Psychotic Experiences and Daily Functioning in Borderline Personality Disorder and Schizophrenia.

ABSTRACT: Psychotic experiences have been shown to be comparable in borderline personality disorder (BPD) and schizophrenia. Preliminary evidence suggests differences in the impact of psychotic experiences on daily functioning. Therefore, in this study, we aimed to investigate the role of psychotic experiences in daily functioning in BPD compared with schizophrenia. We performed post hoc analyses on data from 23 inpatients with BPD and 21 inpatients with schizophrenia, for whom results from the Psychotic Symptom Rating Scales were available. No differences were found in frequency, intensity, and disruption of life in relation to auditory verbal hallucinations and the amount of preoccupation and conviction with regard to delusions. Significant differences were found in the disruption of life due to delusions. The results emphasize that the quality of psychotic experiences in BPD and schizophrenia is comparable, but the impact of delusions on daily life is different, which may improve differential diagnosis.

How Important Is Reprocessing in Personalized Multicomponent Therapy? Analyzing Longitudinal Data of Inpatients With Severe PTSD.

ABSTRACT: Treatment guidelines for complex presentations of posttraumatic stress disorder (PTSD) are often cautious about the reprocessing of traumatic memories and recommend multicomponent treatments that are widely used in clinical practice. Yet, the role of reprocessing in these multicomponent treatments remains unknown. Using naturalistic data of 97 patients treated for PTSD, we used a linear mixed model to investigate the role of reprocessing for the outcome at discharge and at 6-month follow-up. Treatment effects were significant and large ( g = 0.91-1.05). The final model showed good fit and explained 51% of the variance. There was a significant main effect of time ( B = -8.1 [-11.5; -4.8], p < 0.001), as well as a reprocessing by time interaction ( B = -17.2 [-30.5; -3.8], p = 0.012), indicating better outcomes with higher levels of reprocessing. Hence, maximizing the amount of reprocessing used in multicomponent treatments for PTSD may significantly enhance outcomes.

[Can you See and Hear How Bad I Feel Right Now? - Self-Injury and Suicidal Communication in Borderline Personality Disorder - A Secondary Analysis]. / Kannst Du sehen und hören, wie schlecht es mir gerade geht?

Non-suicidal self-injurious behavior (NSSV) and suicide attempts are well-known features of borderline personality disorder; communicative behavior is poorly studied. Differences between patients with and without NSSV as well as differences in current suicide attempts regarding suicidal communication and NSSV were investigated.In a secondary analysis, data on current and anamnestic NSSV, suicide attempts, suicidal communication, and clinical symptomatology of 87 inpatients were studied.Patients with and without current NSSV did not differ in anamnestic but did differ in current suicide attempts and suicidal communication. In regard to the current inpatient stay, it was observed that patients with and without suicide attempts differed considerably in the variables NSSV (100 vs. 32.5 %) and suicidal communication (71.4 vs. 7.5 %).Current self-injury and suicidal communication are highly significant for risk assessment of current suicidality.

[Deliberate Renunciation of Coercion in the Case of Persistent Self-Destructive Behavior]. / Bewusster Verzicht auf Zwangsmaßnahmen bei anhaltendem selbstdestruktivem Verhalten.

The clinical course of borderline personality disorder with persistent suicidal communication and self-destruction is often characterized by freedom-restricting interventions, long-term hospitalization, and a lack of commitment for disorder-oriented treatment. We present the course of a 31-year-old man who was offered the free choice between disorder-oriented treatment or discharge from in-patient treatment. The clinical decision to offer the choice to the patient was based on the judgment of given capacity of self-determination except for short periods of acute crisis. Deliberate refraining from the use of coercive interventions and demanding responsibility for change from the patient paved the way for psychotherapeutic treatment and the reactivation of his own skills.

[Narrative Exposure Therapy in a Refugee with Severe PTSD within the Inpatient Standard Care]. / Narrative Expositionstherapie bei einem Flüchtling mit schwerer PTBS in der stationären Regelversorgung.

Forms of Posttraumatic stress disorder (PTSD) with chronical course hamper the psychosocial integration of refugees. We here report the successful treatment according to the approach of Narrative Exposure Therapy (NET) of a severely affected 42-year-old refugee from Central Africa, facilitated by an inpatient care setting. The treatment course underlines the effectiveness and necessity of the intervention even in more complex cases.

Dissociation in patients with borderline personality disorder in acute inpatient care - A latent profile analysis.

PURPOSE: Dissociation is a common symptom in Borderline Personality disorder (BPD) and its consideration is important for the therapeutic outcome. The aim of this cross-sectional study was to scrutinize the co-occurrence of BPD symptoms and dissociative experiences. In particular, we were interested in the occurrence of specific symptom clusters characterizing qualitatively different patient groups in a clinical sample of BPD patients. BASIC PROCEDURES: We analyzed the data of 103 patients in a specialized acute inpatient care crisis intervention unit. Measures were the Borderline Symptom List (BSL-95), a German adaption of the Dissociative Experience Scale (FDS), and the Symptom Checklist SCL-90-R. We applied a Latent Profile Analysis (LPA) using the subscales of BSL-95 and FDS to investigate the existence of distinct latent classes of symptom profiles. Afterwards, we related the obtained profiles to other clinical and demographic characteristics. MAIN FINDINGS: Dissociative experiences of moderate to severe intensity were common among patients with BPD. LPA revealed that a model of three classes fitted the data best: one class was characterized by co-occurrence of severe borderline symptoms and frequent dissociative experiences, one class showed low symptom burden in both measures, and one class showed considerable borderline symptoms but only moderate dissociative experiences. The classes were closely related to the severity of other self-rated psychological problems and showed significantly different occurrences of stress-related comorbid disorders. PRINCIPAL CONCLUSIONS: The results underline that dissociation is an important factor in many (but not all) BPD patients. This should be addressed by increased attention to dissociative symptoms in the diagnostic process and the adjustment of treatment plans.

Trauma-related dissociation: Psychological features and psychophysiological responses to script-driven imagery in borderline personality disorder.

Defense reactions to threatening situations are vital adaptations to stress that protect organisms from injury and ensure survival. We retrospectively investigated the role of peritraumatic dissociation (PD) in the occurrence of severe psychopathology and dissociative patterns of reactions in borderline personality disorder (BPD). We recruited 28 patients with a clinical diagnosis of BPD and 15 healthy controls. The BPD group was divided according to the level of PD (low vs. high): BPD and PD (n = 15) and BPD only (n = 13). We conducted an extensive investigation of history of trauma, clinical status, and measurements of emotional and physiologic responses to recall of personalized aversive experiences. Participants with BPD and high PD displayed highest degrees of trauma exposure and clinical symptoms. Their significant heart rate decline during the imagery of personal traumatic events was opposed to the heart rate increases exhibited by the other two groups and may indicate a dissociative reaction pattern. Skin conductance responses did not differentiate between groups. Several emotional responses to imagery also reinforced the idea that PD may play a role in memory processing of traumatic events and thus in the aggravation and maintenance of symptoms in particularly severe forms of BPD. Within a stepwise linear regression analysis, the best model for trauma-evoked heart rate responses included PD and borderline symptoms, but no measures of state or trait dissociation. Our findings may provide initial evidence of an evolutionary model of peritraumatic reaction stages evolving from arousal to dissociation.

[Persistent Perpetrator Contact in a Patient with Dissociative Identity Disorder]. / Persistierender Täterkontakt bei einer Patientin mit dissoziativer Identitätsstörung.

The case of a young woman with still ongoing incest and forced prostitution is presented. The criteria for a dissociative identity disorder (DID) were met. Due to persistent contact to the perpetrator she was repeatedly revictimized. Based on the model of trauma-related dissociation we discuss to what extent she was capable of self-determined decision making as well as therapeutic consequences resulting therefrom.