Borderline Personality Disorder (BPD) is an enduring personality disorder marked by severe self-damaging behaviors such as self-harm, substance use, and disordered eating behaviors. This study examined the emotional antecedents and consequences of self-damaging behavior (self-harm, binge drinking, substance use, and disordered eating behavior) among individualls who report features of BPD to assess the function of these behaviors. Additionally, this study examined whether self-reported difficulties in emotion regulation mediated the relationship between features of BPD and the presence of self-damaging behavior. Results from this study found support for the use of self-harm, drugs use, and disordered eating behavior to regulate emotional experiences and all forms of self-damaging behavior were found to significantly increase the presence of pleasant emotional experiences. The function of self-damaging behavior remains stable, regardless of whether the behavior occurs in isolation or co-occurs with other self-damaging behaviors. In addition, higher rates of polysubstance use were found for individuals with features of BPD compared to those without. Higher rates of difficulties in emotion regulation were found to be associated with features of BPD and the presence of self-damaging behavior was found to partially mediate the relationship between the two constructs. Findings from this study have substantial implications for the conceptualization and treatment of self-damaging behavior in individuals with BPD. / Psychology

Borderline personality disorder (BPD) is a highly stigmatized disorder, including among clinicians. Though research indicates a connection between childhood trauma and BPD, there remains considerable debate about the role trauma plays in the diagnosis and whether the diagnosis is properly categorized as a personality disorder. Additionally, studies about counselor perspectives of the Diagnostic and Statistical Manual of Mental Disorders (DSM) indicate conflicted feelings combined with dependency on its use. Research examining clinician views of the diagnosis of BPD, including the role that trauma plays in the diagnosis and categorization as a personality disorder, have largely neglected to explore the views of counselors, indicating a significant gap in the research. This study took a qualitative approach to increasing understanding of the views and experiences of licensed counselors as they work with clients and encounter trauma and the diagnosis of BPD. A total of 17 themes emerged during data analysis. Each theme is examined and conclusions are discussed. / Doctor of Philosophy / Borderline personality disorder (BPD) is a highly stigmatized disorder, including among clinicians. Though research indicates a connection between childhood trauma and BPD, there remains considerable debate about the role trauma plays in the diagnosis and whether the diagnosis is properly categorized as a personality disorder. Additionally, studies about counselor perspectives of the Diagnostic and Statistical Manual of Mental Disorders (DSM) indicate conflicted feelings combined with dependency on its use. Research examining clinician views of the diagnosis of BPD, including the role that trauma plays in the diagnosis and categorization as a personality disorder, have largely neglected to explore the views of counselors, indicating a significant gap in the research. This study took a qualitative approach to increasing understanding of the views and experiences of licensed counselors as they work with clients and encounter trauma and the diagnosis of BPD. A total of 17 themes emerged during data analysis. Each theme is examined and conclusions are discussed.

In writing this autoethnography, I invite you to enter into my world. It is not a world that is easy, or altogether happy. In the end, though, it is a story of survival and of perseverance. Trauma touches almost every person in some way. War, sexual abuse, physical and emotional abuse, death, and difficult life events color how we make sense of the world. Trauma may happen in one blinding moment or slowly eat away at us for years. Writing is often a way to cope with that trauma. This dissertation represents a small portion of my traumatic lived experiences that led me up to the doctoral process, and those that occurred in the ten years it took me to complete my dissertation. / Doctor of Philosophy / In writing this autoethnography, I invite you to enter into my world. It is not a world that is easy, or altogether happy. In the end, though, it is a story of survival and of perseverance. Trauma touches almost every person in some way. War, sexual abuse, physical and emotional abuse, death, and difficult life events color how we make sense of the world. Trauma may happen in one blinding moment or slowly eat away at us for years. Writing is often a way to cope with that trauma. This dissertation represents a small portion of my traumatic lived experiences that led me up to the doctoral process, and those that occurred in the ten years it took me to complete my dissertation.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1992.

Clinicians’ attitudes and behaviors toward patients with borderline personality disorder (BPD) are affected by the label’s stigma. Complex posttraumatic stress disorder (CPTSD) was proposed as a comprehensive and less stigmatizing diagnostic category for clients with BPD and a history of complex trauma. Given considerable similarities across both disorders’ diagnostic criteria, the CPTSD framework holds promise as a means to improve therapists’ attitudes towards clients with BPD and a history of complex trauma. However, this quality of CPTSD had not yet been examined empirically. Using vignettes in a between-subjects experimental design, this study investigated whether CPTSD is a less stigmatizing label than BPD for trauma survivors. Participants were 322 practicing psychotherapists. Evidence of BPD stigma was found, as was an affinity for CPTSD. Results generally supported CPTSD as a less stigmatizing label than BPD; therapists presented with a CPTSD-labeled vignette were somewhat less likely to blame the client for her symptomatic behavior and expected slightly stronger working alliance with the client than therapists presented with the BPD-labeled vignette. However, therapists’ agreement with the BPD diagnosis and theoretical orientation were found to be more salient than diagnostic label in affecting concepts related to the stigmatization of BPD clients. Additionally, familiarity with CPTSD was related to more favorable attitudes toward the client and her course of treatment. Regardless of CPTSD’s recognition as a formal diagnosis, education about the construct is widely recommended for therapists.

The main purpose of the present studies has been to develop the Defense Mechanism Test (DM1) for clinical assessment of severe psychopathology with the focus on the concept of Borderline Personality Organization (BPO) according to Kemberg. By relating the DMT and the Structural Interview to each other, the concurrent validity of the concept of Personality Organization (PO) for psychiatric inpatients has been investigated. Two different assessment approaches have been used for this purpose. One has been to take a theoretical perspective as the starting-point for the classification of PO by means of the DMT. The other has been a purely empirical approach designed to discern natural and discriminating patterns of DMT distortions for different diagnostic groups. A dialogue is also in progress between DMT and current research on the Rorschach test in order to increase understanding of borderline phenomena and pathology. The overall results support Kemberg's idea that borderline patients are characterized by specific intrapsychic constellations different from those of both psychotic and neurotic patients. Both the DMT and the Structural Interview provide reliable and consistent judgements of PO. Patients with the syndrome diagnosis Borderline Personality Disorder exhibit different perceptual distortions from patients suffering from other personality disorders. The classic borderline theory is a one-dimensional developmental model, where BPO constitutes a stable intermediate form between neurosis and psychosis. The present results suggest that a two-dimensional model might be more powerful. Hence, the level of self- and object representations and reality orientation might be considered both from a developmental gad an affective perspective across varying forms of pathology. Kemberg suggests that borderline and psychotic patients share a common defensive constellation, centered around splitting, organizing self- and object representations. This view did not find support. The defensive pattem of the BPO patients is significantly different from the PPO defensive pattern. The BPO patients form their self- and object images affectively and thus the self- and object representations would seem to influence the defensive organization and not the other way around. The results have implications for the procedure and the interpretation of the DMT e.g. one and the same DMT picture can discern different kinds of personality; reactions other than the operationalized defense categories in the DMT manual can be valid predictors of PO; some of the DMT defenses described in the manual have to be reconceptualized such as isolation, repression and to some degree denial. Multivariate models are powerful tools for the integration of reactions to DMT into diagnostic patterns. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1992, härtill 4 uppsatser.</p> / digitalisering@umu

Mindfulness is a core component of dialectical behavior therapy (DBT), a widely utilized treatment for borderline personality disorder (BPD); however, the import of mindfulness in treating BPD has yet to be demonstrated, and the relationship of mindfulness to BPD constructs is unclear. The current study utilized structural equation modeling to examine the relations of mindfulness with BPD features and the underlying constructs of interpersonal problem-solving effectiveness, impulsivity, emotion regulation strategies, and neuroticism in 342 young adults. Mindfulness was significantly related to effectiveness in interpersonal problem-solving, impulsivity and passivity in emotion regulation, and borderline features. Furthermore, mindfulness continued to predict borderline features when controlling for interpersonal problem-solving and impulsive/passive emotion-regulation strategies, as well as when controlling for neuroticism. It is concluded that difficulties with mindfulness may represent a core feature of BPD and that improvement in mindfulness may be a key component of treatment efficacy with BPD. It is recommended that the unique contribution of mindfulness be investigated in future treatment-outcome research.

Borderline Personality Disorder (BPD) is a major health problem and is associated with considerable psychosocial distress and impairment, resulting in a high degree of morbidity and a significant impact on the mental health system. Patients with BPD are difficult to treat clinically, the main issue being engaging the patient and then maintaining the relationship. Patients with BPD constitute 10-20% of psychiatric inpatients, utilise a large amount of mental health resources and have a 10% successful suicide rate. Therefore, it is essential that attention is given to improving effectiveness of treatment approaches for patients with BPD, including engagement. The purpose of the study was to explore and describe the lived world of patients with BPD in order to develop supporting guidelines to improve non-compliance of patients with BPD. The objective of the study was to develop guidelines to improve compliance, which is expected to minimise self-harm risks and improve the quality of the patients’ lives. A qualitative, phenomenological methodology was chosen because it is particularly well suited to study human experiences of health (LoBiondo-Wood & Haber, 2011:141). It is a design that emphasizes discovery through interpreting meaning as opposed to quantification and prediction. Understanding and interpretation of data was thus the hallmark of the research design. This phenomenological study examined human experiences through the descriptions provided by the people involved, i.e. lived experiences. Data collection was done using recorded interviews guided by a semi-structured interview schedule. Memos collected during interviews supplemented the data. Data analysis was hallmarked by constant comparison, contextualisation and description of emerging themes. The main findings, described in three main themes, were the importance of the relationship with the clinician, the overwhelming feelings experienced by the patients and the sense of futility in treatment. These were all linked to the lack of hope the patient felt regarding their clinician, ever being able to manage their continuously oscillating emotions and the purpose of treatment. The findings led to the construction of guidelines to foster initial and continued engagement in treatment with patients with BPD. The guidelines covered issues of clinical practice and management input. / Health Studies / D. Litt. et Phil. (Health Studies)