Eating disorders and the nine symptoms of borderline personality disorder: A systematic review and series of meta-analyses.

OBJECTIVE: Eating disorders and borderline personality disorder have high rates of comorbidity. However, the extent to which individual BPD symptoms are elevated in patients with EDs is largely unknown. Meta-analyses examined: (1) which of the nine BPD symptoms are especially elevated in individuals with versus without EDs, (2) whether particular ED subtypes have elevated levels of certain BPD symptoms, and (3) which BPD symptoms remain unstudied/understudied in relation to EDs. METHODS: We performed nine separate meta-analyses (one for each BPD symptom) to compare levels of symptoms in patients with EDs versus healthy controls. A total of 122 studies (range = 4-34 studies across symptoms) were included. RESULTS: Affective instability was the BPD symptom most elevated, while anger was the BPD symptom least elevated, in patients with EDs compared to controls. When comparing effect sizes across ED subtypes, anorexia nervosa binge-eating/purging subtype had the largest effect sizes for the greatest number of BPD symptoms, while effect sizes for AN restrictive subtype were not significantly larger than those of other EDs for any BPD symptom. The least studied BPD symptoms were identity disturbance and interpersonal difficulties. DISCUSSION: These meta-analyses suggest that certain symptoms of BPD play a more prominent role in the comorbidity between BPD and EDs than others. Targeting affective instability when treating cases of comorbid ED and BPD may be especially likely to ameliorate the negative outcomes related to this comorbidity. Future research should further investigate identity disturbance and interpersonal difficulties in the context of EDs. PUBLIC SIGNIFICANCE: Having an eating disorder and borderline personality disorder is a common comorbidity associated with a severe clinical presentation. BPD is characterized by nine distinct symptoms. This research examined levels of individual BPD symptoms in patients with versus without EDs. Findings can guide researchers and clinicians towards studying and treating symptoms that may be most relevant for BPD-ED comorbidity and in turn, improve outcomes for these patients.

OBJETIVO: Los trastornos de la conducta alimentaria (TCA) y el trastorno límite de la personalidad (TLP) tienen altas tasas de comorbilidad. Sin embargo, se desconoce en gran medida hasta qué punto los síntomas individuales del TLP están elevados en pacientes con TCA. Este metaanálisis examinó: (1) cuál de los nueve síntomas de TLP está especialmente elevado en individuos con TCA versus sin TCA, (2) si los subtipos particulares de TCA tienen niveles elevados de ciertos síntomas de TLP, y (3) qué síntomas de TLP permanecen sin estudiar/poco estudiados en relación con los TCA. MÉTODOS: Se realizaron nueve metanálisis separados (uno para cada síntoma de TLP) para comparar los niveles de síntomas en pacientes con TCA versus controles sanos. Se incluyeron un total de 122 estudios (rango = 4-34 estudios entre los síntomas). RESULTADOS: La inestabilidad afectiva fue el síntoma de TLP más elevado, mientras que el enojo fue el síntoma de TLP menos elevado, en pacientes con TCA en comparación con los controles. Al comparar los tamaños del efecto entre los subtipos de TCA, la anorexia nervosa (AN) subtipo atracón/purgación tuvo los tamaños de efecto más grandes para el mayor número de síntomas de TLP, mientras que los tamaños del efecto para la AN subtipo restrictivo no fueron significativamente mayores que los de otros TCA para cualquier síntoma de TLP. Los síntomas de TLP menos estudiados fueron alteración de la identidad y dificultades interpersonales. DISCUSIÓN: Estos metanálisis sugieren que ciertos síntomas de TLP juegan un papel más prominente que otros en la comorbilidad entre el TLP y los TCA. Enfocarse en la inestabilidad afectiva al tratar casos de TCA y TLP comórbidos puede ser especialmente probable que mejore los resultados negativos relacionados con esta comorbilidad. Los estudios de investigación futuros deben investigar más a fondo la alteración de la identidad y las dificultades interpersonales en el contexto de los TCA.

A Scoping Review on Access and Use of Technology in Youth Experiencing Homelessness: Implications for Healthcare.

Introduction: Youth are among the fastest growing subset of the homeless population. Youth experiencing homelessness (YEH) face multiple barriers in accessing health information and health care services. As such, they may best be reached through information and communication technologies (ICTs); however, limited efforts have been made to synthesize literature on this topic. In this paper, we review studies on access and use of ICTs among YEH. We also discuss the implications of the review for healthcare. Methods: Using scoping review methodology, we searched four databases (Medline, Embase, PsycInfo, and CINAHL) for studies published between 2005 and 2019, screening 1,927 titles and abstracts. Results: We identified 19 articles reporting on studies with YEH between the ages of 12-30, the majority of which were published in the USA. On average, more than half of the samples owned smartphones, used social media, and accessed the internet weekly to search for housing, employment, health information, and to communicate with family, peers, and health workers; however, many youths faced barriers to sustaining their access to technology. Benefits of using ICTs were connecting with home-based peers, family, and case workers, which was associated with a reduction in substance use, risky sexual health behaviors, and severity of mental health symptoms. Connecting with negative, street-based social ties was identified as the most common risk factor to using ICTs due to its association with engaging in risky sex behaviors and substance abuse. Discussion: This review supports the advancement of research and practice on using ICTs to deliver public health information and health services to YEH, while also considering the health-related risks, benefits, and barriers that YEH face when accessing ICTs.