First evidence of a prospective relation between avoidance of internal states and borderline personality disorder features in adolescents.

Classified as probably not a substantial claim. May combine two claims.

Such invalidating environments do not teach adequate emotion management, so the person often uses short-term avoidance strategies when unpleasant internal states arise.

“These environments fail to impart adequate emotion management skills, so the individual often resorts to short-term avoidance strategies (e.g., self-harm, impulsive behavior) when experiencing unpleasant internal states.”

• cites [17] Crowell SE, Beauchaine TP, Linehan MM (2009) A biosocial developmental model of borderline personality: elaborating and extending Linehan’s theory. Psychol Bull 135:485–510 sourceSupported
• cites [18] Linehan MM (1993) Cognitive-behavioral treatment of borderline personality disorder. The Guildford Press, New YorkNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Linehan's biosocial theory proposes that a child with a genetically based, emotionally reactive temperament faces greater risk for BPD if raised in an invalidating early environment.

“She posits that children with a genetically based, emotionally sensitive, and reactive temperament are at an elevated risk of developing BPD when reared in an invalidating (e.g., neglectful, abusive, and/or dismissive) early environment.”

• cites [17] Crowell SE, Beauchaine TP, Linehan MM (2009) A biosocial developmental model of borderline personality: elaborating and extending Linehan’s theory. Psychol Bull 135:485–510 sourceSupported
• cites [18] Linehan MM (1993) Cognitive-behavioral treatment of borderline personality disorder. The Guildford Press, New YorkNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Fonagy's mentalization-based account proposes that insecure caregiver-child attachment leads the child to avoid internal thinking and feeling states because acknowledging them would threaten an already fragile relationship with the caregiver.

“In this account, an insecure attachment relationship between primary caregiver and child results in avoidance of internal thinking and feeling states in the child because acknowledging such internal states would further threaten an already vulnerable relationship with the caregiver.”

• cites [19] Fonagy P, Luyten P (2009) A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol 21:1355–1381 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [20] Sharp C, Fonagy P (2008) Social cognition and attachment-related disorders. In: Sharp C, Fonagy P, Goodyer I (eds) Social cognition and developmental psychopathology. Oxford University Press, Oxford, pp 269–302 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Recent longitudinal and genetic findings establish that BPD in adolescents is a valid diagnostic entity.

“Though initially considered a disorder limited to adults, recent longitudinal and genetic findings establish BPD in adolescents as a valid diagnostic entity, warranting empirical attention [4–6].”

• cites [4] Bornovalova MA, Hicks BM, Iacono WG, McGue M (2009) Stability, change, and heritability of borderline personality disorder traits from adolescence to adulthood: a longitudinal and twin study. Dev Psychopathol 21:1335–1353 sourcePartly supported

  The Results and Discussion (page numbers unavailable) report longitudinal stability and heritability of BPD traits in adolescent twins, supporting the relevance of studying BPD during adolescence. But the study used a dimensional trait measure, and the paper notes that categorical adolescent BPD diagnoses have shown low stability. Its findings do not establish the validity of adolescent BPD as a diagnostic entity. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [5] Miller AL, Muehlenkamp JJ, Jacobson CM (2008) Fact or fiction: diagnosing borderline personality disorder in adolescents. Clin Psychol Rev 28:969–981 sourceNot checked — no full text of the source
• cites [6] Sharp C, Romero C (2007) Borderline personality disorder: a comparison between children and adults. Bull Menninger Clin 71:85–114 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The SCARED has established discriminant and concurrent validity.

“Discriminant validity [37] and concurrent validity [36, 38] have been established in prior studies.”

• cites [37] Muris P, Merckelbach H, Mayer B, Prins E (2000) How serious are common childhood fears? Behav Res Ther 38:217–228 sourceSupported
• cites [36] Muris P, Merckelbach H, Schmidt H, Mayer B (1998) The revised version of the Screen for Child Anxiety Related Emotional Disorders (SCARED-R): factor structure in normal children. Pers Individ Differ 26:99–112 sourceNot checked — no full text of the source
• cites [38] Muris P, Merckelbach H, Mayer B, van Brakel A, Thissen S, Moulaert V, Gadet B (1998) The Screen for Child Anxiety Related Emotional Disorders (SCARED) and traditional childhood anxiety measures. J Behav Ther Exp Psychiatry 29:327–339 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

A dimensional, trait-based perspective holds that BPD traits are distributed continuously in the normal population and denote psychopathology only at the severe end.

“A dimensional, trait-based perspective suggests instead that BPD traits may be distributed continuously within the normal population and may denote psychopathology only at the severe end [15–17].”

• cites [15] Conway C, Hammen C, Brennan PA (2012) A comparison of latent class, latent trait, and factor mixture models of DSM-IV borderline personality disorder criteria in a community setting: implications for DSM-5. J Pers Disord 26:793–803 sourceSupported
• cites [16] Widiger TA, Trull TJ (2007) Plate tectonics in the classification of personality disorder: shifting to a dimensional model. Am Psychol 62:71–83 sourceNot checked — no full text of the source
• cites [17] Crowell SE, Beauchaine TP, Linehan MM (2009) A biosocial developmental model of borderline personality: elaborating and extending Linehan’s theory. Psychol Bull 135:485–510 sourcePartly supported

  In “Terminological and Conceptual Issues” (page unavailable), the paper describes borderline-like traits in people who do not meet full BPD criteria. It does not say that those traits are continuously distributed in the normal population or that they denote psychopathology only at the severe end. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

In that account, the child who avoids such internal states is at greater risk of developing BPD.

“In turn, the child is at increased risk of developing BPD.”

• cites [19] Fonagy P, Luyten P (2009) A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol 21:1355–1381 sourcePartly supported

  In “Moderators of Mentalization” (p. 12), the authors say that a family environment discouraging coherent discussion of mental states is likely to predispose a child to BPD. This supports the increased-risk claim, but the passage identifies the family environment—not the child’s own avoidance of internal states—as the risk factor. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [20] Sharp C, Fonagy P (2008) Social cognition and attachment-related disorders. In: Sharp C, Fonagy P, Goodyer I (eds) Social cognition and developmental psychopathology. Oxford University Press, Oxford, pp 269–302 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The CES-D was developed to measure depressive symptoms in the general population and has reliability, validity, and factor structure similar across demographic characteristics.

“The CES-D scale [34] was developed to study depressive symptomology in the general population and is routinely used in adolescent samples from the community [35].”

• Also stated in: § The Center for Epidemiologic Studies Depression Scale (CES-D Scale) · plain

  “Reliability, validity, and factor structure have been found to be similar across a range of demographic characteristics within the general population.”

• cites [34] Radloff LS (1977) The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401 sourceSupported
• cites [35] Olino TM, Yu L, Klein DN, Rohde P, Steeley JR, Pilkonis PA, Lewinsohn PM (2012) Measuring depression using item response theory: an examination of three measures of depressive symptomatology. Int J Methods Psychiatr Res 21:76–85 sourceSupported

Classified as probably not a substantial claim.

Recent psychopathology research emphasizes studying psychopathology dimensionally across the full latent trait in unselected samples, which requires community samples.

“Recent approaches in psychopathology research [47, 48] have emphasized the value of studying psychopathology dimensionally across the full latent trait in an unselected sample, which requires community samples as used in the current study.”

• cites [47] Cicchetti D (2006) Development and psychopathology. Dev Psychopathol 1:1–23 sourcePartly supported

  In “Developmental psychopathology: Some thoughts on its evolution” (page not provided), Cicchetti emphasizes studying the relationship between normal and abnormal development. The paper does not specify a dimensional analysis across a full latent trait or say that this requires unselected community samples. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [48] Cicchetti D, Cohen DJ (2006) Developmental psychopathology, Volume 1, theory and method. Wiley, New YorkNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Experimental investigations have shown that dialectical behavior therapy affects experiential avoidance in adults diagnosed with BPD.

“While the role of EA has been a central organizing principle of ACT [42], it is also implicated in Linehan’s biosocial theory [18] and experimental investigations have demonstrated effects for DBT on EA in adults diagnosed with BPD.”

• cites [43] Berking M, Neacsiu A, Comtois KA, Linehan MM (2009) The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder. Behav Res Ther 47(8):663–670 sourcePartly supported

  The Methods (Participants; page unavailable) describe adults with BPD assigned to DBT or treatment by community experts. The Results report that experiential avoidance decreased during treatment, and that changes in avoidance significantly mediated depression improvement in the DBT group. They do not establish a DBT-specific causal effect on experiential avoidance relative to the comparison treatment; the sample was also limited to women with a history of self-injury or suicide attempts. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

This is the first study to use only the generalized anxiety disorder subscale of the SCARED, and other anxiety disorders that may relate to experiential avoidance or borderline features were not considered.

“Finally, although research supports the validity of the SCARED subscales [39], we are the first study to use only the generalized anxiety disorder subscale of the SCARED. Other anxiety disorders that may relate to EA and/or borderline features were not considered.”

• cites [39] Hale WW, Raaijmakers Q, Muris P, Meeus WIM (2005) Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in the general adolescent population. J Am Acad Child Adolesc Psychiatry 44:283–290 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In a randomized controlled trial, reductions in experiential avoidance were related to reductions in depression, and failure to reduce experiential avoidance impeded depression reduction.

“For instance, during a recent randomized controlled trial [43], it was demonstrated that in DBT treatment for BPD, a reduction in EA levels related to a reduction in depression levels. Conversely, failure to reduce EA levels impeded the reduction of depression scores.”

• cites [43] Berking M, Neacsiu A, Comtois KA, Linehan MM (2009) The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder. Behav Res Ther 47(8):663–670 sourcePartly supported

  Methods > Participants (page unavailable) identifies the randomized trial comparing DBT with treatment by community experts. The Discussion (page unavailable) reports that reductions in experiential avoidance were associated with reductions in depression, and that higher avoidance predicted less subsequent depression reduction. But it describes impediment as a supported hypothesis, not a demonstrated causal effect; it also says the analysis of subsequent reduction was not conducted separately for DBT. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Previous research supports the five-factor structure of the SCARED and good internal consistency of its GAD subscale (α = 0.86).

“Previous research supports the five-factor structure of the SCARED and demonstrates good internal consistency of the GAD subscale [α = 0.86; 39].”

• cites [39] Hale WW, Raaijmakers Q, Muris P, Meeus WIM (2005) Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in the general adolescent population. J Am Acad Child Adolesc Psychiatry 44:283–290 sourceSupported

May combine two claims.

Sex significantly correlated with both experiential avoidance and borderline features, with higher levels of both in female adolescents.

“Sex significantly correlated with both EA and borderline features, such that higher levels of both were evident for female adolescents.”

May combine two claims.

The full prospective model was significant (F = 31.32; p < 0.001) and explained 23% of the variance in 1-year borderline symptoms.

“The full model was significant (F = 31.32; p < 0.001) and explained 23 % of the variance in the dependent variable (R2 = 0.23).”

May combine two claims.

Experiential avoidance showed significant bivariate correlations with borderline features, depression, and anxiety.

“As is evident in Table 2, significant correlations were found for EA and the total score on the BPFS-C. As expected, EA also showed significant relations with depression and anxiety.”

Classified as probably not a substantial claim. May combine two claims.

Greco et al. developed and validated the AFQ-Y, finding support for its construct and convergent validity and adequate internal consistency (α = 0.90).

“Greco et al. [27] developed and validated the AFQ-Y through a comprehensive, multiphasic, statistic-, and theory-based approach in a large community sample. The results of this evaluative process yielded support for the construct and convergent validity of the AFQ-Y in youth as well as adequate internal consistency (α = 0.90).”

• cites [27] Greco LA, Lambert W, Baer RA (2008) Psychological inflexibility in childhood and adolescence: development and evaluation of the Avoidance and Fusion Questionnaire for Youth. Psychol Assess 20:93–102 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Bijttebier and Vertommen reported that people with BPD used more avoidant coping strategies than controls.

“Additionally, Bijttebier and Vertommen [26] reported that individuals with BPD engaged in more avoidant coping strategies compared to controls.”

• cites [26] Bijttebier P, Vertommen H (1999) Coping strategies in relation to personality disorders. Pers Individ Differ 26:847–856 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

In the present sample, the BPFS-C had internal consistency (Cronbach's α = 0.88) at both baseline and 1-year follow-up.

“In the present sample, this measure was administered at baseline and 1-year follow-up and internal consistency, as measured by Cronbach’s alpha, was 0.88 at both time points.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In the present sample, the CES-D had internal consistency (Cronbach's α = 0.75).

“This measure was administered at baseline only, and internal consistency, as measured by Cronbach’s alpha, was 0.75 in the present sample.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Gratz et al. found that BPD outpatients were less willing than individuals without a personality disorder to tolerate emotional distress while pursuing goals.

“Similarly, Gratz et al. [25] found that, compared with individuals with no personality disorder, BPD outpatients were less willing to allow the experience of emotional distress in the pursuit of goals.”

• cites [25] Gratz KL, Rosenthal MZ, Tull MT, Lejuez CW, Gunderson JG (2009) An experimental investigation of emotion dysregulation in borderline personality disorder. Pers Disord: Theory Res Treat S:18–26 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Because Schramm et al. used an inpatient sample, the relation between experiential avoidance and BPD across the full latent trait of borderline pathology was not examined, indicating a need for a community sample.

“However, given that this study utilized an inpatient sample, the relation between EA and BPD across the full latent trait of borderline pathology was not examined, suggesting the need for studying these relations in a community sample.”

• cites [29] Schramm AT, Venta A, Sharp C (2013) The incremental validity and mediating role of experiential avoidance in the association between borderline features and emotion regulation in adolescents. Pers Disord: Theory Res Treat 4:138–144 sourceNot checked — no full text of the source

May combine two claims.

Schramm et al. found that experiential avoidance made a significant independent contribution to borderline feature variance and partially mediated the link between emotion regulation difficulties and borderline features.

“In adolescent inpatients with BPD, Schramm et al. [29] found that EA made a significant and independent contribution to the variance in borderline features, while partially mediating the relation between difficulties in emotion regulation and borderline features.”

• cites [29] Schramm AT, Venta A, Sharp C (2013) The incremental validity and mediating role of experiential avoidance in the association between borderline features and emotion regulation in adolescents. Pers Disord: Theory Res Treat 4:138–144 sourceNot checked — no full text of the source

May combine two claims.

Avoidance of unpleasant thoughts and sensations may relieve distress briefly, but it increases the chance that they will recur and raises physiological arousal and distress.

“While these behaviors alleviate distress in the short term, avoidance of unpleasant thoughts and sensations actually increases the likelihood of experiencing them again in the future, elevating physiological arousal and distress [23].”

• cites [23] Chawla N, Ostafin B (2007) Experiential avoidance as a functional dimensional approach to psychopathology: an empirical review. J Clin Psychol 63:871–890 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Long-term repeated experiential avoidance is proposed to produce harmful outcomes, including high psychopathology, high negative affect, low positive affect, high emotional reactivity, and various problem behaviors.

“Repeated long-term engagement in EA is posited to have damaging effects such as high rates of psychopathology, high negative affect and low positive affect, high emotional reactivity, as well as a number of problem behaviors [e.g., substance abuse, self-injury, and eating disorders; 22, 23].”

• cites [22] Chapman AL, Dixon-Gordon KL, Walters KN (2011) Experiential avoidance and emotion regulation in borderline personality disorder. J Ration-Emot Therapy 29:35–52 sourceNot checked — no full text of the source
• cites [23] Chawla N, Ostafin B (2007) Experiential avoidance as a functional dimensional approach to psychopathology: an empirical review. J Clin Psychol 63:871–890 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The BPFS-C has established construct validity, and borderline features measured by it are moderately stable over 1 year.

“Construct validity has been established [32, 33], and borderline personality features detected by the BPFS-C have been shown to be moderately stable across time. Specifically, BPD features were found to be moderately stable over the course of 1 year across three time points: fall of year 1, spring of year 1, and fall of year 2.”

• cites [32] Crick NR, Murray-Close D, Woods K (2005) Borderline personality features in childhood: a short-term longitudinal study. Dev Psychopathol 17:1051–1070 sourceNot checked — no full text of the source
• cites [33] Chang B, Sharp C, Ha C (2011) The criterion validity of the Borderline Personality Features Scale for Children in an adolescent inpatient setting. J Pers Disord 25:492–503 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

In the present sample, the AFQ-Y had adequate internal consistency (Cronbach's α = 0.82).

“In the present sample, this measure was administered only at baseline and internal consistency of this measure, as measured by Cronbach’s alpha, was 0.82.”

May combine two claims.

Although the study did not test the developmental model, the findings suggest that variability in experiential avoidance may independently predict borderline features prospectively.

“While the findings of this study do not explicitly test this developmental model (given the adolescent age range studied in the current study), our findings speak to the possibility that variability in EA is an independent predictor of borderline features prospectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Avoidance of internal experiences is a core feature of the mentalization-based conceptualization of BPD.

“Avoidance of internal experiences is a core feature of the mentalization-based conceptualization of BPD developed by Fonagy and colleagues [20, 41, 44].”

• cites [20] Sharp C, Fonagy P (2008) Social cognition and attachment-related disorders. In: Sharp C, Fonagy P, Goodyer I (eds) Social cognition and developmental psychopathology. Oxford University Press, Oxford, pp 269–302 sourceNot checked — no full text of the source
• cites [41] Bateman A, Fonagy P (2004) Psychotherapy for borderline personality disorder. Oxford, London sourceNot checked — no full text of the source
• cites [44] Fonagy P (1991) Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient. Int J Psycho-Anal 72:639–656Not checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

There were no significant differences between adolescents who completed follow-up and those who did not in sex or racial identification.

“There were no significant differences between adolescents who did and did not complete the follow-up assessments with regard to sex (χ2 = 0.07, p = 0.80) or racial identification (χ2 = 5.13, p = 0.27).”

Probably not a substantial claim: may not pass S3 (load-bearing).

In the present study, the SCARED GAD subscale had internal consistency (Cronbach's α = 0.85).

“In the present study, this measure was administered at baseline only and internal consistency, as measured by Cronbach’s alpha, was 0.85.”

Probably not a substantial claim: may not pass S3 (load-bearing).

All measures in the study were self-report based.

“A second limitation of the current study relates to the fact that all measures were self-report based.”