BackgroundThe short form of the Borderline Symptom List (BSL-23) is a self-rating instrument used to assess specific symptoms of borderline personality disorder (BPD). The original German version has shown good psychometric proprieties. The BSL-23 can also be used to measure the effects of therapy on patients with BPD. The aim of this study was to assess the psychometric properties of the French version of the BSL-23.MethodsThe French version of the BSL-23 was given to 265 subjects with BPD. Factor structure, reliability, test-retest stability, convergent validity, divergent validity, and sensitivity to change were analysed. Forty-five subjects suffering from attention-deficit hyperactivity disorder (ADHD) were used as controls to evaluate the specificity of BSL-23.ResultsA one-factor structure was obtained in the French version of the BSL-23, showing high internal consistency (Cronbach’s alpha = .94) and test-retest reliability (r = .841). The French version of the BSL-23 was highly correlated with depression severity, hopelessness, anger, motor impulsiveness, and BPD diagnosis. It was an efficient tool to discriminate between BPD patients and ADHD patients, and showed good sensitivity to change in a group of BPD patients who took part in a one-month DBT intervention.ConclusionsThe French version of the BSL-23 shows similar psychometric properties as the original German version. This study therefore provides clinicians and researchers with a French instrument to measure BPD symptomatology.

Emotion dysregulation and interpersonal hardships constitute core features of borderline personality disorder (BPD). Research has established the link between these core dysregulations and fluctuations in the capacity to appreciate the mental states that underlie behavior (mentalizing, operationalized as reflective functioning (RF)). As emotion dysregulation and interpersonal hardships also characterize adults with attention deficit hyperactivity disorder (ADHD), this study sought to examine the potential RF impairments affecting this population. 101 adults with ADHD, 108 with BPD and 236 controls were assessed using the RF questionnaire (RFQ), evaluating how individuals employ information about mental states to better understand their own and others' behaviors. The RFQ comprises two dimensions, certainty (RF_c) and uncertainty (RF_u) about mental states. RF scores helped distinguish ADHD from controls, but also from BPD (F=48.1(2/441); p<0.0001 for RF_c and F=92.5(2/441); p<0.0001 for RF_u). The ADHD group showed intermediary RF scores compared to the controls (b=-0.70; p<0.0001 and b=0.89; p<0.0001 for RF_c and RF_u) and BPD group (b=0.44; p=0.001 and b=-0.56; p=0.001 for RF_c and RF_u). Lower RF scores correlated with poor anger control and high levels of impulsivity. Higher severity of ADHD (more attentional and hyperactive/impulsive symptoms) was correlated with RF impairments.In conclusion, RF may constitute an important process underlying attentional, hyperactive/impulsive as well as emotional symptoms in ADHD; it should therefore be considered in the assessment of these patients.

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IntroductionMood disorder patients have a tendency to be more internally oriented, with difficulties in switching attentional focus, which might result in the generation of negative thoughts, such as rumination. The present study explored self-referential neural activity correlating with rumination tendency and attentional switching capacity in bipolar disorder.MethodsTwenty euthymic bipolar patients and twenty matched healthy controls underwent a novel introspection task of switching between internally and externally focused attention during a word processing task, while their brain activity was assessed using functional MRI.ResultsDuring internal focus, higher activity in self-related regions (mPFC, PCC) was found in euthymic bipolar patients as compared to controls, verifying the hypothesis of exaggerated recruitment of self-referential processes in bipolar subjects. Switching from internal to external focus revealed higher parahippocampal activity in patients as compared to controls, additionally more pronounced when switching away from negative as compared to positive self-referential information. Furthermore, rumination traits correlated with activity in PCC, subgenual and pregenual ACC, and bilateral anterior insula during repetition of internal focus, specifically when evaluating negative words. Finally, we used ACC subregions that correlated with tendency to ruminate as seeds for a whole brain connectivity analysis. Patients showed stronger connectivity between sgACC (seed), pgACC, dPFC, and anterior insula during internal focus, whereas pgACC (seed) was more strongly connected to parahippocampal gyrus when switching from internal to external focus.ConclusionsThese findings reveal an overactive rumination-related network whose activity is enhanced by negative information in euthymic bipolar patients, which could possibly contribute to impaired switching of thoughts away from internal attention.Electronic supplementary materialThe online version of this article (10.1186/s40345-018-0137-5) contains supplementary material, which is available to authorized users.

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