Bakgrund: Borderline personlighetsstörning (BPS) har en bred symtombild som främst karaktäriseras av en känslomässig instabilitet hos individen. Flertalet förklaringar till uppkomsten finns men de allra flesta grundar sig i en otrygg uppväxt. Inom patientgruppen är det vanligt med suicidala handlingar samt ett aktivt självskadebeteende utan avsikt att avlida. Syfte: Denna studie siktade till en ökad insyn och förståelse för hur patientgruppen upplevde det att leva med diagnosen BPS samt hur de upplevde att de blir bemötta inom vården.Metod: Litteraturstudien genomfördes med en kvalitativ ansats. Åtta stycken vetenskapliga artiklar svarade mot underliggande studies syfte. Resultat: Analysen resulterade i följande kategorier: Att få diagnosen BPS, ett liv i utanförskap, att sträva efter hälsa och värdighet, att ha städig kontakt med vården, att uppleva sig stämplad, att ha relationer till specifika andra samt att önska sig specialiserad vård, delaktighet, tid, tillgång och kontinuitet. Slutsats: För att kunna ge patientgruppen adekvat vård samt bygga goda vårdrelationer är det av yttersta vikt att vårdpersonalen har kunskap kring patientgruppens livsvärld. Genom en ökad kunskap och förståelse är förhoppningen att minska missförstånd, bristande kommunikation samt känslan av maktlöshet i relationen mellan vårdpersonalen samt patientgruppen, vilket i sin tur kan reducera patientgruppens upplevelse av att vara stämplad. / Background: Borderline personality disorder (BPD) has a broad symptomatology mainly characterized by emotional instability. There is several explanations for the rise but the vast majority are based in an insecure upbringing. Within the patient group it is common with suicidal acts and active self-injury without the intent to die.Objective: This study aimed to greater transparency and understanding of how the patient group experienced it to live with a diagnosis of BPD and how they felt that they were treated within the care system.Method: The literature review was conducted with a qualitative approach. Eight scientific papers responded to the underlying studies purpose.Results: The analysis resulted in the following categories: Getting diagnosed with BPD, a life of alienation, to strive for health and dignity, to have steady contact with health care, to experience themselves as stamped, to have relationships with specific others and also to wish for specialized care, participation, time, availability and continuity.Conclusion: In order to give the patient group adequate care and build good relationships it is of the utmost importance that health professionals have knowledge of the patient groups life world. Through increased knowledge and understanding, the hope is to reduce misunderstandings, lack of communication and the sense of powerlessness in the relationship between the nursing staff and the patient group, which in turn may reduce the patient group experience of being stamped.

Genome-wide association studies (GWASs) have reported numerous associations between risk variants and major psychiatric disorders (MPDs) including schizophrenia (SCZ), bipolar disorder (BPD), major depressive disorder (MDD) and others. We reviewed all of the published GWASs, and extracted the genome-wide significant (p<10) and replicated associations between risk SNPs and MPDs. We found the associations of 6 variants located in 6 genes, including L type voltage-gated calcium channel (LTCCs) subunit alpha1 C gene (), that were genome-wide significant ( ) and replicated at single-point level across at least two GWASs. Among them, the associations between MPDs and rs1006737 within are most robust. Thus, as a next step, the expression of the replicated risk genes in human hippocampus was analyzed. We found had significant mRNA expression in human hippocampus in two independent cohorts. Finally, we tried to elucidate the roles of venlafaxine and ω-3 PUFAs in the mRNA expression regulation of the replicated risk genes in hippocampus. We used cDNA chip-based microarray profiling to explore the transcriptome-wide mRNA expression regulation by ω-3 PUFAs (0.72/kg/d) and venlafaxine (0.25/kg/d) treatment in chronic mild stress (CMS) rats. ω-3 PUFAs and venlafaxine treatment elicited significant up-regulation. We concluded that might confer the genetic vulnerability to the shared depressive symptoms across MPDs and CACNA1C might be the therapeutic target for depressive endophenotype as well.

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Die Borderline-Persönlichkeitsstörung (BPS) ist eine schwere psychiatrische Störung, die durch tiefgreifende Probleme in Emotionsregulation und zwischenmenschlichen Beziehungen gekennzeichnet ist. In der vorliegenden Dissertation wurde die Beziehung zwischen Leitsymptomen der BPS und kognitiven Fähigkeiten, die für die Bewältigung eines gut funktionierenden Alltags notwendig sind (Aufmerksamkeit, adäquate Belohnungsverarbeitung), untersucht. Weiter wurde für zukünftige Untersuchungen der interpersonellen Instabilitäten und Empathiefähigkeit ein neues Stimulus Set zur Erforschung von sozialer Kognition im Alltag erstellt: die ToMenovela. Mittels fMRT-Untersuchungen konnte gezeigt werden, dass das Ausmaß an selbstberichteter Ängstlichkeit positiv mit der Verarbeitung von emotionalen, ablenkenden Reizen in konfliktbehafteten Bedingungen korreliert. Dies ist ein Hinweis darauf, dass Patientinnen möglicherweise eine erhöhte unbewusste Verarbeitung von irrelevanten Informationen haben, die emotional negativ besetzt sind. Weiter wurde gezeigt, dass das Ausmaß von selbstberichteter Impulsivität negativ mit der neuronalen Signatur der Erwartung von (vermeidbaren) aversiven Konsequenzen korreliert. Dieser Befund steht im Einklang mit dem bei BPD bekannten Phänomen von riskanten Entscheidungen oder selbstschädigendem Verhalten. Die dritte Studie stellt die ToMenovela vor, eine Sammlung von 190 emotional aufgeladenen Photographien mit hoher ökologischer Validität, die von einem fiktiven Freundeskreis handeln. Fragestellungen zur 1. und 3.-Person-Perspektive sowie affektiven und kognitiven Theory of Mind sind durch die Komposition der Fotos möglich. Die Bilder wurden von einer gesunden Kontrollgruppe nach emotionaler Valenz bezüglich der 6 Basis-Emotionen nach Ekman (Freude, Trauer, Wut, Angst, Überraschung, Ekel) bewertet, und stehen nun für den experimentellen Einsatz in der Empathie- und Emotionsforschung, auch über das BPS-Klientel, hinaus zur Verfügung. / Borderline personality disorder (BPD) is a severe mental health disorder characterized by severe problems in emotion regulation and interpersonal relationships. In this dissertation, the relation between core symptoms of BPD and two cognitive abilities that are necessary for a well-functioning daily life, attention and adequate reward processing, were investigated. Furthermore, a new stimulus set for the investigation of social cognition in daily life that is suitable for future research on relational instabilities and trait empathy was generated: the ToMenovela. Using fMRI, it could be shown that self-reported trait anxiety and neural BOLD-response correlated positively during conflict processing in an experimental flanker task with emotional distractors. These results indicate that patients might exhibit more pronounced implicit processing of irrelevant negative emotional information. In a second study, using a reward paradigm, a negative relationship was observed between self-reported impulsivity and neural signature of loss anticipation. This result is in line with recent findings on BPD patients’ tendency towards disadvantageous, risky choices or self-harming decisions. The third publication introduces the ToMenovela, a new stimulus set for the assessment of social interaction in daily life. The ToMenovela presents a set of 190 emotionally charged pictures of a fictitious circle of friends with high ecological validity. The stimulus set is suitable for experimental designs on 1st and 3rd person perspectives, as well as for affective and cognitive Theory of Mind tasks. The stimulus set was rated by healthy control subjects according to emotional valence with respect to Ekman’s basic emotions (happiness, sadness, anger, fear, surprise and disgust) and is available for further use in experiments on empathy and emotions within and beyond the context of research on BPD.

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The purpose of the current study was to investigate the relationship between Borderline Personality Disorder (BPD) symptoms and childhood experiences, and to explore the role of Early Maladaptive Schemas and core beliefs as variables possibly mediating this relationship. Previous research with clinical samples has established a strong link between childhood maltreatment and adult BPD (& other PD) symptoms in clinical samples. However, difficulties with these studies limit the specificity of results. For example, BPD has been shown to be highly comorbid with other axis I and axis II psychiatric conditions. Given that studies examining the relationship between BPD and childhood maltreatment generally fail to control for these comorbid conditions, the specificity of their results must be questioned. Furthermore, it has been well established that childhood familial environment is strongly related to childhood maltreatment. Again studies examining the relationship between BPD and childhood maltreatment have generally failed to concurrently assess childhood familial environments, hence opening the possibility that the relationship between BPD and childhood maltreatment may be due to family functioning rather than childhood maltreatment per se. Finally, studies linking childhood maltreatment with adult BPD have primarily utilized clinical samples. However, the primary use of clinical samples to examine the aetiology of disorders in this context ignores the vast literature showing adequate psychological functio ning for the majority of individuals exposed to childhood maltreatment. Hence, the primary aim of the current study was to examine the relationship between childhood maltreatment and adult BPD symptoms in a primarily non-clinical sample whilst statistically controlling for commonly comorbid axis I and axis II symptomatology and concurrently measuring childhood familial functioning. It was a secondary aim of the current study to examine the mediating effects of beliefs on the relationship between childhood factors (i.e., childhood maltreatment & childhood familial functioning) and adult BPD symptomatology. That is, cognitive-behavioural theorists argue that personality disorders may be triggered by adverse childhood experiences leading to maladaptive beliefs (or schemas) related to the self, others, and the world, and it is these beliefs which lead to the behavioural disturbances evident in personality disorders. One hundred and eighty-five primarily non-clinical participants completed questionnaires measuring a variety of axis I and axis II symptoms, early maladaptive schemas and core beliefs, as well as retrospective reports of family functioning and childhood maltreatment. Results showed a significant relationship between childhood factors and adult BPD symptomatology. For example, the largest correlation between BPD symptoms and a childhood factor was .27 (for childhood emotional abuse). Furthermore, early maladaptive schemas and core beliefs were found to mediate the relationship between childhood factors and adult BPD symptomatology thus supporting cognitive-behavioural theories of personality disorders. However, early maladaptive schemas and core beliefs were also found to mediate the relationship between childhood factors and other Axis I and Axis II symptoms. Hence, it was concluded that while there was some support for a cognitive mediation hypothesis for BPD symptoms, future research is needed in exploring the specificity of the cognitive mediation hypothesis for BPD.

Clients diagnosed with Borderline Personality Disorder (BPD) interact with healthcare professionals in compelling ways. By virtue of the symptoms that define BPD, it is likely that the client will challenge the therapist with regards to their theoretical approach or therapeutic style. In addition, clients with BPD are likely to project their need for a therapeutic interaction that is both genuine, empathic and at the same time, flexible. In light of this, it is not uncommon for healthcare practitioners to consider clients with BPD as “difficult” in some way or the other. This study explores how clinical psychologists in Gauteng conceptualise and manage a “difficult” client presenting with Borderline Personality Disorder. Further, coping strategies of the clinician will also be explored. The qualitative study, couched in a social constructionist paradigm, involved interviewing seven clinical psychologists practicing in Gauteng, South Africa. The transcripts of the semi-structured interviews were thematically analysed. The findings of the current study indicated that the difficulties experienced are reflective of the general criteria of the disorder. The picture of the difficult client is painted by personal experience, as well as stereotypes gained from interactions with colleagues and other healthcare professionals. It was further found that management of these patients were viewed and implemented based on the nature of the disorder. In addition, management by the clinician often included supervision and leisure activities. / Psychology / M.A. (Clinical Psychology)