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      Personality Disorder and Changes in Affect Consciousness: A 3-Year Follow-Up Study of Patients with Avoidant and Borderline Personality Disorder


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          Personality disorders (PDs) are highly prevalent in patients receiving psychiatric services, and are associated with significant personal and social costs. Over the past two decades, an increasing number of treatment studies have documented the effectiveness of treatment for patients with PDs, especially when it comes to reduction of symptom distress, risk taking behavior, self-harm, or suicide attempts. However, less is known about the more complex aims of improving the personality structure itself, such as identity- and interpersonal disturbances. Emotional dysfunction is closely associated with PD pathology. The present study investigated changes in affect consciousness (AC) in patients with avoidant or borderline PD, and how these changes were associated with clinical status after 3 years of follow-up. The study included 52 individuals; 79 percent were females, and mean age was 30 years. The evaluations included the Affect Consciousness Interview, Symptom Checklist-90-R, Circumplex of Interpersonal Problems, the Index of Self-Esteem, and three domains (Identity Integration, Relational Capacities, and Self-Control) of the Severity Indices of Personality Problems (SIPP-118). There was a significant increase in the Global AC and AC scores for most of the specific affects from baseline to follow-up. As the present study did not include a control group, it cannot be concluded that changes in AC are effects of psychotherapy, and the possibility of age-related maturation processes cannot be excluded. The change in Global AC contributed significantly to explained variance in the follow-up levels of Circumplex of Interpersonal Problems, and the two SIPP-118 domains Relational Capacities and Identity Integration. Improved AC was not associated with change in the Self-Control domain or the Global Severity Index of Symptom Checklist-90-R. The results suggest that AC may be altered for patients with borderline and avoidant PDs, and this is the first study to report that improvement in AC contribute significantly to the variance in the self- and interpersonal domains of personality functioning.

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          Most cited references40

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          Intimacy as an interpersonal process: the importance of self-disclosure, partner disclosure, and perceived partner responsiveness in interpersonal exchanges.

          H. T. Reis and P. Shaver's (1988) interpersonal process model of intimacy suggests that both self-disclosure and partner responsiveness contribute to the experience of intimacy in interactions. Two studies tested this model using an event-contingent diary methodology in which participants provided information immediately after their social interactions over 1 (Study 1) or 2 (Study 2) weeks. For each interaction, participants reported on their self-disclosures, partner disclosures, perceived partner responsiveness, and degree of intimacy experienced in the interaction. Overall, the findings strongly supported the conceptualization of intimacy as a combination of self-disclosure and partner disclosure at the level of individual interactions with partner responsiveness as a partial mediator in this process. Additionally, in Study 2, self-disclosure of emotion emerged as a more important predictor of intimacy than did self-disclosure of facts and information.
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            Emotion regulation and mental health: recent findings, current challenges, and future directions.

            In recent years, deficits in emotion regulation have been studied as a putative maintaining factor and promising treatment target in a broad range of mental disorders. This article aims to provide an integrative review of the latest theoretical and empirical developments in this rapidly growing field of research. Deficits in emotion regulation appear to be relevant to the development, maintenance, and treatment of various forms of psychopathology. Increasing evidence demonstrates that deficits in the ability to adaptively cope with challenging emotions are related to depression, borderline personality disorder, substance-use disorders, eating disorders, somatoform disorders, and a variety of other psychopathological symptoms. Unfortunately, studies differ with regard to the conceptualization and assessment of emotion regulation, thus limiting the ability to compare findings across studies. Future research should systematically work to use comparable methods in order to clarify the following: which individuals have; what kinds of emotion regulation difficulties with; which types of emotions; and what interventions are most effective in alleviating these difficulties. Despite some yet to be resolved challenges, the concept of emotion regulation has a broad and significant heuristic value for research in mental health.
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              At times, people keep their emotions from showing during social interactions. The authors' analysis suggests that such expressive suppression should disrupt communication and increase stress levels. To test this hypothesis, the authors conducted 2 studies in which unacquainted pairs of women discussed an upsetting topic. In Study 1, one member of each pair was randomly assigned to (a) suppress her emotional behavior, (b) respond naturally, or (c) cognitively reappraise in a way that reduced emotional responding. Suppression alone disrupted communication and magnified blood pressure responses in the suppressors' partners. In Study 2, suppression had a negative impact on the regulators' emotional experience and increased blood pressure in both regulators and their partners. Suppression also reduced rapport and inhibited relationship formation.

                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                23 December 2015
                : 10
                : 12
                : e0145625
                [1 ]Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
                [2 ]Research Department, Division of Mental Health and Addiction, Vestfold Hospital Trust, Tonsberg, Norway
                [3 ]Institute of Clinical Medicine, University of Oslo, Oslo, Norway
                [4 ]Department of Research and Development, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
                Central Institute of Mental Health, GERMANY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: MSJ TW. Performed the experiments: ENE MSJ TNE. Analyzed the data: ENE TW. Contributed reagents/materials/analysis tools: ENE MSJ TNE JE TW. Wrote the paper: ENE JE TW.

                ‡ These authors also contributed equally to this work.

                © 2015 Normann-Eide et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                : 24 June 2015
                : 7 December 2015
                Page count
                Figures: 0, Tables: 3, Pages: 18
                This research was funded by the Vestfold Hospital Trust and Oslo University Hospital. The funding sources had no further role in the study design; collection, analysis or interpretation of data; the writing of the report; or the decision to submit the paper for publication.
                Research Article
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                Due to restrictions imposed by the Regional Medical Ethics Committee regarding patient confidentiality, data are available upon request. Requests for data may be sent to the hospital's Privacy and Data Protection Officer at: personvern@ 123456ous-hf.no .



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