Although affect dysregulation is considered a core component of borderline personality disorder (BPD) and somatoform disorders (SoD), remarkably little research has focused on prevalence and nature of affect dysregulation in these disorders. BPD and SoD diagnoses were confirmed or ruled out in 472 psychiatric inpatients using clinical interviews. Three qualitatively different forms of affect dysregulation were identified: under-regulation, over-regulation of affect and combined under- and over-regulation of affect. BPD was associated with under-regulation of affect, and SoD was associated with over-regulation of affect. However, one in five patients with BPD also reported substantial over-regulation, and one in six patients with SoD reported clinically significant under-regulation, and the comorbid BPD and SoD group reported more frequently both over- and under-regulation than patients diagnosed with BPD or SoD alone or those with other psychiatric disorders.

Affect dysregulation and dissociation may be associated with borderline personality disorder (BPD) and somatoform disorder (SoD). In this study, both under-regulation and over-regulation of affect and positive and negative somatoform and psychoform dissociative experiences were assessed. BPD and SoD diagnoses were confirmed or ruled out in 472 psychiatric inpatients using clinical interviews and clinical multidisciplinary consensus. Affect dysregulation and dissociation were measured using self-reports. Under-regulation (but not over-regulation) of affect was moderately related to positive and negative psychoform and somatoform dissociative experiences. Although both BPD and SoD can involve dissociation, there is a wide range of intensity of both somatoform and psychoform dissociative phenomena in patients with these diagnoses. Compared with other groups, SoD patients more often reported low levels of dissociative experiences and reported fewer psychoform (with or without somatoform) dissociative experiences. Compared with the other groups, patients with both BPD and SoD reported more psychoform (with or without somatoform) dissociative experiences. Evidence was found for the existence of 3 qualitatively different forms of experiencing states. Over-regulation of affect and negative psychoform dissociation, commonly occurring in SoD, can be understood as inhibitory experiencing states. Under-regulation of affect and positive psychoform dissociation, commonly occurring in BPD, can be understood as excitatory experiencing states. The combination of inhibitory and excitatory experiencing states commonly occurred in comorbid BPD + SoD. Distinguishing inhibitory versus excitatory states of experiencing may help to clarify differences in dissociation and affect dysregulation between and within BPD and SoD patients.

Somatoform disorders are characterised by persistent physical symptoms that suggest the presence of a medical condition, but are not explained fully by that condition or by the direct effects of substance misuse or mental disorder (DSM-IV).1 The prevalence of somatoform disorders is estimated at 6% in the general population.2 Patients with such disorders usually have high functional impairment, 3,4 are difficult to treat, 5,6 and show high utilisation of medical care. 7 Moreover, it typically takes years before they are referred to mental healthcare. 6,8,9 A strictly somatic approach and unnecessary diagnostic examinations may increase somatising behaviours, 10 and lead to chronic symptoms and high medical costs: 7,11,12 these findings emphasise the need for early intervention.13 Psychotherapy may be a viable treatment option given the role of behavioural, cognitive and emotional processes in these disorders and their high degree of comorbidity with mental disorders.14-16 Some reviews and meta-analyses suggest that psychotherapy may be effective in patients with somatoform disorder. [17][18][19] However, these reviews were restricted to psychodynamic psychotherapy only, 17 or predominantly involved groups with less severe disorder, with functional neurological or conversion disorder generally being excluded. 18 Hypochondriasis and body dysmorphic disorder were typically included in these reviews, 19 although it is still a matter of debate whether these conditions should be classified as somatoform disorder.14, 20 The results of previous reviews cannot always be generalised to patients with strictly defined somatoform disorder in secondary and tertiary care, as these patients are generally more impaired than those seen in primary care. 21 Finally, previous meta-analyses typically included only randomised trials, often excluding effectiveness studies, [22][23][24] whereas the inclusion of both randomised and non-randomised studies allows the meta-analytic comparison of effect sizes between these designs.The aim of our meta-analysis therefore was to examine the effectiveness of psychotherapy for patients with strictly defined, severe somatoform disorder treated in secondary and tertiary care. To that aim, we compared effect sizes from pre-to post-treatment and from post-treatment to follow-up of psychotherapy and treatment as usual, excluding waiting-list control groups. This study focused on pre-to post-treatment contrasts, and not on between-group contrasts, given the limited number of controlled treatment studies in this context. Given the small number of studies included, moderators of treatment effect were examined only exploratively. We examined methodological quality of the studies, 25 intervention characteristics (type, modality, frequency and length), 26 and whether treatment was offered in tertiary (multimodal and integrative) or secondary care settings, 18 as potential factors influencing treatment effectiveness. MethodA multiple-phase search was conducted in March 2010 to retrieve as many studies as pos...

This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.

Disorders of Extreme Stress Not Otherwise Specified (DESNOS), also known as Complex posttraumatic stress disorder, was assessed in a sample (N = 472) of adult psychiatric patients with confirmed diagnoses of Borderline Personality Disorder (BPD), Somatoform Disorders (SoD), comorbid BPD + SoD, or Affective or Anxiety Disorders (Psychiatric Controls, PC). BPD + SoD patients had the most extensive childhood trauma histories and were most likely (38%) to meet DESNOS criteria, followed by BPD (26%), PC (17%), and SoD (10%), The BPD + SoD and BPD-only groups reported significantly higher levels of DESNOS symptoms than the SoD or PC groups, and did not differ from each other except for greater severity of DESNOS somatic symptoms by the BPD + SoD group. DESNOS warrants further investigation with psychiatrically impaired adults as a potential independent syndrome or as a marker identifying a subgroups of affectively or both affectively and somatically dysregulated patients diagnosed with BPD who have childhood trauma histories.