonal stress and about specific predictions of mania or depression. METHODS: Forty-seven outpatients with bipolar I disorder participated in a 1-year longitudinal study. A close collateral of the patient completed the Five Minute Speech Sample (FMSS) to assess EE, and participants completed perceived criticism and negativity ratings of collaterals. Clinical outcomes and chronic interpersonal stress were assessed by interview at 3-month intervals. RESULTS: High EE predicted depressive, but not manic recurrence. Other variables of close interpersonal relationships were not significant predictors of recurrence. LIMITATIONS: Participants nominated collaterals, and those who did not have such a confidant were excluded. CONCLUSIONS: The FMSS was sensitive to even mild negativity by the collateral that predicted later depressive episodes. This is the first study to demonstrate polarity-specific effects of EE on the prediction of recurrence in bipolar disorder.

Effects of stress and social support on recurrence in bipolar disorder.

BACKGROUND: Limited research has examined the impact of social support on the course of bipolar disorder, although results suggest a probable link. This study examines prospectively the effects of stressful events and social support on episode recurrence in bipolar I disorder. METHODS: Fifty-two outpatients with bipolar I disorder recruited from an urban community were followed every 3 months for up to 1 year. At the initial interview, individuals reported separately on perceived social support from a best friend, parent, and romantic partner, combined to form a total network support score. Ongoing prospective assessments of stressful life events, symptomatology, and medication compliance were completed over 1 year. Logistic regressions were utilized to predict episode recurrence. RESULTS: As predicted, both higher levels of stress and lower levels of social support from the total network independently predicted depressive recurrence over a 1-year follow-up, after controlling for clinical history and compliance. Social support did not moderate the impact of stress. LIMITATIONS: Only a 1-year follow-up was obtained, and sample sizes may have been insufficient to detect prediction of manic episodes. Direction of causality between support and recurrence is hypothesized but cannot be definitively determined. CONCLUSIONS: Higher levels of stress and perceptions of less available and poorer quality close relationships are associated with recurrence. Interventions that target these psychosocial vulnerabilities may help alter the course of bipolar I disorder. Research with larger samples should further examine the possible polarity-specific effects of social risk factors.

Depressive symptoms and close relationships during the transition to adulthood: perspectives from dysphoric women, their best friends, and their romantic partners.

Late adolescent women's depressive symptoms and interpersonal functioning were assessed using reports from participants, their best friends, and their romantic partners. As predicted, the associations between relationship dysfunction and dysphoria were stronger in romantic relationships than in friendships. Unlike friends, romantic partners perceived dysphoric women as having poorer social skills. Romantic partners also reported providing less emotional support to dysphoric women, whereas friends reported providing more. Finally, romantic partners of dysphoric women had more Cluster A (odd-eccentric) personality disorder symptoms; these symptoms mediated the relation between women's depression and partners' nonsupportiveness. The findings suggest that dysphoric women may find themselves in emotionally nonsupportive romantic relationships because they have paired (through assortative pairing or mutual influence) with symptomatic partners.

Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity.

The relationships between romantic relationship dysfunction and symptoms of borderline personality disorder (BPD), other personality disorders, and depression were examined prospectively in a community sample of 142 late adolescent women. Although BPD symptoms predicted 4-year romantic dysfunction (romantic chronic stress, conflicts, partner satisfaction, abuse, and unwanted pregnancy), the associations were not unique to BPD. Instead, relationship dysfunction was better predicted by a cumulative index of non-BPD Axis II pathology. Depression did not predict outcomes uniquely when Axis II symptoms were included, except in the case of unplanned pregnancy. The results suggest that although BPD is associated with relationship dysfunction, the effect is a more general phenomenon applying rather broadly to Axis II pathology. The results also highlight the importance of subclinical psychopathology in the construction of early intimate relationships.