الفهرس 
BORDERLINE PERSONALITY DISORDEROnly 14 pages are availabe for public view
 |  | from | 282 |  |  |
| | | from | 282 | | |
Abstract
B
orderline personality disorder (BPD) is a severe psychiatric disease that predominantly manifests in young adults through a pattern of instability in interpersonal relationships, self-image, and affect, along with intense impulsivity.
This disorder is a serious psychiatric illness that affects 5.9% of the population. It is considered to be the most prevalent personality disorder in the clinical setting, accounting for 10% of psychiatric outpatients and 15–20% of hospitalized patients. Despite its high prevalence, however BPD is often underdiagnosed.
The clinical course of BPD patients is variable, and almost constantly unstable with acute periods of crisis, auto-mutilation, aggressive behavior, suicide attempts, drug abuse, etc. All of them comes along with an important affective correlate.
Social cognition is a broad term that includes a wide variety of interrelated cognitive processes that enable successful and adaptive behavior in a social context. It includes, among other things, the ability to recognize social cues such as facial emotions, the ability to understand others’ mental states [known as theory of mind (TOM) or mentalizing], the ability to share the experiences and emotions of others, as well as the capacity to regulate one’s emotional responses to others. Disturbances in these social cognitive abilities are important predictors of social and functional impairments in psychiatric disorders.
Social cognition is a specialized cognitive domain that promotes effective social communication and relationships. Two aspects of mentalizing are functionally and neurally recognizable: the attribution of emotional states and the inference of thoughts, intentions, and desires. Mental state decoding refers to the ability to detect cues, for example facial expressions to infer what another person is thinking or feeling. Mental state reasoning denotes reflection about possible reasons that underlie others’ behaviours based on evidence from multiple sources including context and personal history of the object of the mental state attributions.
This thesis was designed aiming to; (1) to compare the social cognitive performance between cases with borderline personality disorder and controls, (2) to correlate social cognition with alexithymia and emotional dysregulation in borderline personality disorder. This case control study was carried out at outpatient clinics of Psychiatry department at Ain Shams University Hospital and outpatient Clinic of Psychiatry department at Kafr Elsheikh General Hospital during 9 months interval starting from May 2022 to February 2023. A simple random sample of 30 patients with personality disorder and fulfilled criteria of DSM-IV criteria of borderline personality disorder and 30 healthy control patients not fulfilling any criteria of mental disorder. After obtaining informed written consent, and inclusion criteria were insured before the study was conducted which included age between 18-45 years, males and females are invited to participate in this study.
The tools were precisely selected to fulfill the purpose of the study, that included an extensive designed questionnaire to elicit demographic data, personal history, and previous psychiatric consultation. Past history of major general medical diseases. Previous surgical history and family history of neuropsychiatric disorders. Diagnosis of any psychiatric disorders was done using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) for assessing the DSM-IV personality disorders, Reading the Mind in the Eyes test - revised version for assessing social cognition, The Faux Pas Recognition Test for assessing cognitive empathy, Toronto Alexithymia Scale (TAS-20) for assessing how people identify and describe their emotions and finally The Emotion Regulation Questionnaire (ERQ) cognitive reappraisal and expressive suppression of emotional regulation.
The collected data were coded, tabulated, and statistically analyzed using the software SPSS (Statistical Package for the Social Sciences) version 26. Categorical variables were described using their absolute frequencies and were compared using chi square test, and fisher exact test when appropriate. To compare ordinal data between two groups, chi square for trend test was used. Shapiro-Wilk test was used to verify assumptions for use in parametric tests. Quantitative variables were described using their means and standard deviations. To compare quantitative data between two groups, independents sample t test (for normally distributed data) and Mann Whitney test (fir not normally distributed data) were used. To assess strength and direction of correlation between two continuous variables, Spearman rank correlation coefficients (for not normally distributed data) was used. The level statistical significance was set at P<0.05. Highly significant difference was present if p≤0.001. Results were display to fulfill the purpose of the study.
On sociodemographic characteristics, this study demonstrated that the mean (SD) age was 33.33 (±8.38) years for cases group, and in control group the mean (SD) age was 32.0 (±9.53) years, there was statistically non-significant difference between the studied groups (non-significantly higher in case group), sex (43.3% and 50% within cases and control groups were females), level of education (46.7% and 53.3% within cases and control groups were university graduate), occupation (60% and 50% within cases and control groups worked as professional) and social class (73.3% and 76.7% within cases and control groups were of middle social class).
On clinical characteristics, (63.3% within case group versus 23.3% within control group had positive family history of neuropsychiatric disorders), there is statistically non-significant difference between both groups regarding medical history of neuropsychiatric disorders (no one within case or control group had comorbid disease) or surgical history of neuropsychiatric surgery (43.3% and 50% within cases and control groups had positive surgical history).
Regarding scores of Faux PAS recognition and the reading mind in eye test, there were statistically significant differences between the studied groups (significantly lower in case group).
Regarding valence test, there was statistically significant difference between the studied groups regarding valence test (70% within case group versus 20% of control group had negative valence, 30% within case group had neutral valence versus 60% within control group),with marked decrease in positive valence.
Regarding TAS-20, there was statistically significant difference between the studied groups regarding Toronto alexithymia scale (significantly higher in case group), difficulty in identifying feeling (90% and 0% within cases and control groups reported difficulty), difficulty in describing feeling (100% and 0% within cases and control groups reported difficulty), external oriented thinking (10% and 100% within cases and control groups had external oriented thinking) and presence of alexithymia (90% cases had alexithymia and 10% probably alexithymia).
Regarding emotional regulation questionnaire, there was statistically significant difference between the studied groups regarding cognitive reappraisal (significantly lower in case group) and expressive suppression facet (significantly higher in case group).
There was statistically significant positive correlation between Reading the mind in the eye test and both Faux PAS recognition test and cognitive reappraisal facet of emotion regulation questionnaire while there was significant negative correlation between Reading the mind in the eye test and both TAS20 and expressive suppression facet of emotion regulation questionnaire. There was non-significant correlation between reading the mind in the eye test and either age, gender, education, occupation or social class.
There was statistically significant positive correlation between Faux PAS recognition test and both Reading the mind in the eye test and cognitive reappraisal facet of emotion regulation questionnaire while there was significant negative correlation between Faux PAS test and both TAS-20 and expressive suppression facet of emotion regulation questionnaire, there was non-significant correlation between Faux PAS recognition test and either age, gender, education, occupation or social class.
There was statistically significant positive correlation between TAS-20 score and expressive suppression facet of Emotion Regulation Questionnaire while there was significant negative correlation between TAS-20 and all of Faux PAS recognition test, Reading the mind in the eye test and cognitive reappraisal of emotion regulation questionnaire, there was nonsignificant correlation between TAS-20 and either age, gender, education, occupation or social class.
Also, there was statistically significant positive correlation between cognitive reappraisal of emotional regulation questionnaire and both Reading the mind in the eye test and Faux PAS recognition test, while there was significant negative correlation between cognitive reappraisal of emotional regulation questionnaire and TAS-20.
There was statistically significant negative correlation between expressive suppressive reappraisal of emotional regulation questionnaire and both Reading the mind in the eye test and Faux PAS recognition test, while there was significant positive correlation between expressive suppressive reappraisal of emotional regulation questionnaire and TAS-20.
In this study TAS-20 and Cognitive reappraisal facet of ERQ were significantly predictors for Reading the mind in the eye test and Faux PAS recognition test, expressive suppression facet of ERQ were significantly predictors for TAS-20 and vice versa. while Reading mind in eye test and Faux-PAS were significantly predictors for cognitive reappraisal facet of emotion regulation questionnaire.