Thesis (Ph. D.)--University of Hawaii at Manoa, 2004. / Includes bibliographical references (leaves 271-279).

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 72-83).

Thesis (M.A.)--State University of New York at Binghamton, Department of Psychology, 2005. / Includes bibliographical references.

Thesis (Ph. D.)--Western Conservative Baptist Seminary, 1987. / Typescript. Includes bibliographical references (leaves 102-113).

Dysfunction in interpersonal relationships is central to Borderline Personality Disorder (BPD) and provides the context in which self-harming behaviour, impulsivity and affective liability manifest (Lazarus et al., 2014). A growing evidence base exists for Mentalisation Based Treatment (MBT) in regard to symptom burden and extent of personality disturbance in BPD (Choi-Kain, Albert, & Gunderson, 2016). Less is known about patients’ experience of MBT, potential moderators or the utility of group only MBT. Method: First, a meta-analysis examining the relationship between attachment organisation and BPD diagnosis was conducted. Second, a mixed method design was employed to assess change in interpersonal problems and symptomatic distress following a group only MBT intervention. Potential moderators were examined and patient narratives were elicited and qualitatively analysed. Results: Across 20 studies including 1,948 participants, we found significant, medium to large effect sizes linking BPD to insecure attachment organisation. The largest effect sizes were found for a negative relationship between BPD diagnosis and attachment security, and a positive relationship between BPD and unresolved, anxious and avoidant attachment. The results of the empirical study revealed a significant reduction in interpersonal problems and psychological distress over the course of the intervention. Pre-treatment level of interpersonal problems did not function as a moderator. Patients found the group to be a challenging but rewarding experience. Conclusion: There is a strong relationship between BPD and insecure and disorganised attachment. Less intensive, group only MBT interventions may be effective in reducing levels of interpersonal problems and psychological distress in adults with a diagnosis of BPD.

Professionals in the mental health industry often attach a stigma to Borderline Personality Disorder (BPD). It is commonly thought of as a frustrating disorder to treat. As a result many professionals avoid dealing with BPD individuals. In an attempt to promote positive treatment outcomes, the aim of the study is to explore how the introduction of altruistic behaviours would affect the outcome of the overall treatment of individuals with BPD. Snowball sampling procedures were implemented. Data were collected through the use of semi-structured interviews with six mental health professionals and analysed through qualitative data processing and thematic analysis procedures. To the researcher’s knowledge, no research has been conducted specifically exploring the relationship between altruistic behaviour and BPD to date. The following superordinate themes emerged: treatment challenges, treatment context, treatment approach, diagnostic challenges, altruism/prosocial influences, and altruism/prosocial behaviour. It is the researcher’s hope that the findings of this study will increase awareness of this possible avenue in the treatment of BPD, so that the results of this study can then be taken to the next level of exploration in research and in clinical practice.

Thesis (Ph.D.)--Boston University / Research suggests that "eating disorder not otherwise specified" (EDNOS) is particularly prevalent among individuals with borderline personality disorder (BPD). However, longitudinal data concerning course and predictors of outcome among different subtypes of EDNOS are scarce, particularly with comorbid BPD. The purpose of this study was to examine the longitudinal course of ED NOS subtypes and baseline predictors of outcome of ED NOS over 1 0 years of prospective follow-up in borderline patients. Two hundred and ninety patients who met Revised Diagnostic Interview for Borderlines (DIB-R) and Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised (DSM-111-R) criteria for BPD were followed prospectively over 10 years. Five subtypes of Structured Clinical Interview for DSM-111-R Axis I Disorders (SCID-1) diagnosed EDNOS were identified: subthreshold anorexia nervosa (AN) above the low-weight cut-off; subthreshold AN without loss of menses, subthreshold bulimia nervosa (BN); binge eating disorder (BED); and purging disorder. At baseline, 20% of the sample met criteria for an EDNOS subtype. In the first study, generalized estimating equations were first conducted to determine the prevalence of EDNOS subtypes over time. We used Kaplan-Meier survival analyses to examine time-to-remission, recurrence, and new onsets of the EDNOS subtypes. In the second study, baseline body mass index (BMI), socioeconomic status (SES), global assessment of functioning (GAF), social security disability income (SSOI), polypharmacy, and severity of childhood neglect, sexual abuse, and "other abuse" (e.g., physical, verbal, emotional) were examined as predictors of the course of EDNOS. Findings from the first study indicate that over time, rates of EDNOS were observed to decrease, and remissions were common. Among the EDNOS subtypes, BED was observed to have a particularly slow rate of remission and moderate rates of new onsets. Subthreshold AN without low weight had high rates of recurrence and new onsets. Findings of the second study indicate that borderline patients with EDNOS who were receiving SSDI at baseline were less likely to experience a remission of EDNOS and more likely to experience a recurrence. Additionally, severity of childhood adversity predicted new onsets of EDNOS. Findings suggest that receiving SSOI and severity of childhood adversity importantly impact the course of EDNOS in BPD.

Background: Borderline personality disorder (BPD) is a psychiatric diagnosis characterized by emotional and behavioural instability, and impaired ability to maintain relationships. Previous research has demonstrated an association between BPD and insecure attachment style. It has been argued that BPD is a disorder of attachment, with insecure attachment being associated with inadequate capacity to represent mental states, or to “mentalize”. There is evidence that people with BPD are impaired in their capacity to mentalize in the context of attachment relationships. The term “mentalization” encompasses a broad range of processes including metacognition. There is a theoretical basis for metacognitive deficits in BPD. However, there is a lack of empirical evidence regarding the role of metacognition in BPD and its relationship to adult attachment style. Method: Participants with BPD were recruited from Community Mental Health Teams, Clinical Psychology and a Dialectal Behaviour Therapy (DBT) service within NHS Highland. A comparison group of participants without BPD were recruited from the Clinical Psychology service, having been referred for symptoms of depression. Both groups were administered the Relationship Scales Questionnaire (RSQ)(a self-report measure of attachment); and a short version of the Metacognitions Questionnaire (MCQ-30). Severity of clinical symptoms and current mood was assessed using the Clinical Outcomes in Routine Evaluation (CORE) and the Hospital Anxiety and Depression Scale (HADS). Results: Participants with BPD scored significantly higher than those without BPD on the attachment-anxiety and attachment-avoidance dimensions of the RSQ. The BPD group also endorsed MCQ-30 items more than the comparison group. There was a significant difference between the groups on the MCQ-30 total score and four of the five subscale scores. There were significant positive correlations between attachment dimension scores and metacognition subscales. The strongest associations were between attachmentanxiety and “uncontrollability and danger” and “need to control thoughts” subscales of the MCQ-30. Only metacognition was predictive of current mood and distress levels. Conclusions: The results of this study show that people with BPD report high attachment-avoidance and attachment-anxiety in their relationships, relative to a non-BPD, depressed comparison group. These findings are consistent with the existing literature regarding the profile of attachment in BPD. This study also found that people with BPD also have more maladaptive metacognitions than people with symptoms of depression. An association between self-reported adult attachment style and maladaptive metacognitiion was demonstrated in the present study. Maladaptive metacognitive strategies and beliefs potentially contribute to maintenance of depressed and anxious mood, as well as broader symptoms of distress.

Women interpersonal chronic trauma survivors are frequently misdiagnosed with borderline personality disorder (BPD) or post traumatic stress disorder (PTSD), which often results in mistreatment. Neither PTSD nor BPD adequately describes the unique character alterations observed among those exposed to prolonged early childhood trauma.  Researchers suggest survivors of interpersonal and chronic trauma should be subsumed under complex PTSD (CPTSD)(MacLean & Gallop, 2003).  The primary purpose of this study was to test the validity of complex PTSD as a construct. MANOVA, ANOVA, chi- Square, and independent samples t- Tests were utilized to test hypotheses. Results revealed that women who experienced higher frequencies of trauma met more CPTSD criteria and had higher mean base rate scores on the Major Depression, Depressive, Avoidant, Masochistic, Anxiety, PTSD, and Borderline scales of the MCMI- III than women who experienced fewer traumas. Additionally, findings suggest that the Major Depression, Depressive, Anxiety, PTSD, and Borderline scales may highlight differences among women interpersonal trauma survivors who meet five of six CPTSD criteria versus those who meet full CPTSD diagnostic criteria. Lastly, the mean Borderline scale score for women who met full CPTSD diagnostic criteria was below the cutoff for personality traits. Overall, these findings provide evidence and validation for the distinction of CPTSD from BPD and PTSD.

D.Phil. / Please refer to full text to view abstract