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Borderline personality disorder (BPD) is a severe and highly prevalent psychiatric disorder, more common in females than in males and with notable differences in presentation between genders. Recent studies have shown that epigenetic modifications such as DNA methylation may modulate gene × environment interactions and impact on neurodevelopment. We conducted an epigenome wide study (Illumina Infinium HumanMethylation450k beadchip) in a group of BPD patients with (N = 49) and without (N = 47) childhood traumas and in a control group (N = 44). Results were confirmed in a replication cohort (N = 293 BPD patients and N = 114 controls) using EpiTYPER assays. Differentially methylated CpG sites were observed in several genes and intragenic regions in the X chromosome (PQBP1, ZNF41, RPL10, cg07810091 and cg24395855) and in chromosome 6 (TAP2). BPD patients showed significantly lower methylation levels in these CpG sites than healthy controls. These differences seemed to be increased by the existence of childhood trauma. Comparisons between BPD patients with childhood trauma and patients and controls without revealed significant differences in four genes (POU5F1, GGT6, TNFRSF13C and FAM113B), none of them in the X chromosome. Gene set enrichment analyses revealed that epigenetic alterations were more frequently found in genes controlling oestrogen regulation, neurogenesis and cell differentiation. These results suggest that epigenetic alterations in the X chromosome and oestrogen-regulation genes may contribute to the development of BPD and explain the differences in presentation between genders. Furthermore, childhood trauma events may modulate the magnitude of the epigenetic alterations contributing to BPD.

Background Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties. Methods This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability. Results The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%. Conclusions The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.

Cushing’s syndrome (CS) results from chronic exposure to cortisol excess, produced by the adrenal cortex. Hypercortisolism predisposes to psychiatric and neurocognitive disorders, mainly to depression and anxiety disorders. Screening tools to identify psychiatric symptoms are available for clinicians in their daily practice, although a specific diagnosis should be performed by specialists. Even if psychiatric symptoms improve after remission of hypercortisolism, complete recovery may not be achieved. Given the burden of these symptoms, psychiatric or psychological monitoring and treatment should be offered through all phases of CS, with a multidisciplinary approach. The aim of this article is to review data on the prevalence, diagnosis and management of psychiatric symptoms seen in patients with CS and to propose therapeutic approaches that may be followed in clinical practice. The prevalence of different psychiatric disorders has been described in both the active phase and after CS remission. Patients may not talk spontaneously about psychiatric symptoms they present, thus clinicians should ask directly about them. We recommend the use of screening tools in clinical practice to detect and treat these symptoms promptly. Even if reference endocrinologists cannot perform a definite psychiatric diagnosis, it will be important to ask patients directly about the presence of symptoms and refer if necessary to a psychiatrist. Additionally, patient information and educational programmes could be useful to manage psychiatric symptoms and to improve quality of life in patients with CS.

We characterize the extreme points of the closed unit ball of the dual of a Banach space which are preserved by the adjoint of any extreme operator. The result is related to the structure topology introduced by Alfsen and Effros on the set of all extreme points in the dual of any Banach space. As a consequence, we prove that c0(I) is the only Banach space such that the adjoint of every extreme operator taking values into it preserves extreme points.

Individuals with non-suicidal self-injury (NSSI) may be particularly vulnerable to social media exposure, yet the extent to which this vulnerability is linked to altered reward processing remains unclear. To address this gap, we investigated social media-related reward processing in NSSI by recruiting ninety-one young women, divided into three groups: a clinical group (NSSI with borderline personality disorder), a subclinical group (NSSI without co-occurring disorders), and a healthy control group. While undergoing functional magnetic resonance imaging (fMRI), participants received positive and negative comments on their own Instagram photos in a naturalistic task simulating real-life social media interactions. Clinical participants rated positive comments as less pleasant and negative comments as more unpleasant than controls. Coherently, they showed blunted activation in core reward regions such as the nucleus accumbens, caudate, and medial frontal cortex when receiving positive vs negative feedback. Subclinical participants reacted similarly to clinical participants to negative feedback but similarly to controls to positive feedback and presented intermediate activation in most regions, bridging the pattern observed in controls and patients. Results highlight reward system dysfunction as central to NSSI pathology, with both clinical and subclinical groups showing altered processing of social media-based feedback. Subclinical participants showed selective vulnerability to negative feedback, while clinical participants showed impaired sensitivity to both positive and negative feedback. These findings reflect a continuum of severity mapped on the reward system, highlighting potential intervention targets and emphasizing the need to address social media interactions in NSSI treatment.

The aim of this prospective study was to expand previously reported evidence on the 10-year clinical and functional course of borderline personality disorder (BPD) in a Spanish sample. Participants diagnosed with BPD were assessed at baseline and at 10-year follow-up to evaluate BPD symptomatology and other relevant clinical measures, suicidal behavior, dimensional personality traits, Axis I and II comorbidity, use of mental health resources, and psychosocial functioning. At the 10-year follow up, significant improvements were observed on BPD domains, suicidal behavior, and other clinical measures. Neuroticism, impulsiveness, and aggression-hostility features trended toward normalization, whereas activity and sociability were impaired over time. Comorbidity with Axis I and personality disorders remained high. Social functioning and occupational functioning were largely unchanged. These findings confirm the tendency toward a symptomatic remission of BPD over the long term with regard to symptom criteria and characteristic dimensional traits. However, psychosocial functioning remains impaired.

Non-suicidal self-injury (NSSI) is an increasingly prevalent phenomenon associated with many detrimental outcomes, ranging from poor academic performance to suicide attempts. Research on self-harming behaviors has identified emotion dysregulation, negative affect, and borderline pathology as strong risk factors of NSSI, whereas the potential protective effects of metacognitive skills such as decentering have not yet been explored. The current study combined ecological momentary assessment (EMA) and self-report measures to explore potential risk and protective factors of NSSI in a clinical group of Borderline Personality Disorder (BPD) patients with NSSI (N = 22), a subclinical group of college students with NSSI (N = 19), and a non-clinical healthy control group (N = 23). Participants completed self-report measures of borderline pathology, emotion dysregulation, decentering ability, and negative emotional symptoms, and they used the Sinjur App (EMA instrument) at least three times a day for 15 days to capture negative affect and NSSI in daily life. A multilevel mixed-effect regression analysis with both self-report and EMA measures was conducted to identify predictors of NSSI. The multilevel analysis showed that only momentary frustration directly predicted NSSI. Momentary guilt and anger only predicted NSSI when interacting with more stable traits of borderline pathology and negative emotional symptoms. Most importantly, greater decentering capacity protected against self-injury and attenuated the association between momentary sadness and NSSI. Findings contribute novel knowledge about NSSI, documenting the protective effects of decentering and highlighting the benefit of interventions that target metacognitive emotion regulation skills.

Background: Mindfulness skills training is a core component of dialectical behavior therapy (DBT) that has proven to be an effective stand-alone treatment for the general symptoms commonly present in patients with borderline personality disorder (BPD). The aim of the present study was to compare the effectiveness of mindfulness-based DBT skills training (DBT-M) to interpersonal effectiveness-based DBT skills training (DBTIE) in reducing BPD symptoms. We also evaluated the specific mechanism of action of these therapies through two proposed mediators: decentering and emotion dysregulation. Method: A total of 102 participants diagnosed with BPD were included in the study. Multivariate repeated-measures ANOVAs were performed followed by a multiple mediation analysis. Results: The analyses showed that DBT-M was more effective than DBTIE in reducing BPD symptoms, although both interventions were effective in reducing emotion dysregulation. We identified a serial mediation model in which DBT-M reduced BPD symptoms by increasing decentering ability, which in turn reduced emotion dysregulation. This mediation effect showed that changes in decentering preceded improvements in emotion dysregulation. Conclusions: These findings underscore the key role of decentering as a primary mechanism of action in DBT-M, suggesting that this skill is a main component for BPD treatment. Keywords: Borderline personality disorder; mindfulness; decentering; emotion dysregulation; mediation analysis. Mindfulness en el Trastorno Limite: el Descentramiento Media la Efectividad del Entrenamiento. Antecedentes: el entrenamiento de habilidades en Mindfulness es un componente central en la terapia dialectica conductual para el tratamiento del trastorno limite de la personalidad (TLP). El objetivo del estudio fue comparar la efectividad del entrenamiento de habilidades DBT basado en mindfulness (DBT-M) con el entrenamiento de habilidades DBT basado en la efectividad interpersonal (DBT-IE), en reducir sintomas TLP. Tambien evaluamos el mecanismo de accion especifico de estas terapias a traves de dos mediadores propuestos: descentramiento y desregulacion emocional. Metodo: 102 participantes diagnosticados con TLP fueron incluidos en el estudio. Se realizaron Anova de medidas repetidas y analisis de mediacion multiple. Resultados: DBT-M fue mas efectivo que DBT-IE en reducir sintomas TLP, aunque ambas intervenciones fueron eficaces para reducir la desregulacion emocional. Identificamos un modelo de mediacion en serie en el que DBT-M redujo sintomas TLP al aumentar la capacidad de descentramiento, lo que a su vez redujo la desregulacion emocional. Este efecto de mediacion mostro que los cambios en el descentramiento precedieron a las mejoras en la desregulacion emocional. Conclusiones: estos hallazgos destacan el rol del descentramiento como un mecanismo de accion primario en DBT-M y sugiere que esta habilidad es un componente principal para el tratamiento del TLP. Palabras clave: trastorno limite de la personalidad; mindfulness; descentramiento; desregulacion emocional; analisis de mediacion.

Given a normed space X it can be easily proven that every extreme point in Bx＊, the unit ball of X＊, is the restriction of an extreme point in Bx Our purpose is to study when the restrictions of extreme points in Bx＊＊＊ are extreme points in Bx＊. Namely, we characterize Ll-preduals satisfying the aforementioned property.

Clarification of personal values and meditation practice has been associated in most meditation traditions and in academic texts. Both values-related behavior and meditation practice increases well-being, but their relationship has not been well studied. It has been suggested that values, together with self-regulation, psychological flexibility, and exposure, are key mechanisms of action in mindfulness. The aims of this study were to explore the association between meditation and values and to examine the processes involved in this relation. A sample of 235 meditation-naïve participants and 274 subjects with varying levels of experience in meditation practice completed an online assessment protocol composed of Five Facets of Mindfulness Questionnaire (FFMQ), Decentering Questionnaire (EQ), Valued Living Questionnaire (VLQ), and Engagement with Life Scale (ELS). Results revealed that daily meditators were more consistent, aware, and life-fulfilled about their values; moreover, these measures correlated with the mindfulness process and decentering. The relation between meditation practice and values-related behavior (assessed by the VLQ) was mediated by decentering. The association between meditation practice and Valued Living and Life Fulfillment (measured by the ELS) was mediated by the decentering, describing, and non-judging dimensions of mindfulness. The findings in this study support the relation between meditation and personal values, mediated by the decentering, describing, and non-judging facets of mindfulness.