Na clínica contemporânea, percebe-se que as compulsões, as patologias do agir e a experiência de vazio estão cada vez mais presentes, contaminadas pela pressão de ideais de consumo ou constituídas sob a égide desses ideais, na promessa de completude presente nos valores atuais da cultura. Tais manifestações tornam-se ainda mais evidentes com a erupção de formas de sofrimento marcadas pela repetição de experiências dolorosas que limitam e empobrecem a vida dessas pessoas. Nesse contexto, quadros clínicos como a personalidade borderline e as adicções ganham relevância e exigem dos profissionais do campo da saúde mental produções acadêmicas para maior compreensão e cuidado desses fenômenos psicopatológicos. Frente a isto, o objetivo desta pesquisa consistiu em refletir sobre a relação entre as denominadas personalidades borderline e as adicções, a partir de uma investigação fundamentada em uma leitura psicanalítica. Pretende-se ainda enriquecer os instrumentos teórico-clínicos de que se dispõe, de forma a favorecer uma maior compreensão diagnóstica, imprescindível no manejo desses casos. Para tanto, esses conceitos foram estudados a partir da leitura hermenêutica entendida como construção dialética de conhecimento numa relação de intersubjetividade com as condições de sofrimento que podem ser agrupadas sob as nomeações aqui referidas e ilustradas através da utilização de material clínico. A noção de relação adictiva foi utilizada como conceito articulador, pois comporta elementos centrais da dinâmica psíquica própria das adicções e da personalidade borderline. A partir desse estudo, formulou-se a proposta de compreensão da organização borderline de personalidade como uma modalidade de adicção, cujo objeto é uma pessoa, mesmo que coisificada / Compulsive behavior, acting out pathologies and feelings of emptiness are increasingly frequent in contemporary psychoanalytical practice. Such symptoms are contaminated or even brought forth by the pressure of strongly rooted ideals of current culture regarding consumerism and its void promises of providing inner fulfillment. The result becomes even more evident in the outbursts of modern-day ways of suffering characterized by the repetition of painful experiences that limit and deplete the lives of these patients. Hence the understanding of clinical diagnosis and treatment of disorders such as addictions and borderline personality syndrome becomes an important academic requirement for mental health professionals. The goal of this research is therefore to reflect on the relation between borderline personality and addictions from a psychoanalytical perspective and thus, through the development of both theoretical and clinical knowledge, contribute to improve diagnosis, which is essential for the handling of such cases. In order to achieve such goals, these concepts have been studied from a hermeneutic approach understood as a dialectic construction of knowledge , with great attention to relations of intersubjectivity between them and conditions of suffering that may be brought together under the classification referred here. Additionally, those ideas have also been illustrated by clinical observations. The notion of addictive relations has proved to be a valuable starting point in the articulation of these studies, since it contains essential elements of the mental dynamics of patients suffering both from addictions and borderline personality syndrome. This study gave rise to the understanding of borderline personality as a modality of addiction in which the object is a person, although most probably objectified

Na clínica contemporânea, percebe-se que as compulsões, as patologias do agir e a experiência de vazio estão cada vez mais presentes, contaminadas pela pressão de ideais de consumo ou constituídas sob a égide desses ideais, na promessa de completude presente nos valores atuais da cultura. Tais manifestações tornam-se ainda mais evidentes com a erupção de formas de sofrimento marcadas pela repetição de experiências dolorosas que limitam e empobrecem a vida dessas pessoas. Nesse contexto, quadros clínicos como a personalidade borderline e as adicções ganham relevância e exigem dos profissionais do campo da saúde mental produções acadêmicas para maior compreensão e cuidado desses fenômenos psicopatológicos. Frente a isto, o objetivo desta pesquisa consistiu em refletir sobre a relação entre as denominadas personalidades borderline e as adicções, a partir de uma investigação fundamentada em uma leitura psicanalítica. Pretende-se ainda enriquecer os instrumentos teórico-clínicos de que se dispõe, de forma a favorecer uma maior compreensão diagnóstica, imprescindível no manejo desses casos. Para tanto, esses conceitos foram estudados a partir da leitura hermenêutica entendida como construção dialética de conhecimento numa relação de intersubjetividade com as condições de sofrimento que podem ser agrupadas sob as nomeações aqui referidas e ilustradas através da utilização de material clínico. A noção de relação adictiva foi utilizada como conceito articulador, pois comporta elementos centrais da dinâmica psíquica própria das adicções e da personalidade borderline. A partir desse estudo, formulou-se a proposta de compreensão da organização borderline de personalidade como uma modalidade de adicção, cujo objeto é uma pessoa, mesmo que coisificada / Compulsive behavior, acting out pathologies and feelings of emptiness are increasingly frequent in contemporary psychoanalytical practice. Such symptoms are contaminated or even brought forth by the pressure of strongly rooted ideals of current culture regarding consumerism and its void promises of providing inner fulfillment. The result becomes even more evident in the outbursts of modern-day ways of suffering characterized by the repetition of painful experiences that limit and deplete the lives of these patients. Hence the understanding of clinical diagnosis and treatment of disorders such as addictions and borderline personality syndrome becomes an important academic requirement for mental health professionals. The goal of this research is therefore to reflect on the relation between borderline personality and addictions from a psychoanalytical perspective and thus, through the development of both theoretical and clinical knowledge, contribute to improve diagnosis, which is essential for the handling of such cases. In order to achieve such goals, these concepts have been studied from a hermeneutic approach understood as a dialectic construction of knowledge , with great attention to relations of intersubjectivity between them and conditions of suffering that may be brought together under the classification referred here. Additionally, those ideas have also been illustrated by clinical observations. The notion of addictive relations has proved to be a valuable starting point in the articulation of these studies, since it contains essential elements of the mental dynamics of patients suffering both from addictions and borderline personality syndrome. This study gave rise to the understanding of borderline personality as a modality of addiction in which the object is a person, although most probably objectified

Bakgrund: Borderline personlighetsstörning (Emotionellt instabil personlighetsstörning, IPS) förkommer i samhället och visar sig på olika sätt. Sjukdomen är omfattande och komplex, vilket utgör att personer har svårt att få en bra sjukdomsbild som kan medför växling i sjukdomsinsikt.   Sjukdomen kan medföra en ökad risk för samsjuklighet vilket kan leda till konsekvenser som sviktande förmåga till egenvård och för tidig död. Syfte: Syftet med studien är att beskriva personers upplevelser av att leva med borderline. Metod: Metoden som används i denna studie är en kvalitativ forskningsmetod i form av en litteraturanalys av självbiografier. Resultat: Analysprocessen resulterade i två teman; Leva i ständiga känslostormar och att behöva och erhålla stöd för att klara vardagen samt fem subtema; känsla av både befrielse och skam, känsla av frustration och ilska, känsla av förtvivlan och otrygghet, att behöva mer stöd och att erhålla stöd. Diskussion: Resultatet visar hur att leva med borderlinediagnos är en utmaning och generellt innebär att leva med denna diagnos ständiga utmaningar och omvärderingar. Eftersom idag ges personer en framträdande roll i sin vård och ska därmed vara delaktiga i sin vård så måste olika aspekter av hur de upplever att leva med sin sjukdom, som att leva i ständiga känslostormar och behov av mer stöd, beaktas. / Background: Borderline personality disorder occurs in society and shows itself in different ways. The disease is extensive and complex, which means that persons with this disease can find it difficult to have a right disease insight, which can lead to varying disease insight. The disease can lead to an increased risk of co-morbidity that can lead to consequences such as failing ability to self-care and premature death. Purpose: The purpose of the study is to describe people's experiences of living with borderline. Method: The method used in this study is a qualitative research method in the form of a literature analysis of autobiographies. Result: The analysis process resulted in two themes; Living in constant emotional storms and the need of both support and to receive support, so as to cope with everyday life.  Five sub-themes; sense of both liberation and shame, sense of frustration and anger, sense of despair and insecurity, the need of more support and receiving support. Discussion: The result shows how living with borderline diagnosis is a challenge and generally means living with this diagnosis constant challenges and revaluations. Since today people are given a prominent role in their care and should therefore be more actively involved in their care, different aspects of how they feel to live with their illness, such as living in constant emotional storms and the need for more support must be taken into account.

<p> </p><p><strong>Background:</strong> Self-injury can be defined as deliberate harm one's own body without conscious intent to commit suicide. These patients need skilled care. <strong>Purpose:</strong> Illuminate nursing staff attitudes and treatment of patients with self-injury behaviour for individuals diagnosed with borderline personality disorder. <strong>Method:</strong> A general literature study has been made. Based on the objective was a literature search in various databases with ten relevant articles were selected and reviewed. <strong>Results:</strong> The results were presented along four main categories: a challenging patient population, health professionals perceptions, attitudes before and after education and Attitude of health professionals when they feel they can help. The results show that some staff working with patients with self-injury behaviour may find that this can be a challenging patient group. Training and regular supervision of health workers is a positive change in attitude and response. <strong>Discussion:</strong> Through training and mentoring for health professionals obtain the knowledge required to get a different understanding of patients with self-injury behaviour. This may change their attitude that can lead to better care.<strong> Conclusions:</strong> These patients are unique individuals with special needs. Through education one can obtain the knowledge required to understand these patients, who in turn may lead to the nursing staff is able to maintain respect and understanding for these people.</p><p> </p>

Bakgrund: Borderline personlighetsstörning är en vanlig sjukdom på alla vårdinrättningar och många sjuksköterskor möter dessa patienter dagligen. I omvårdnaden av dessa patienter behöver sjuksköterskan använda sig av dagliga händelser för att försöka lära patienten att lita på andra människor. Sjuksköterskans uppgift är att försöka lotsa patienten genom vardagen.  Syfte: Syftet med studien är att belysa sjuksköterskors upplevelser av att möta personer med borderline personlighetsstörning. Metod: Metoden som använts är en litteraturöversikt där vetenskapliga artiklar använts som grund för resultatet.  Resultat: Resultatet visar att många sjuksköterskor önskar mer kunskap om störningen och de tror att många av de problem som omger patienten beror på hur organisationen och strukturen på avdelningen fungerar. Sjuksköterskorna skulle vilja ha bättre struktur på hur de ska vårda dessa patienter och vill att arbetsplatsen ska ha samma mål med omvårdnaden. Detta presenteras i fem teman som påverkar hur bra mötet blir: Handledning/Organisation, Relationer, Erfarenheter, Attityder och Utbildning samt Empati. / Background: Borderline personality disorder is a common disease in all nursing units and many nurses meet patients with Borderline personality disorder in their daily work. The nursing care of these patients require that the nurse uses everyday events to make the patient begin to trust other people. Nurse’s job is to try to guide the patient through everyday life. Aim: The aim of this study is to examine how nurses experience their meeting with patients with borderline personality disorder. Method: The method used is a literature study in which scientific articles are used as a base to the results. Result: The result shows that many nurses want to have more knowledge about the disorder and they think that a lot of the problems surrounding these patients depend on how the organisation and structure in the units work. The nurses would like to have better structure to handle these patients and need the working units to have the same goals with the care. This is presented in five themes that affect the burnout of the meeting: Tutoring/Organization, Relationship, Experiences, Attitudes and Education, and Empathy.

Background: Self-injury can be defined as deliberate harm one's own body without conscious intent to commit suicide. These patients need skilled care. Purpose: Illuminate nursing staff attitudes and treatment of patients with self-injury behaviour for individuals diagnosed with borderline personality disorder. Method: A general literature study has been made. Based on the objective was a literature search in various databases with ten relevant articles were selected and reviewed. Results: The results were presented along four main categories: a challenging patient population, health professionals perceptions, attitudes before and after education and Attitude of health professionals when they feel they can help. The results show that some staff working with patients with self-injury behaviour may find that this can be a challenging patient group. Training and regular supervision of health workers is a positive change in attitude and response. Discussion: Through training and mentoring for health professionals obtain the knowledge required to get a different understanding of patients with self-injury behaviour. This may change their attitude that can lead to better care. Conclusions: These patients are unique individuals with special needs. Through education one can obtain the knowledge required to understand these patients, who in turn may lead to the nursing staff is able to maintain respect and understanding for these people.

<p><em>Bakgrund: </em>Borderline personlighetsstörning är en vanlig sjukdom på alla vårdinrättningar och många sjuksköterskor möter dessa patienter dagligen. I omvårdnaden av dessa patienter behöver sjuksköterskan använda sig av dagliga händelser för att försöka lära patienten att lita på andra människor. Sjuksköterskans uppgift är att försöka lotsa patienten genom vardagen. </p><p><em>Syfte: </em>Syftet med studien är att belysa sjuksköterskors upplevelser av att möta personer med borderline personlighetsstörning.</p><p><em>Metod: </em>Metoden som använts är en litteraturöversikt där vetenskapliga artiklar använts som grund för resultatet. </p><p><em>Resultat:</em> Resultatet visar att många sjuksköterskor önskar mer kunskap om störningen och de tror att många av de problem som omger patienten beror på hur organisationen och strukturen på avdelningen fungerar. Sjuksköterskorna skulle vilja ha bättre struktur på hur de ska vårda dessa patienter och vill att arbetsplatsen ska ha samma mål med omvårdnaden. Detta presenteras i fem teman som påverkar hur bra mötet blir: Handledning/Organisation, Relationer, Erfarenheter, Attityder och Utbildning samt Empati.</p> / <p><em>Background: </em>Borderline personality disorder is a common disease in all nursing units and many nurses meet patients with Borderline personality disorder in their daily work. The nursing care of these patients require that the nurse uses everyday events to make the patient begin to trust other people. Nurse’s job is to try to guide the patient through everyday life.</p><p><em>Aim:</em> The aim of this study is to examine how nurses experience their meeting with patients with borderline personality disorder.</p><p><em>Method:</em> The method used is a literature study in which scientific articles are used as a base to the results.</p><p><em>Result: </em>The result shows that many nurses want to have more knowledge about the disorder and they think that a lot of the problems surrounding these patients depend on how the organisation and structure in the units work. The nurses would like to have better structure to handle these patients and need the working units to have the same goals with the care. This is presented in five themes that affect the burnout of the meeting: Tutoring/Organization, Relationship, Experiences, Attitudes and Education, and Empathy.</p>

Exekutivfunktionen sind die Grundlage der Aufmerksamkeitssteuerung, Handlungsplanung, Impulskontrolle, und notwendig für zielgerichtetes Handeln. Impulskontrolle bedeutet dabei die Fähigkeit, behaviorale Impulse und Gedanken zu unterdrücken (Evenden, 1999). Erkrankungen, wie die Borderline Persönlichkeitsstörung (BPS) oder die Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörung (ADHS), die sich durch Einschränkungen der Impulskontrolle auszeichnen, gehören zu den häufigsten psychiatrischen Erkrankungen unserer Zeit und sind schwer zu behandeln. Klinische Beobachtungen (Linehan, 1996) wie auch aktuelle Forschungsergebnisse (Silbersweig et al., 2007) zur BPS lassen einen engen Zusammenhang der affektiven und impulsiven Symptomatik vermuten. Ziel der Studie war zum einen, die gestörte Impulskontrolle bei BPS mit Hilfe psychometrischer und neuropsychologischer Verfahren zu bestätigen und zum anderen die komplexe Interaktion affektiver und inhibitorischer Netzwerke mit Hilfe funktioneller Magnetresonanztomographie zu untersuchen. Dazu wurde ein fMRI-Paradigma entwickelt, dass Emotionsinduktion (Ärger, Freude, Neutral) mit einer Impulskontrollaufgabe (Go/NoGo) verband. Neben dem Vergleich mit einer gesunden Kontrollgruppe wurden zur störungsspezifischen Abgrenzung auch Frauen mit ADHS untersucht. Patientinnen mit BPS gaben dabei in Selbstbeurteilungsmaßen höhere Impulsivitätswerte als gesunde Kontrollen und ähnlich hohe Werte wie Patientinnen mit ADHS an, waren aber in den Aufgaben behavioraler Impulskontrolle nicht beeinträchtigt. In allen drei Versuchsgruppen ergab sich eine emotionale Modulation durch die vorher induzierten Emotionen. Während aber gesunde Kontrollen für erfolgreiche Inhibition v. a. den inferioren Präfrontalkortex verstärkt rekrutieren, war sowohl in der BPS- als auch in der ADHS eine Modulation im Nucleus subthalamicus zu beobachten. Während Patienten mit BPS entsprechend früherer Befunde mit verstärkter Amygdalaaktivierung auf die Emotion Ärger reagierten, zeigten die Patientinnen mit ADHS veränderte Aktivierungen des affektiven Netzwerkes bei der Emotion Freude. Emotionsunabhängig zeigten sich in der ADHS-Gruppe Hypoaktivierungen im mittleren Cingulum und dorsolateralen Präfrontalkortex. Zusammengefasst entsprechen die Ergebnisse der Annahme eines hyperaktivierten limbischen affektiven Systems und eines hypoaktivierten präfrontalen Kontrollsystems bei Borderline Persönlichkeitsstörung (Depue &amp; Lenzenweger, 2005; Dinn et al., 2004; Posner et al., 2003). Eine emotionale Modulation scheint zu einer kompensatorischen Aktivierung von Hirnregionen des Hemmungsnetzwerkes zu führen. Eine generell beeinträchtige neutrale Impulskontrollfähigkeit scheint in Abgrenzung zur ADHS jedoch nicht vorzuliegen.

The aims of the present thesis were: * To investigate how women patients with borderline personality disorder (BPD) perceive their suffering, quality of life and encounter with psychiatric care (paper 11 and III). * To describe BPD patients' and psychiatric professionals' perceptions of receiving and giving dialectical behavioural therapy, DBT (paper I). * To investigate how starting treatment of BPD patients with DBT affected the psychiatric professionals' experience of occupational stress and professional burnout (paper IV) Due to the different types of research questions the thesis deal with, it uses a mix of qualitative and quantitative research methods. In two of the studies (11 and 111) the main methods were qualitative. Data from free format questionnaires, individual- as well as group interviews and biographical texts, were analysed with content analysis or a hermeneutic approach. In study Ill the methods were quantitative. A summated rating scale measuring healthrelated quality-of-life (HRQOL) was analysed with descriptive and inferential statistics. In study IV quantitative and qualitative methods were combined. Two burnout inventories were analysed with descriptive and inferential statistics, and data from free format questionnaires and group interviews were analysed with qualitative content analysis. The main findings were that BPD patients suffer to an extent that is often unendurable, leading to deliberate self-harm (DSH) and suicide attempts to relieve suffering or just try to get away from it all (paper 11). In study Ill the BPD patients showed significantly poorer quality-of-life (even physical) than normal population controls of comparable age. The suffering, suicide attempts, DSH and poor quality-of-life (paper 11 and 111) put the patients in a position of voluntarily or involuntarily getting involved with psychiatric care. Study II revealed a double role of the psychiatric care in relation to BPD patients. On one hand, psychiatric professionals can add to the suffering by not being understanding and being disrespectful, on the other hand they can be helpful and relieve suffering by being respectful, understanding and validating. There was a clear relationship between the patients' experience of validation and the experience of being helped. DBT seems (both from the patients' and psychiatric professionals' perspective) to be a treatment with a philosophy, content and structure being able to relieve BPD patients suffering and helping them to independence and a bearable life-situation (paper I). Study IV confirms previous findings that psychiatric professionals experience treatment of self-harming patients as profoundly stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients due to its high degree of structure and specific techniques. The DBT team-work and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some professionals felt also improved their handling of other work stressors not related to DBT. This finding also corresponds to BPD patients' perceptions of the mindfulness component in DBT, which they reported as particularly helpful (paper 1). It should be noted that the patient samples in the thesis may be considered as a "worse off" subgroup among BPD patients, as they usually entered special treatment programs after a period of escalating symptoms, which standard psychiatric services had had difficulties handling. The rather small number of participants and the lack of equivalent andlor concurrent control groups in the quantitative studies limit the generalization of the results.

Thesis (M.A.) - Carleton University, 2002. / Includes bibliographical references (p. 60-71). Also available in electronic format on the Internet.