M.A. (Psychology) / Please refer to full text to view abstract

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand , in partial fulfillment of the requirements for the degree of Master in the branch of Psychiatry / The aim of this report was to establish the profile of all the patients with borderline personality disorder admitted to the Acute Inpatient Psychiatric Assessment Unit at the Helen Joseph Hospital over the course of one year. A retrospective record review was conducted to investigate the prevalence, demographics, reasons for admission, treatment and length of stay of the group of patients that was selected based on discharge diagnosis and DSM-IV-TR criteria, that were admitted throughout the course of 2010. The follow-up plan upon discharge was also reviewed. Statistical data analysis revealed findings mainly in keeping with international norms. The length of stay of patients with borderline personality disorder exceeded the average length of stay of all the patients in the ward in 2010, which illustrates that these patients are above-average users of resources. Patients with borderline personality disorder were shown in the review to be extremely inconsistent with regards to scheduled follow up plans, however significantly used emergency services at the hospital. Implementation of targeted prevention and early intervention strategies, based on systematised programs such as dialectical behavioural therapy and mentalisation-based therapy, may be useful in addressing this. This report supports further research into the utilisation of services available for patients with borderline personality disorder in the wider context of both psychiatric and psychological interventions in Southern Gauteng.

Borderline personality disorder (BPD) is a disabling psychiatric condition that causes pervasive and enduring impairments in social and occupational functioning. Previous literature has outlined the core components of the disorder to include disturbances in affect regulation, identity problems, disrupted interpersonal relationships, and impulsive behavior. While several theories have postulated the primacy of one component in driving the remaining components, the etiological and maintaining mechanisms of BPD are poorly understood. Therefore, the present study examined the primacy of one of these components, identity disturbance, in eliciting changes in the affective, interpersonal, and impulsive components of the disorder. The current study employed an experimental manipulation of identity coherence in 388 undergraduates who were screened for high or low levels of borderline personality features. All participants completed measures of affect prior to and immediately following the manipulation and then completed a GoStop task of impulsivity and an interpersonal trust task in a counterbalanced order. The results suggest individuals with high levels of borderline personality features generally report reduced self-concept clarity and are more susceptible to efforts to alter the coherence of their identity than those with lower levels of borderline personality features. Destabilization of identity coherence led to greater difficulties inhibiting behavior in those with high levels of borderline features, whereas it improved behavioral control in those with low levels of borderline features. These results support theoretical articulations of BPD that indicate impulse control problems are a means of regulating one’s internal self-state. Contrary to some characterizations of the disorder, there was no evidence to suggest that alterations of identity coherence led to an exaggerated emotional response or disturbed interpersonal behavior. This finding is consistent with a number of studies examining affective reactivity to emotion induction procedures, interpersonal stimuli, and now alterations in identity coherence indicating that BPD is better characterized by severe, trait negative affect valence compared to healthy controls rather than hyper-reactivity. Moreover, the failure of interpersonal behavior to vary as a function of borderline personality status or experimental task type indicates the importance of dynamic influences during interactions as potential sources for variability in behavior. Although further research is needed to clarify the mechanisms linking identity, affective dysregulation, and interpersonal behavior; psychosocial interventions aimed at maintaining and developing a stable sense of identity may be beneficial for reducing the impulsive behaviors in BPD, which are potentially most critical for establishing the patient’s safety.

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Dissertation (Ph.D.) -- The Institute for Clinical Social Work, 1998. / A dissertation submitted to the faculty of the Institute of Clinical Social Work in partial fulfillment for the degree of Doctor of Philosophy.

Dissertation (Ph.D.) -- The Institute for Clinical Social Work, 1992. / A dissertation submitted to the faculty of the Institute of Clinical Social Work in partial fulfillment for the degree of Doctor of Philosophy.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 211-220). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 211-220). Also available on the Internet.

The principal intention of this study was to explore the heuristic value of the story of the alchemical vessel in understanding borderline conditions and pursuing their psychotherapy. It establishes the pertinence of the case study as a method of exploring the content and process of psychotherapy. The essential nature of story-telling is examined and the hypothesis is made that psychotherapy, borderline conditions, the myth of the alchemical vessel and the case study all reflect instances of story-telling. Towards the end of examining their mutual reflection, and thus heuristic value, elements of Jungian theory, the phenomenology of borderline conditions and case material are examined. Through the examination of certain shared themes which emerge from the story of the alchemical vessel and the material of psychotherapy it is established that there is indeed a metaphoric resonance between the different stories. Furthermore this resonance is useful in that it provides a secure vantage point as well as guidance towards effecting transformation for the client. The validity of the metaphoric resonance is examined and areas of weakness highlighted. Some suggestions are made concerning further research.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2004. / Also held in print (72 leaves, 30 cm.) in Akoranga Theses Collection (T 616.858520651 CHR)