Borderline Personality Disorder and Emotion Dysregulation最新文献

{"title":"Mentalizing on the edge: borderline traits and their association with real-time self-reflection - an ecological momentary assessment study.","authors":"Inken Höller, Sarah Schwitzky, Thomas Forkmann, Saskia Forster, Philip S Santangelo","doi":"10.1186/s40479-026-00347-1","DOIUrl":"10.1186/s40479-026-00347-1","url":null,"abstract":"<p><strong>Background: </strong>Mentalization plays a key role in borderline personality disorder (BPD), yet its moment-to-moment fluctuations remain understudied. This study is the first to use established self-report items within an Ecological Momentary Assessment (EMA) to explore the links between aspects of mentalizing in daily life and BPD traits in a community sample.</p><p><strong>Methods: </strong>The non-clinical sample consisted of 86 participants (86% female) aged between 18 and 51 years (M = 22.93, SD = 5.36). As part of a baseline survey in the laboratory, the participants completed self-report questionnaires to assess borderline accentuation and mentalizing in the form of subjective certainty regarding their own and others' mental states (self-certainty and other-certainty). In addition, in a subsequent one-week EMA, they reported momentary self-certainty and other-certainty at six randomized times during the day.</p><p><strong>Results: </strong>Using multiple regression (enter method), self-certainty proved to be a negative predictor of borderline accentuation, with intraindividual variations correlating positively with borderline personality style. Contrary to expectations, however, neither the level of other-certainty in the EMA nor the corresponding intraindividual fluctuations were related to borderline accentuation.</p><p><strong>Conclusion: </strong>Future studies should consider the high intraindividual variability of self- and other-certainty in order to obtain ecologically valid insights into mentalizing processes in the context of BPD. Promoting self-certainty may be a valuable target in BPD treatment. However, other-certainty might not be as important.</p>","PeriodicalId":48586,"journal":{"name":"Borderline Personality Disorder and Emotion Dysregulation","volume":"13 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13170161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of dialectical behaviour therapy training: a quantitative systematic review using Kirkpatrick's four-level model.","authors":"Melanie Harris, Carolien Lamers, Michaela Swales","doi":"10.1186/s40479-026-00344-4","DOIUrl":"10.1186/s40479-026-00344-4","url":null,"abstract":"<p><p>Effective therapist training is critical to the successful implementation of Dialectical Behaviour Therapy (DBT) in routine clinical practice. Although various training approaches exist, their outcomes have not been comprehensively synthesised. This systematic review examined the effectiveness of DBT training across different delivery formats and identified key factors associated with training success. Four databases (Medline, CINAHL, PsycInfo, and PubMed) were searched for quantitative studies, and the quantitative components of mixed-methods studies, evaluating training outcomes according to Kirkpatrick’s Four-Level Model. Twenty-four studies met inclusion criteria. Six priority outcomes were assessed for certainty using the GRADE approach. Overall, DBT training was well received and associated with positive effects on therapists’ knowledge, self-efficacy, attitudes, and self-reported DBT use. More intensive training models with implementation support were linked to improved knowledge acquisition, motivation, self-reported DBT use, and, in some cases, client outcomes. The studies were highly heterogeneous in design and measures, few reported effect sizes, and most carried moderate risk of bias. As a result, the overall certainty of evidence was generally low. These findings highlight the potential effectiveness of DBT training while emphasising the need for more rigorous, standardised evaluations to strengthen the evidence base.</p>","PeriodicalId":48586,"journal":{"name":"Borderline Personality Disorder and Emotion Dysregulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DBT skills + parent training for preschool parents with emotion dysregulation and substance misuse.","authors":"Yoel Everett, Olivia A Frigoletto, Ian Shryock, Ana C Hernandez, Angela H Lee, Ruby Cuellar, Kavya Mudiam, Robyn E Metcalfe, Candice Mottweiler, Maureen Zalewski","doi":"10.1186/s40479-026-00343-5","DOIUrl":"10.1186/s40479-026-00343-5","url":null,"abstract":"<p><p>BACKGROUND: Parenting and substance use recovery often intersect, as many adults accessing substance use disorder (SUD) treatment are also parents. Critically, parental SUDs are a risk factor for poorer parenting behaviors, with downstream impacts on child mental health. However, extant evidence-based interventions do not target proximal, parent-specific relapse risk factors (e.g., parental emotion dysregulation [ED], parenting stress), and relapse risk remains high. We sought to address this by integrating best practices in SUD, ED, and parenting interventions to expand reach and improve outcomes. METHODS: This pilot study assessed feasibility, acceptability, and preliminary efficacy of a 20-week Dialectical Behavior Therapy Skills + Parent Training (DBT Skills + PT) telehealth group intervention for parents in SUD remission with elevated ED. Participants were 12 parents (11 mothers) of preschool-aged children (5 female). RESULTS: Intervention feasibility (i.e., attendance, attrition, diary card compliance) and acceptability (i.e., satisfaction, skills use) were high. All treatment-completers maintained their SUD remission and reported large reductions in ED, child behavior problems, negative parenting behaviors, and parenting stress. Quantitative results were corroborated by qualitative feedback provided at an exit interview. CONCLUSIONS: The present findings support further larger scale testing of DBT Skills + PT as a promising intervention for parents in SUD remission with elevated ED, with prospective intergenerational impacts. </p>","PeriodicalId":48586,"journal":{"name":"Borderline Personality Disorder and Emotion Dysregulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric properties of the Spanish structured interview of personality organization revised (STIPO-R) in a clinical and community sample.","authors":"Maria Jesus Rufat, Josep Lluís Matalí, Fernando Gutiérrez, Marc Ferrer, Elisabet Sánchez, Claudia Zumel, Eulàlia Ripoll, Joan Vegué, Natàlia Calvo","doi":"10.1186/s40479-026-00342-6","DOIUrl":"10.1186/s40479-026-00342-6","url":null,"abstract":"<p><p>BACKGROUND: The diagnosis of personality disorders (PD) remains challenging in clinical practice. The Diagnostic and Statistical Manual of Mental Disorders reviewed (DSM-5-TR) proposes an alternative diagnostic hybrid model (AMPD), that emphasizes dimensional assessment of personality pathology, particularly severity of impairment in personality functioning (Criterion A), a construct conceptually derived from Kernberg’s model of personality organization (PO) but operationalized in a highly simplified form. However, few structured diagnostic interviews aligned with this framework are available in Spanish. The Structured Interview of Personality Organization–Revised (STIPO-R) provides a dimensional assessment of the original PO construct and may offer clinically valuable information beyond current Criterion A measures. The aim of the present study was to validate the Spanish version of the STIPO-R and to examine its reliability (internal consistency) and construct validity. METHOD: A cross-sectional study was carried out with a sample of 206 subjects distributed into two groups: a clinical group comprised 134 outpatient psychiatric patients diagnosed with PD who were administered both the SCID-II and the Spanish version of the STIPO-R. The control group comprised 72 subjects without a PD diagnosis in the preceding ten years to whom the Spanish STIPO-R was administered. Reliability (internal consistency) and four types of validity evidence were examined: criterion, content, structural and concurrent with the SCID-II. RESULTS: The results confirmed that the Spanish STIPO-R has adequate reliability (internal consistency), and content, structural, criterion and concurrent validity. The CFA confirmed a six-factor solution consistent with the domain structure proposed in the original English version: (1) Identity, (2) Object relations, (3) Primitive defenses, (4) Advanced defenses, (5) Aggression and (6) Moral values. CONCLUSIONS: The Spanish STIPO-R is empirically confirmed to be valid and reliable for assessing normal and pathological personality organization according to Kernberg’s full theoretical model; including Defense Mechanisms, absent from the AMPD, and Aggression and Moral values, only partially represented within its trait domains - thereby offering clinicians a more comprehensive assessment of personality pathology. </p>","PeriodicalId":48586,"journal":{"name":"Borderline Personality Disorder and Emotion Dysregulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mentalization as a mediator of the effects of early life stress on borderline personality disorder in a South Korean clinical sample.","authors":"You Sun Chung, HyunKyung Shin, Bon-Hoon Koo, Seokho Yun, Uk-Jin Oh, Sun-Woo Choi, Bokyung Choo, Jeong-Ho Seok","doi":"10.1186/s40479-026-00338-2","DOIUrl":"10.1186/s40479-026-00338-2","url":null,"abstract":"<p><p>BACKGROUND: Borderline Personality Disorder (BPD) is a severe mental condition characterized by instability in self-image, emotions, and interpersonal relationships. Within mentalization models of BPD, the interaction between genetic vulnerabilities and early attachment-related adversity is understood to hinder the development of mentalization, contributing to core BPD symptoms. This study investigated early life stress (ELS) and mentalization difficulties in a Korean BPD sample and tested whether mentalization difficulties mediated their associations with BPD diagnosis and symptom severity. METHODS: We conducted a cross-sectional study with 90 individuals with BPD and 47 healthy controls using self-report measures of ELS, mentalization difficulties, and BPD symptoms. Group differences were examined, and a mediation model was tested using the PROCESS Macro. RESULTS: The BPD group showed higher levels of ELS across all domains and higher levels of most mentalization difficulties, with the exception of hasty mentalizing. Emotional abuse and bullying were associated with BPD diagnosis. Psychic equivalence and lack of emotional expression were associated with diagnosis, while psychic equivalence and lack of emotional awareness were associated with symptom severity. Mentalization difficulties partially mediated the links between ELS and both BPD diagnosis and symptom severity. CONCLUSIONS: Preventive efforts targeting emotional abuse and bullying, along with interventions to address mentalization difficulties, may help inform preventive strategies and improve treatment outcomes. Results support the need for mentalization-based interventions for individuals with BPD in Asian populations. </p>","PeriodicalId":48586,"journal":{"name":"Borderline Personality Disorder and Emotion Dysregulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences in close relationships, interpersonal trust and OXTR expression in individuals with childhood maltreatment.","authors":"Inga Niedtfeld, Marie Kolar Née Hofmann, Johanna Hepp, Sara E Schmitz, Sylvia Steinmann, Stephanie H Witt","doi":"10.1186/s40479-026-00340-8","DOIUrl":"10.1186/s40479-026-00340-8","url":null,"abstract":"<p><p>BACKGROUND: Social cognition is essential for forming and maintaining intimate relationships. Individuals with a history of childhood maltreatment (CM) often show impairments in interpersonal functioning, including trust and romantic attachment. The oxytocin system has been implicated in social behavior, yet the role of oxytocin receptor (OXTR) gene expression in CM-related social functioning remains insufficiently understood. This study examined the impact of CM on social cognition in a large web-based sample and explored the association between CM and OXTR gene expression in a well-characterized clinical cohort. METHODS: Both studies were preregistered ( https://doi.org/10.17605/OSF.IO/KNC2X ), and data and code are available at OSF ( https://doi.org/10.17605/OSF.IO/4DZWK ). Study 1 assessed the relationship between CM severity, interpersonal trust, and romantic attachment in a web-based sample (N = 252). Participants completed the Childhood Trauma Questionnaire, the Generalized Trust Scale, a behavioral distrust game, and the Experiences in Close Relationships Questionnaire. Study 2 analyzed OXTR gene expression in peripheral blood samples from N = 92 CM-exposed individuals and examined associations with self-reported CM severity. Exploratory analyses additionally included measures of interpersonal sensitivity, social functioning, and maladaptive personality traits. RESULTS: In Study 1, greater CM severity was significantly associated with lower interpersonal trust (both self-reported and behavioral), and with higher levels of attachment-related anxiety and avoidance. In Study 2, no significant association was found between CM severity and OXTR gene expression in blood. However, exploratory analyses revealed that CM severity was associated with social interaction difficulties, while OXTR gene expression was associated with the maladaptive personality trait of detachment. CONCLUSIONS: The findings highlight robust associations between CM and impairments in trust as well as insecure romantic attachment. Although no direct link was found between CM and OXTR expression, future research should investigate gene–environment interactions using larger samples and alternative tissue sources. Interventions targeting trust and attachment processes may offer promising avenues to improve relational functioning in individuals with a history of CM. </p>","PeriodicalId":48586,"journal":{"name":"Borderline Personality Disorder and Emotion Dysregulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating a brief MBCT programme for non-suicidal self-injury in individuals with BPD: a within-subject pre-post pilot study.","authors":"Szilvia Kresznerits, Ágnes Zinner-Gérecz, Mónika Miklósi, Tamás Szekeres, Dóra Perczel-Forintos","doi":"10.1186/s40479-026-00337-3","DOIUrl":"10.1186/s40479-026-00337-3","url":null,"abstract":"<p><p>BACKGROUND: Non-suicidal self-injury (NSSI) is highly prevalent among individuals with borderline personality disorder (BPD) and a robust predictor of future suicide attempts and death. Access to comprehensive treatments such as dialectical behaviour therapy remains limited. METHODS: This exploratory study evaluated the feasibility and preliminary outcomes of a brief, group-based mindfulness-based cognitive therapy program tailored to reduce NSSI (MBCT-NSSI) and improve associated psychological processes. Using a nonrandomised within-subject pre–post design with a waiting-period comparison, assessments were conducted at baseline (T1; n = 120), pre-intervention (T2; n = 72), and post-intervention (T3; n = 50). Outpatients with BPD and recent NSSI participated in a 9-week MBCT-NSSI group programme; key exclusions were acute suicide risk, psychosis, mania, and severe substance use. Primary outcomes were NSSI frequency and mindfulness. Secondary outcomes included self-compassion, self-esteem, impulsivity, depression, dissociation, and emotion regulation. Within-subject changes were analysed via linear mixed modelling and Wilcoxon signed-rank tests. Binary logistic regression identified predictors of dropout among eligible participants. No blinding or randomisation procedures were applied. RESULTS: Among completers (N = 50), primary outcomes showed a significant reduction in NSSI frequency and an increase in mindfulness. Improvements were also observed across several secondary outcomes, including depressive symptoms, impulsivity, and emotion regulation. For mindfulness and secondary self-report outcomes, changes were observed between T2 and T3 but not during the waiting-list period. For NSSI, which was evaluated only at T1 and T3, findings should be interpreted as preliminary signal detection. Dissociative symptoms showed a non-significant trend toward improvement. Dropout among eligible patients was associated with higher impulsivity, maladaptive regulation, and, unexpectedly, higher self-compassion, whereas fewer comorbid diagnoses predicted lower treatment retention. CONCLUSIONS: MBCT-NSSI may be a feasible and potentially beneficial adjunctive intervention for individuals with BPD who engage in NSSI, with improvements in emotion regulation and preliminary signals of reduced self-harm frequency. These findings support further investigation through controlled trials and longer follow-up. TRIAL REGISTRATION: Not applicable. The study had a within-subject pre–post design without a control condition, and therefore does not meet the ICMJE definition of a clinical trial. De-identified data are openly available via the Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/ZUR84 . </p>","PeriodicalId":48586,"journal":{"name":"Borderline Personality Disorder and Emotion Dysregulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13085490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluctuations of dissociation and inner tension during inpatient dialectical behavior therapy: associations with self-injury and suicidal ideation.","authors":"Ana Macchia, Dimitri Löchner, Christian Montag, Philip Santangelo, Michelle Voit, Simon Sanwald, Birgit Abler","doi":"10.1186/s40479-026-00339-1","DOIUrl":"10.1186/s40479-026-00339-1","url":null,"abstract":"<p><p>BACKGROUND: In Dialectical Behavior Therapy (DBT), monitoring inner tension and state dissociation is considered helpful for understanding a patient’s affective and behavioral responses, especially regarding self-harming behaviors. This study aims to investigate how potentially aversive internal states including dissociation, inner tension and fluctuations of tension, i.e. affective instability, during the initial phase of inpatient DBT relate to self-injury, suicidal ideation, and symptom reduction. METHODS: 41 patients with personality disorder (borderline or combined), undergoing an 8-week inpatient DBT program used a smartphone application for ecological momentary assessment of inner tension and state dissociation. We assessed the Borderline Symptom List (BSL-23) upon admission and discharge, self-injury during the inpatient stay, and the intensity of suicidal ideation per day (diary card ratings) retrospectively from digital patient files. We employed linear mixed models to analyze the trajectories of inner tension, affective instability (i.e. squared difference between consecutive inner tension ratings), and state dissociation over the initial 3 weeks of therapy and variability across hours, as well as daily associations with the intensity of suicidal ideation. We used logistic regression to examine if aversive internal states are associated with the occurrence of self-injury during DBT. RESULTS: We found a slight reduction in state dissociation, affective instability, and high levels of inner tension during the initial 3 weeks of therapy. Analyses of intraday data showed a slight increase in state dissociation from morning to midday and self-injury during DBT was associated with slightly higher mean dissociation levels. On days with greater intensity of suicidal ideation, elevated inner tension and state dissociation levels were found while affective instability was not related to self-injury or suicidal ideation. Changes in BSL-23 over therapy were not related to aversive internal states during the initial therapy phase. CONCLUSION: Aversive internal states decreased early in inpatient DBT, with midday emerging as a critical time for dissociation management. Daily increases in state dissociation and inner tension might serve as warning signs for suicidality and our data confirm the utility of their monitoring in self-harm prevention. When state dissociation is therapeutically addressed during DBT as in the program investigated, it does not seem to hamper improvement in borderline symptoms. TRIAL REGISTRATION: Retrospectively registered - https://osf.io/dfq9y/?view_only=4c19b891bb6448009b22f60b2552bd73 . </p>","PeriodicalId":48586,"journal":{"name":"Borderline Personality Disorder and Emotion Dysregulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147370558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathology of the self: a network analysis of personality functioning, narcissistic vulnerability, mentalizing, and epistemic trust across trauma profiles.","authors":"Ilaria Maria Antonietta Benzi, Andrea Fontana, Nicola Carone, Francesca Locati, Laura Parolin, Karin Ensink","doi":"10.1186/s40479-026-00335-5","DOIUrl":"10.1186/s40479-026-00335-5","url":null,"abstract":"<p><p>BACKGROUND: Trauma exposure impairs personality functioning, mentalizing, and epistemic trust, yet the mechanisms linking these processes remain unclear. METHODS: Using network analysis, we examined how narcissistic traits, personality functioning, reflective functioning, and epistemic stances interact across trauma profiles in emerging adults (N = 1,081; 72.4% female). Participants completed the Childhood Trauma Questionnaire–Short Form (CTQ-SF), Levels of Personality Functioning Scale–Brief Form (LPFS-BF), Pathological Narcissism Inventory (PNI), Reflective Functioning Questionnaire for Youth (RFQY-13), and Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ). Latent profile analysis identified three trauma profiles: low trauma, emotional trauma, and complex trauma. RESULTS: For all three trauma profiles, narcissistic vulnerability and self-impairment formed a stable, central dyad, indicating a core of transdiagnostic dysfunction. Trauma exposure was associated with denser, more interconnected networks, likely reflecting self-reinforcing maladaptive patterns. Uncertainty about mental states emerged as the primary bridge mechanism, increasing with trauma severity and transmitting dysfunction into epistemic stances. Trauma was associated with both mistrust and credulity—mistrust predominated in emotional trauma, credulity in complex trauma. CONCLUSIONS: These findings delineate common and trauma-specific processes linking personality dysfunction and interpersonal traits. Clinically, they highlight the importance of addressing narcissistic vulnerability and self-functioning as stable mechanisms, reducing uncertainty through mentalization-based interventions, and tailoring treatment to trauma-specific epistemic patterns. </p>","PeriodicalId":48586,"journal":{"name":"Borderline Personality Disorder and Emotion Dysregulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How specific are affective and attachment instability to adolescents with non-suicidal self-injury? A comparison with adolescents with major depression.","authors":"Annekatrin Steinhoff, Julian Koenig, Julia Blanke, Philip Santangelo, Ulrich Ebner-Priemer, Michael Kaess","doi":"10.1186/s40479-026-00336-4","DOIUrl":"10.1186/s40479-026-00336-4","url":null,"abstract":"<p><p>BACKGROUND: Affective and interpersonal instability are suggested to underlie adolescent non-suicidal self-injury (NSSI). However, previous research has not directly compared adolescents with NSSI to those with psychiatric conditions that are often, but not always, correlated with NSSI. We explored the specificity of affective and interpersonal instability to adolescent NSSI compared to depression. METHODS: Based on a clinical sample of 70 adolescents (56 female and 14 male), we compared a group with NSSI (n = 50) with a clinical comparison group diagnosed with major depression and no engagement in NSSI (n = 20). We used high-frequency ecological momentary assessments (EMA) of affect and interpersonal attachment over four days. Mean affect and mean attachment as well as the root mean squares of successive differences (RMSSD) indicating instability of affect and attachment were calculated. The groups were compared using regression modeling. RESULTS: Adolescents with NSSI reported less positive affect and lower levels of attachment to their mothers and best friends than those with depression. Moreover, models adjusting for gender and mean affect and attachment, respectively, indicated that the NSSI group experienced more affective instability (b = 6.26, 95% CI = 0.79—11.73, p = 0.025). The two groups experienced similar average levels of attachment instability. Although there was no moderating effect of gender in the reported associations, the link between affective instability and NSSI was mainly driven by the male subsample, whereas low levels of attachment were associated with NSSI especially in females. CONCLUSIONS: Affective instability is especially high among adolescents with NSSI. When co-occurring with other disorders, NSSI may serve as an identifier of a patient’s particularly strong need for treatment aiming at affect stabilization. </p>","PeriodicalId":48586,"journal":{"name":"Borderline Personality Disorder and Emotion Dysregulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12997848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}