Chair: Katie Nicol
Co-chair: Jane Cannon
Aims: Personality disorder (PD) usually emerges during adolescence and early adulthood. This developmental period represents a key opportunity for prevention and early intervention. Methods: This symposium will feature current research conducted with young people (ages range from 12 to 25 years) recruited from mental health services and from the general population. Results: The first study found that while emotion regulation ability in young people with borderline personality disorder (BPD) was largely normative, cognitive reappraisal might be ineffective in the context of social rejection, and act as an accelerant that heightens the expression of negative affect. The second study found that young people with BPD appear to have a specifically altered stress response, with a high affective response to stress alongside a significantly attenuated cortisol response. Participant recruitment for the third study is ongoing, but early findings indicate that 30% of young people with concurrent first-episode psychosis (FEP) and BPD, and 19% of those with FEP described hallucinations directly related to childhood trauma. The final study is continuing data collection and will report on the utility of life narratives to aide in the assessment of personality functioning. Conclusions: Early intervention for young people with PD requires new knowledge regarding emotion regulation, stress response, hallucinations, and personality functioning. This must involve samples recruited from clinical and community settings, and will need to utilise multi-modal approaches (e.g. interview, self-report measures, lab-based tasks).
Cognitive reappraisal impairs negative affect regulation in the context of social rejection for youth with early-stage borderline personality disorder
Elizabeth Pizarro-Campagna, Gill Terrett, Martina Jovev, Peter Rendell, Julie D. Henry, Andrew Chanen
The effective application of emotion regulation strategies might be especially susceptible to the context of social rejection for individuals with BPD. This study compared the ability of 27 outpatient youths (aged 15-25 years) with early-stage BPD and 37 healthy controls (HC) to apply expressive suppression and cognitive reappraisal in standard and socially rejecting laboratory contexts. They were instructed to apply these strategies to regulate induced negative affect, which was assessed via self-report and facial electromyography. BPD youths were largely as able as HCs to regulate negative affect across instruction and contexts. However, cognitive reappraisal in the context of social rejection heightened BPD negative facial expression relative to HCs. Thus, while BPD emotion regulation ability was largely normative, cognitive reappraisal might be ineffective in the context of social rejection for this group, acting as an accelerant that heightens the expression of negative affect. Given the common experience of perceived and actual social rejection for this group, clinicians should carefully consider treatments that include cognitive reappraisal strategies as they might be contraindicated.
The psychobiological stress response among young people with borderline personality disorder
Michael Kaess, Julian Koenig, Andrew Chanen
Objectives: Stress vulnerability is a commonly postulated feature of BPD. The hypothalamic-pituitary adrenal axis (HPAA) is one of the major stress response systems of the human body. While findings from adults with BPD suggest increased stress vulnerability to stress compared to healthy individuals, there is a lack of data for youth with BPD as well as insufficient evidence for the specificity of an altered stress response. Method: Two studies will be presented, one study from Melbourne (N=164 youth aged 15 to 25 years) and one from Heidelberg (N=243 adolescents aged 12 to 17 years). Both studies comprised individuals with BPD as well as clinical and healthy control participants. All participants underwent the Trier Social Stress Test (TSST) including measures of affect, heart rate and cortisol over its course. Results: Two independent studies using large samples provide increasing evidence for a specifically altered stress response in young individuals with BPD: a particularly high affective response to stress alongside with a significantly attenuated cortisol response. Conclusions: Youth with BPD show specific stress vulnerability compared to both clinical and healthy individuals. Improvement of stress tolerance and learning of coping skills may be important treatment targets for early intervention in youth with BPD.
Exploration of conceptual links between trauma and hallucinations amongst young people with borderline personality disorder and first episode psychosis
Jessica O’Connell, Michelle Lim, Sarah Bendall
Background: Hallucinations in BPD are phenomenologically similar to schizophrenia. Theories propose childhood trauma (CT) can inform hallucination content directly. This study explores the conceptual links between trauma and hallucinations amongst those with BPD and first episode psychosis (FEP). Method: 100 young people with FEP will undertake a semi-structured interview using the PANSS, PSYRATS, and SCID-5-PD. A theoretically-informed coding frame will determine content relationships. Results: 42 young people have participated to date. 37 experienced CT and hallucinations, and 10 also have BPD. 30% of those with BPD and FEP, and 19% of those with FEP described hallucinations directly related to CT. For example, a participant with BPD reported a trauma where, “she had her hands around my throat,” and tactile hallucinations where, “I feel them touch me on my throat.” Young people with BPD also describe hallucinations without direct reference to CT. For example, a young person who experienced family violence described auditory hallucinations of “cats meowing.” Data from the full sample will be presented. Conclusion: A significant minority of young people with FEP and with or without BPD report trauma-related hallucinations. Understanding the quality of the relationship between trauma and hallucinations amongst those with BPD provides opportunities for psychological intervention.
Using the life story as a lens to assess personality functioning in emerging adults
Kennedy M. Balzen, Majse Lind, Estefania Fernandez, Carla Sharp
Identity disturbance has been established as a core component of personality pathology. The narrative identity framework uses life stories as a lens to provide rich insight to one’s interpretation of how their life events have shaped their identity. The primary aim of this study is to examine the utility of life narratives to aide in the assessment of personality functioning in young persons for whom identity consolidation forms a major developmental task. A sample (expected size N = 110) of 18–25-year-olds will be used. Life story narratives are obtained from the Emerging Life Story Interview (ELSI) and content coding is used to examine narratives for themes of agency, communion, exploratory processing, growth, and deterioration. Participants are also administered the Semi-Structured Interview for Personality Functioning (STiP-5.1), and the Level of Personality Functioning Scale Brief Form 2.0 (LPFS-BF 2.0). Data collection continues. We will analyze the associations between narrative themes and level of personality functioning. We expect that agency, communion, growth, and exploratory processing will be negatively associated with personality functioning and that exploratory processing will interact with event outcome (i.e., growth, deterioration) in predicting level of personality functioning, such that exploratory processing x greater deterioration will predict poorer personality functioning.