Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System

Eisenlohr‐Moul, Tory A.; Schmalenberger, Katja M.; Owens, Siân-Eleri; Peters, Jessica R.; Dawson, Danyelle N.; Girdler, Susan S.

doi:10.1017/s0033291718001253

Cited by 35 publications

(40 citation statements)

References 65 publications

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“…Therefore, the backward counting method is particularly well suited for determining an individual’s time of ovulation, her early-to-mid luteal phase, and her premenstrual phase. In line with previous literature [55,56], for studies in the present review that provide onset of next menses and onset of prior menses, we characterized three of the cycle phases more precisely: ovulatory (cycle days −15 to −12), early-to-mid luteal (cycle days −11 to −8), and premenstrual (cycle days −7 to −1).…”

Section: Methodsmentioning

confidence: 69%

A Systematic Review and Meta-Analysis of Within-Person Changes in Cardiac Vagal Activity across the Menstrual Cycle: Implications for Female Health and Future Studies

Schmalenberger

Eisenlohr‐Moul

Würth

et al. 2019

JCM

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Interest in cardiac vagal activity (CVA; e.g., parasympathetically-mediated heart rate variability) as a biomarker of physical and mental health has increased exponentially in recent years. However, the understanding of sources of within-person change (i.e., intra-individual variance) in CVA is lagging behind. This systematic review and meta-analysis summarizes and quantifies current empirical evidence of within-person changes in measures of CVA across the menstrual cycle in naturally-cycling premenopausal females. We conducted an extensive literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement in five databases to identify observational studies with repeated measures of CVA in at least two menstrual cycle phases. A broad meta-analysis (nstudies = 37; nindividuals = 1,004) revealed a significant CVA decrease from the follicular to luteal phase (d = −0.39, 95% CI (−0.67, −0.11)). Furthermore, 21 studies allowed for finer-grained comparisons between each of two cycle phases (menstrual, mid-to-late follicular, ovulatory, early-to-mid luteal, and premenstrual). Significant decreases in CVA were observed from the menstrual to premenstrual (nstudies = 5; nindividuals = 200; d = −1.17, 95% CI (−2.18, −0.17)) and from the mid-to-late follicular to premenstrual phases (nstudies = 8; nindividuals = 280; d = −1.32, 95% CI (−2.35, −0.29)). In conclusion, meta-analyses indicate the presence of CVA fluctuations across the menstrual cycle. Future studies involving CVA should control for cycle phase. Recommendations for covarying or selecting cycle phase are provided.

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Section: Methodsmentioning

confidence: 69%

A Systematic Review and Meta-Analysis of Within-Person Changes in Cardiac Vagal Activity across the Menstrual Cycle: Implications for Female Health and Future Studies

Schmalenberger

Eisenlohr‐Moul

Würth

et al. 2019

JCM

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“…It is likely that psychotropic medication and other biological markers may have influenced daily diary ratings (e.g. hormonal changes; Eisenlohr-Moul, DeWall, Girdler, andSegerstrom, 2015, 2018), which should be controlled for in future studies.…”

Section: Discussionmentioning

confidence: 99%

Reciprocal effects between daily situational perceptions and borderline personality symptoms in young adulthood: the role of childhood parenting experiences

Vanwoerden¹,

Hofmans²,

Clercq³

2020

Psychol. Med.

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Background Recent research has emphasized the importance of within-person transactions between situational perceptions and borderline symptomatology. The current study extends current evidence by evaluating a broad range of situational perceptions and their transactions with borderline symptomatology across both private and professional contexts. Additionally, it explores whether early experiences of parental harsh punishment and emotional support during childhood, two well-established etiological factors in developmental theories of borderline symptomatology, influence the effect of daily situation perception in adulthood on borderline symptom presentation. Methods N = 131 young adults (Mage = 20.97, s.d. age = 1.64) completed end-of-day diaries of their borderline symptoms and perceptions of the home and school or work environment for 14 days. During their mid-childhood, reports of maternal strategies of harsh punishment and emotional support were collected. Results Findings revealed that on the same day, borderline symptoms were associated with more negative and stressful, and less positive perceptions of both the private and professional context. Additionally, borderline symptoms predicted more negative and stressful perceptions of school/work on subsequent days. Finally, while early harsh punishment predicted overall increases in daily borderline symptoms 10 years later, emotionally supportive parenting in childhood predicted decreases in borderline symptom expression in less positive and more stressful contexts. Conclusions The current study points to the importance of managing BPD symptoms to reduce subsequent negative perceptions of the environment, and also indicates the relevance of exploring adult person-situation processes based on early parenting experiences.

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“…Complete details of recruitment and procedures for this sample are presented in Eisenlohr-Moul et al (2018). Listservs, flyers, and social media advertisements were used to recruit "females with emotional and interpersonal problems that interfere with life"; no materials involved references to the menstrual cycle to avoid self-selection bias.…”

Section: Methodsmentioning

confidence: 99%

“…Two studies demonstrated links between reproductive hormone changes and BPD feature expression in non-clinical samples (DeSoto, Geary, Hoard, Sheldon, & Cooper, 2003;Eisenlohr-Moul, DeWall, Girdler, & Segerstrom, 2015). Only one study to date has examined cycle effects on symptoms in a sample (N=15) of unmedicated cycling participants diagnosed with BPD (Eisenlohr-Moul et al, 2018). Despite the majority of the sample describing themselves in retrospective reports as experiencing low levels of premenstrual or menstrual symptom changes, in prospective daily assessments, many emotional and behavioral symptoms demonstrated a clear pattern of perimenstrual exacerbation across the sample, with high arousal symptoms such as irritability and anger rising in the luteal phase and peaking in the perimenstrual phase.…”

Section: Menstrual Cycle Effects In Borderline Personality Disordermentioning

confidence: 99%

“…The present study uses the same sample of unmedicated cycling individuals with BPD previously described (Eisenlohr-Moul et al, 2018) to examine the prospective impact of cycle phase (in ovulatory, normal menstrual cycles) on daily self-reported anger expression and reactive and proactive aggressive behavior in unmedicated females with BPD (N = 15) not recruited for perceived perimenstrual symptoms. Although participants collected saliva eight times to verify cycle phase, the present study was not powered to examine hormonal effects, instead focusing on cycle phase.…”

Section: Present Studymentioning

confidence: 99%

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Differential effects of the menstrual cycle on reactive and proactive aggression in borderline personality disorder

Peters

Owens

Schmalenberger

et al. 2020

Aggressive Behavior

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Borderline personality disorder (BPD) is characterized by rapidly shifting symptoms, including intense anger and aggressive behavior. Understanding how fluctuations in ovarian hormones across the menstrual cycle may contribute to symptom instability is key for accurate assessment of BPD symptoms and effective interventions. Reactive and proactive aggression, as well as anger in and out, were assessed daily in 15 physically healthy, unmedicated naturally cycling female individuals without dysmenorrhea meeting criteria for BPD across 35 days. Urine LH surge and salivary progesterone were used to confirm ovulation and verify cycle phase. Cyclical worsening of symptoms was evaluated using multilevel models to evaluate symptom differences between cycle phases. Both forms of aggressive behavior demonstrated marked cycle effects, with reactive aggression highest during perimenstrual cycle phases, co-occurring with increases in anger in and out. In contrast, highest levels of proactive aggression were observed during the follicular and ovulatory phases, when emotional symptoms and anger were otherwise at lowest levels. These findings highlight the importance of identifying the function of aggression when considering potential psychological and biological influences. Naturally cycling individuals with BPD may be at elevated risk for perimenstrual worsening of a range of interpersonally reactive symptoms, including reactive aggression, whereas proactive aggression may occur more in phases characterized by less emotional and cognitive vulnerability and greater reward sensitivity. Research on aggression in this population should consider cycle effects. Cycling individuals with BPD attempting to reduce aggressive behavior may benefit from cycle-tracking to increase awareness of these effects and to develop appropriate strategies.

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Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System

Abstract: Females with BPD may be at elevated risk for perimenstrual worsening of emotional symptoms. Longitudinal studies with fine-grained hormonal measurement as well as hormonal experiments are needed to determine the pathophysiology of perimenstrual exacerbation in BPD.

Cited by 35 publications

References 65 publications

A Systematic Review and Meta-Analysis of Within-Person Changes in Cardiac Vagal Activity across the Menstrual Cycle: Implications for Female Health and Future Studies

A Systematic Review and Meta-Analysis of Within-Person Changes in Cardiac Vagal Activity across the Menstrual Cycle: Implications for Female Health and Future Studies

Reciprocal effects between daily situational perceptions and borderline personality symptoms in young adulthood: the role of childhood parenting experiences

Differential effects of the menstrual cycle on reactive and proactive aggression in borderline personality disorder

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