Subjective and objective sleep in young people with borderline personality disorder features

Jenkins, Claire A; Thompson, Katherine; Chanen, Andrew M; Hartmann, Jessica; Nicol, Katie; Nicholas, Christian L.

doi:10.1111/jsr.13463

Cited by 9 publications

(6 citation statements)

References 77 publications

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“…These are likely to persist for years after the initial trauma, and their subjective interpretations depend on the impact of the trauma on one's developing personality (Benson et al, 1990). The sleep architecture in this patient is disturbed with significant episodes of apnea and arousals, which are commonly reported in borderline patients (Jenkins et al, 2022). As per the polysomnography findings, she had arousals occurring typically more frequently in the REM phase, which is a finding seen in borderline patients irrespective of their PTSD status (Schredl et al, 2012).…”

Section: Discussionmentioning

confidence: 72%

Personality disorder chiefly presenting with chronic dream reality confusion: A case report.

Mudaliyar¹,

Venkatesan²,

Toppo³

et al. 2022

Dreaming

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The phenomenon of having difficulty differentiating experiences in sleep and wakefulness is called dream-reality confusion (DRC) and can cause significant functional impairment along with diagnostic challenges. Here, we present the first documented case of DRC from India, which for several years since early adolescence masqueraded as psychotic symptoms leading to poor treatment response. The case also underscores the importance of detailed history-taking and descriptive psychopathology in patients showing treatment resistance. Here, we also reiterate the commonly overlooked symptom of sleep disturbances in patients with a borderline personality trajectory with significant childhood trauma. Individuals with Cluster B personality traits are likely to experience DRC more, compared with normal individuals, due to their excessive dissociative tendencies, negative dream content, and fantasy proneness. Here, we describe the stepwise approach to reconceptualization and management of this patient, which led to a better outcome. The impact of childhood trauma on the sleep-wake cycle is further discussed. We also emphasize the common phenotypes seen in Cluster B personality, major mood disorders, and complex posttraumatic stress disorder that may cause diagnostic pitfalls.

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Section: Discussionmentioning

confidence: 72%

Personality disorder chiefly presenting with chronic dream reality confusion: A case report.

Mudaliyar¹,

Venkatesan²,

Toppo³

et al. 2022

Dreaming

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“…While this reduces the external validity of these ndings with existing literature, it also raises the issue of how trait dissociation might be assessed in future studies. Heightened subjective experiences are common in BPD and have been observed in other studies of young people with BPD regarding distress [36] and sleep [37], as well as among adults with BPD experiencing depression [38]. Finally, state dissociation is di cult to reliably induce in experimental paradigms.…”

Section: Discussionmentioning

confidence: 97%

Associations of state or trait dissociation with severity of psychopathology in young people with borderline personality disorder

Salmon

Nicol

Kaess

et al. 2022

Preprint

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Background State and trait dissociation are associated with borderline personality disorder (BPD) severity and severity of commonly co-occurring mental health symptoms. Although these distinct constructs do not consistently co-occur in experimental settings, they are frequently reported as the same construct, namely dissociation. This study aimed to investigate the co-occurrence of state and trait dissociation among young people with BPD and to examine whether state or trait dissociation were associated with symptom severity in this population. Methods State dissociation was induced using a stressful behavioural task in a clinical sample of 55 young people (aged 15–25 years) with three or more BPD features. Diagnoses, state and trait dissociation, BPD severity and severity of posttraumatic stress disorder (PTSD), depressive, and stress symptoms were assessed by self-report or research interview. Results A chi-square test of independence showed a strong association between state and trait dissociation. Bonferroni corrected t-tests showed that state dissociation was significantly associated with PTSD symptom severity and likely associated with BPD severity and severity of depressive and stress symptoms. Trait dissociation was not associated with symptom severity or severity of BPD features. Conclusions These findings highlight the need to distinguish between state and trait dissociation in personality disorder research. They suggest that state dissociation might be an indicator of higher severity of psychopathology in young people with BPD.

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“…Case in point: around core unifying criteria, the new ICD‐11 and DSM‐V alternative models of PDs will now better position work on PD to consider trait domains, translatable with the Big 5 personality traits, which have a long‐standing evidence base in sleep research. Moreover, subjective sleep‐state misperception—the experience of having slept for significantly shorter or longer than observed by objective measures—may be more common in people with PD (Bastien et al, 2008; Philipsen et al, 2005), particularly OCPD (Ruiter et al, 2012) and given the signal from Petrov and colleagues that behavioral therapy for insomnia and supported withdrawal from hypnotic medication may improve the accuracy of perception of sleep‐state, future work should look at both subjective and objective outcome measures, given that subjective sleep quality appears, more than objective quality to be associated with dysfunction and emotion regulation in some studies (Jenkins et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

“…The cognitive and behavioral factors specific to PD are directly associated with subjective and objective sleep disturbances (Simor & Horváth, 2013). For example, emotional lability, an inconsistent sense of self, difficulties with reality testing, increased nightmare frequency, specific circadian profiles (including phase delay and rest‐activity misalignment), and dissociative experiences, among others, are likely to mean that treating sleep disturbance in the context of PD requires a different approach to individuals with disturbed sleep but without personality difficulty (Jenkins et al, 2022; McGowan & Saunders, 2021; Rezaie et al, 2020). Moreover, “sleep‐state misperception,” a significant discrepancy between subjective sleep quality and objective quality, is thought to be common for people with PD (Bastien et al, 2008; Philipsen et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Interventions to improve the sleep quality of adults with personality disorder: A systematic review

King,

Cheng,

Fok

et al. 2023

Personality & Mental Health

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Poor quality sleep is common for people who have a diagnosis of personality disorder (PD). Core cognitive and behavioral features of PD may cause and perpetuate poor sleep, but to date, no review has collated the evidence on the efficacy of interventions to improve sleep quality for people with PD. Structured searches for interventional studies among adults with PD and reporting validated measures of sleep quality were conducted up to November 2022 in multiple databases. Single‐case reports were excluded. Study quality was assessed with standardized risk of bias tools. Unreported data was sought systematically from authors. This review was pre‐registered with an international prospective register of systematic reviews (PROSPERO) (CRD42021282105). Of the 3503 identified studies, nine met inclusion criteria, representing a range of psychological, pharmaceutical, and other interventions and outcome measures. Meta‐analytic methods were not feasible because of the serious risk of bias in all studies, and results were therefore synthesized narratively. There is limited and low‐quality evidence of the effects of a variety of interventions to improve the sleep quality of people living with PD. Further research might consider specifically including people diagnosed with PD in trials of sleep interventions and using sleep outcome measures in trials of established PD treatments.

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Subjective and objective sleep in young people with borderline personality disorder features

Cited by 9 publications

References 77 publications

Personality disorder chiefly presenting with chronic dream reality confusion: A case report.

Personality disorder chiefly presenting with chronic dream reality confusion: A case report.

Associations of state or trait dissociation with severity of psychopathology in young people with borderline personality disorder

Interventions to improve the sleep quality of adults with personality disorder: A systematic review

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