Submitted by Maicon Juliano Schmidt (maicons) on 2015-04-15T18:41:58Z No. of bitstreams: 1 Edilson Pastore.pdf: 1708498 bytes, checksum: cb7f365a867bba996d379bf77353991f (MD5) / Made available in DSpace on 2015-04-15T18:41:58Z (GMT). No. of bitstreams: 1 Edilson Pastore.pdf: 1708498 bytes, checksum: cb7f365a867bba996d379bf77353991f (MD5) Previous issue date: 2012-01-31 / Nenhuma / A presente dissertação de Mestrado investigou o desempenho cognitivo de participantes com Transtorno de Personalidade Borderline (TPB) com e sem histórico de tentativas de suicídio. A apresentação da revisão de literatura e dos resultados empíricos deste trabalho foi descrita em um artigo teórico e um artigo empírico sobre o TPB, suicídio e funções cognitivas. Primeiramente, apresenta-se o artigo teórico, que traz uma revisão assistemática e crítica da literatura sobre o transtorno, abordando as particularidades do desenvolvimento dessa patologia e discutindo sobre os aspectos cognitivos. Essa revisão teve como foco as funções executivas, especialmente: atenção, concentração, tomada de decisões, organização do pensamento e memória operacional, sugerindo que déficits nessas funções podem ser fatores de risco para o suicídio em pacientes com esse diagnóstico. As conclusões do artigo teórico apontam para a existência de déficits específicos na cognição, especialmente na área de execução em participantes com diagnóstico de TPB. Discutiram-se artigos atuais encontrados sobre a temática e problematizou-se a necessidade e relevância de investigações e achados dessa natureza. O artigo empírico apresenta os resultados de uma pesquisa quantitativa, transversal e de comparação entre grupos realizada com uma amostra de 82 pacientes (M=31,80; DP=0,96) diagnosticados com TPB internados em uma clínica psiquiátrica de Porto Alegre, Rio Grande do Sul, Brasil. Foi aplicada a Escala Wechsler de inteligência para adultos (WAIS III), a Escala Barratt de Impulsividade, a Escala Beck de Suicídio e a Escala FAST, além de um questionário contendo dados sociodemográficos. Não foi encontrada diferença significativa em termos de QI total entre os participantes com TPB com e sem histórico de tentativas de suicídio, indicando assim que a heterogeneidade dos pacientes que apresentam esse diagnóstico, assim como o grande número de comorbidades apresentadas por essa população, podem ter sido fatores importantes para explicar esse resultado. Entretanto, verificou-se que pacientes com histórico de tentativas de suicídio apresentam índice de impulsividade mais elevado, especialmente abaixo de 30 anos de idade, o que salienta que nesta idade pacientes com TPB podem ser mais vulneráveis tanto para tentativas de suicídio quanto para sua efetivação. Embora não se tenha encontrado diferença significativa entre os grupos, as médias na Escala Wechsler (funções cognitivas) quanto ao QI total situaram-se dentro do nível médio de funcionamento cognitivo com QI de 92,73 (DP=14,39) para o grupo dos pacientes com histórico de tentativa de suicídio e 96,06 (DP=17,8) para o grupo sem tentativas de suicídio. Os níveis de impulsividade foram maiores no grupo de pacientes com histórico de tentativas de suicídio, assim como o grau de adaptação medido pela Escala FAST se mostrou mais prejudicado no mesmo grupo. Os resultados desta dissertação elucidam aspectos sobre o TPB e permitem refletir sobre adequadas formas de tratamento. Fica também evidenciada a necessidade da realização de outros estudos dentro dessa mesma temática, em virtude da carência de pesquisas neuropsicológicas ou sobre funções cognitivas em pacientes com diagnóstico de TPB no Brasil. / The objective of the present Master's thesis was to investigate the cognitive performance of participants with Borderline Personality Disorder (BPD) with and without a history of suicide attempts. The review of the literature and the empirical results of this study were described in a theoretical article and an empirical article about BPD, suicide, and cognitive functions. The theoretical article consisted of an asystematic and critical review of the literature on the disorder, addressing the characteristics of the development of this pathology and discussing its cognitive aspects. This review of the literature focused on executive functions, especially: attention, concentration, decision making, organization of thought, and working memory, suggesting that deficits in these functions may be risk factors for suicide in patients with this diagnosis. The conclusions of the theoretical article indicate the presence of specific cognition deficits, mainly in the executive functions of the participants diagnosed with BPD. We discussed recent articles on the topic and approached the need and relevance of further studies and similar findings. The empirical article presents the results of a quantitative, cross-sectional and comparative study conducted with a sample of 82 patients (M=31.80, SD=0.96) diagnosed with BPD and admitted to a psychiatric clinic in Porto Alegre, Rio Grande do Sul, Brazil. The Wechsler Adult Intelligence Scale (WAIS III), the Barratt Impulsiveness Scale, the Beck Suicide Scale, the FAST scale, and a questionnaire containing sociodemographic data were administered to the participants. There was no significant difference in terms of total IQ among the participants with BPD with and without a history of suicide attempts, suggesting that the heterogeneity of patients with this diagnosis, as well as the large number of comorbidities in this population, may have been important factors to explain this result. However, we found that patients with a history of suicide attempts have higher index of impulsivity, especially patients younger than 30 years, leading to the conclusion that individuals of this age group with BPD may be more vulnerable to both suicide and suicide attempts. Although there was no significant difference between the groups, the means on the Wechsler Scale (cognitive functions) in terms of total IQ were within the mean level of cognitive functioning with an IQ of 92 for the group of patients with a history of suicide attempt and 96 for the group without suicide attempts. Levels of impulsivity were higher in patients with a history of suicide attempts; in addition, the degree of adaptation measured by the FAST Scale was lower in the same group. These results explain aspects of BPD and provide the opportunity of developing appropriate therapeutic methods. The need for further studies on this topic was also evidenced by the lack of neuropsychological research or studies on cognitive functions in patients diagnosed with BPD in Brazil.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-11-30T15:02:34Z No. of bitstreams: 1 Aline Alvares Bittencourt_.pdf: 354620 bytes, checksum: 42685cd66ef9f8cbcec738eec89cf25d (MD5) / Made available in DSpace on 2015-11-30T15:02:34Z (GMT). No. of bitstreams: 1 Aline Alvares Bittencourt_.pdf: 354620 bytes, checksum: 42685cd66ef9f8cbcec738eec89cf25d (MD5) Previous issue date: 2015-08-13 / Nenhuma / Esta dissertação nasce da constatação de que é necessário conjugar a tradição clínica com a investigação empírica para ampliar o entendimento da desorganização aguda vivenciada por pacientes com transtorno de personalidade borderline em tratamento psicoterápico de orientação psicanalítica e estabelecer diretrizes para o seu manejo pelo psicoterapeuta. É uma dissertação de mestrado organizada em dois artigos empíricos. O primeiro, em formato de ensaio, trata da aparente dissociação entre a prática clínica e a pesquisa empírica e discute as possibilidades de uma aproximação entre estes dois campos a partir da conjugação de métodos clínicos e empíricos para a compreensão do processo psicoterápico e das mudanças observadas na psicoterapia psicanalítica. O caso de uma paciente borderline é utilizado para ilustrar como instrumentos empíricos e anotações clínicas feitas pelo psicoterapeuta podem se complementar e oferecer subsídios para a compreensão do processo de mudança em psicoterapia. São feitas considerações sobre o potencial deste tipo de perspectiva contribuir para a diminuição da brecha existente entre pesquisa e prática clínica. O segundo artigo é um estudo empírico que buscou aprofundar e contribuir para o aumento do conhecimento dos aspectos subjacentes às crises borderline e o seu manejo pelo psicoterapeuta de orientação psicanalítica, visto que elas são esperadas, recorrentes, mas alvo de poucos estudos. O caso é de uma paciente borderline em psicoterapia psicanalítica há aproximadamente três anos. A análise se concentrou num período de aproximadamente três meses, perto do final do primeiro ano de tratamento, no qual houve uma desorganização aguda que culminou numa tentativa de suicídio da paciente, seguida por uma internação psiquiátrica e reorganização psíquica após a mesma. A psicoterapia não foi interrompida neste período, que compreendeu 12 sessões. Estas foram analisadas, em profundidade, por meio das anotações clínicas da terapeuta, de uma medida empírica do processo terapêutico, o Psychotherapy Process Q-set (PQS), e de instrumento de avaliação de sintomas. Os achados apontam para a recomendação da não interrupção da psicoterapia na vigência da crise borderline e para a importância da empatia, sensibilidade e flexibilidade dos terapeutas para adaptar suas técnicas às necessidades destes pacientes. De modo geral, a dissertação demostra a necessidade do envolvimento de psicoterapeutas com a leitura e co-construção do conhecimento empírico para auxiliá-los a nortear suas práticas, tornando-as mais efetivas. Pacientes borderline podem apresentar crises intensas, vivenciadas dentro do setting, o que constitui desafio técnico para terapeutas psicanalíticos. A adoção de perspectivas integradas de investigação, que contemplem métodos empíricos e a perspectiva clínica do psicoterapeuta, é fortemente recomendada. / This paper is born from the realization that it is necessary to combine the clinical tradition and empirical research to increase the understanding of acute disorganization experienced by patients with borderline personality disorder in psychoanalytic psychotherapy and establish guidelines for their management by the psychotherapist. It is a dissertation arranged on two empirical articles. The first, in assay format, deals with the apparent dissociation between clinical practice and empirical research and discusses the possibilities of a closer relationship between these two fields from the combination of clinical and empirical methods for understanding the psychotherapeutic process and observed changes in psychoanalytic psychotherapy. The case of a borderline patient is used to illustrate how empirical tools and clinical notes made by the psychotherapist can complement each other and offer subsidies for understanding the psychotherapy change process. Considerations about the potential of this kind of perspective contribute to reducing the gap between research and clinical practice. The second article is an empirical study that aimed to deepen and contribute to increase knowledge of the underlying aspects of the borderline crises and their management by the psychoanalytic psychotherapist, as they are expected, applicants, but subject to few studies. The case is a borderline patient in psychoanalytic psychotherapy for about three years. The analysis focused on a period of approximately three months near the end of the first year of treatment, in which there was an acute disorganization that culminated in an attempt to patient suicide, followed by a psychiatric hospitalization and psychological reorganization after. Psychotherapy was not interrupted during this period, which included 12 sessions. These were analyzed in depth through clinical notes from the therapist, an empirical measure of the therapeutic process, the Psychotherapy Process Q-Set (PQS), and symptom evaluation tool. The findings point to the recommendation to not interrupt the psychotherapy in the presence of borderline crisis and the importance of empathy, sensitivity and flexibility of therapists to adapt their techniques to the needs of these patients. Overall, the dissertation demonstrates the need for the involvement of psychotherapists with reading and co-construction of empirical knowledge to help them guide their practices, making them more effective. Borderline patients may present experienced intense crises inside the setting, which is technical challenge for psychoanalytic therapists. The adoption of integrated perspectives of research that include empirical and clinical perspective from the psychotherapist, is strongly recommended.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-10-24T12:03:16Z No. of bitstreams: 1 Solange Veronez.pdf: 3638948 bytes, checksum: 7086eb09cc3ab3c8f87a0ede146a59fe (MD5) / Made available in DSpace on 2017-10-24T12:03:16Z (GMT). No. of bitstreams: 1 Solange Veronez.pdf: 3638948 bytes, checksum: 7086eb09cc3ab3c8f87a0ede146a59fe (MD5) Previous issue date: 2017-10-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This study aims to reflect on the need for physical contact with the psychologist of a borderline patient attended at a public institution. To this end, aspects of the Theory of the Maturing of D.W.Winnicott and their application in the clinic, such as body holding, regression management and egoic needs are included here. Also discussed are questions of technique, transference and countertransference, involving the abstinence rule, analyst neutrality and the necessary modification of classical psychoanalysis in the care of patients who have suffered from inadequate environmental care in a phase of absolute dependence. Diagnosed with schizoaffective disorder, the patient in question was assisted in a task group proposal and in individual consultations when she requested it. It was possible to conclude that in some moments, the attendance to the need for corporal contact - touch to the hands and the hair - proved adequate to unfreeze the environmental fault lived by the patient in the beginnings of its existence; in others, however, it was important to deny her the request in order to safeguard the setting and the psychologist as a real person in the treatment / Este estudo tem como proposta realizar uma reflexão acerca da necessidade de contato físico com a psicóloga de uma paciente borderline atendida em instituição pública. Para tanto, são aqui retomados aspectos da Teoria do Amadurecimento de D. W. Winnicott e sua aplicação na clínica, tais como holding corporal, manejo da regressão e necessidades egoicas. Também são abordadas questões da técnica, da transferência e contratransferência, envolvendo a regra da abstinência, a neutralidade do analista e a necessária modificação da psicanálise clássica no atendimento de pacientes que sofreram falhas de cuidados ambientais numa fase de dependência absoluta. Diagnosticada com transtorno esquizoafetivo, a paciente em questão foi atendida numa proposta de grupo de tarefas e em consultas individuais, quando assim o solicitava. Foi possível concluir que, em alguns momentos, o atendimento à necessidade de contato corporal – toque nas mãos e nos cabelos – mostrou-se adequado para descongelar a falha ambiental vivida pela paciente nos primórdios de sua existência; em outros, porém, foi importante negar-lhe o pedido, de modo a salvaguardar o setting e a psicóloga como pessoa real no tratamento

Introdução: O Transtorno Afetivo Bipolar (TAB) e o Transtorno de Personalidade Borderline (TPB) apresentam características clínicas em comum que frequentemente tornam difícil seu diagnóstico diferencial, podendo implicar em indicações terapêuticas inadequadas. Assim, é importante ampliar o conhecimento diagnóstico sobre esses transtornos mentais buscando identificar marcadores que auxiliem sua diferenciação. A história de estresse precoce, associada à vulnerabilidade individual no desenvolvimento de transtornos mentais relatada na literatura, pode representar um fator de diferenciação entre TAB e TPB, assim como sua associação com manifestações clínicas e respostas neuroendócrinas específicas a cada um desses diagnósticos. Objetivo: Avaliação e comparação de pacientes com diagnóstico de TAB e TPB buscando indicadores de seu diagnóstico diferencial, relacionados a fatores associados a sua sintomatologia, etiopatogênese e marcadores neuroendócrinos. Metodologia: A amostra do estudo foi composta por 51 mulheres, distribuídas em 3 grupos constituídos por pacientes com diagnóstico clínico de TAB (n=16) e TPB (n=20), e controles saudáveis (n=15). Para sua avaliação, foram utilizados instrumentos para confirmação diagnóstica e entrevista semiestruturada para delineamento do perfil sócio-demográfico e clínico. A gravidade da sintomatologia psiquiátrica foi avaliada através dos instrumentos de Beck para avaliação de ansiedade, depressão, desesperança e ideação suicida, além de escalas de avaliação de sintomas maníacos e impulsividade. A história de estresse precoce foi investigada pelo Questionário de Traumas na Infância (CTQ), e classificada segundo os subtipos abuso emocional, abuso físico, abuso sexual, negligência emocional e negligência física. O funcionamento do eixo hipotálamo- hipófise-adrenal (HHA) foi avaliado pela dosagem de cortisol basal plasmático. Os resultados das avaliações foram analisados em um segundo momento de acordo com a presença ou ausência de estresse precoce. Resultados: A amostra de pacientes com diagnósticos de TAB e TPB analisadas apresentaram diferenças significativas em relação à idade e tempo de tratamento, maiores no grupo TAB. A análise da sintomatologia psiquiátrica indica maior gravidade de ansiedade, impulsividade, depressão, desesperança e ideação suicida no grupo TPB. A história de estresse precoce foi identificada como mais prevalente e significativamente mais grave nas pacientes do que em controles saudáveis, nos escores de CTQ total, abuso emocional, negligência emocional e negligência física, que também diferenciaram os grupos diagnósticos, sendo maiores no TPB comparado ao TAB. A partir da presença do estresse precoce em níveis de moderado a extremo, o subtipo negligência física diferenciou significativamente os diagnósticos, indicando ser mais grave quando associado ao TPB. A avaliação endócrina indicou diferenças entre os diagnósticos TAB e TPB em relação aos controles saudáveis, com níveis mais baixos de cortisol apresentados pelas pacientes. A presença de estresse precoce em pacientes com TAB demonstrou diferença significativa com menores níveis de cortisol em relação aos controles. O cortisol mensurado nas pacientes com TPB foi significativamente menor comparado ao dos controles na presença de negligência emocional e negligência física. O cortisol apresentou correlações significativas e opostas nos grupos diagnósticos com o abuso sexual, sendo uma correlação de Pearson negativa no TAB e positiva no TPB. A presença de estresse precoce associada ao diagnóstico de TPB revelou ainda correlação significativa negativa do cortisol com a negligência física. Discussão: Considerando a necessidade de uma análise multifatorial, o diagnóstico diferencial entre TAB e TPB pode ser facilitado pela análise dos sintomas psiquiátricos e da história de estresse precoce. O diagnóstico de TPB se associa a sintomatologia mais grave de ansiedade, impulsividade, depressão, desesperança e ideação suicida; assim como, a maior prevalência e gravidade da história de estresse precoce em geral e em relação aos subtipos abuso emocional, negligência emocional e, especialmente, negligência física quando presente em maior gravidade. O funcionamento do eixo HHA avaliado pelo cortisol sugere diferenciar-se em ambos os diagnósticos, na associação com experiências estressantes precoces no TAB e, especialmente, com história de negligência física no TPB. Conclusão: Assim, a análise integrada dos parâmetros relacionados a psicopatologia, ao estresse precoce e funcionamento neuroendócrino fornecem indicadores úteis na diferenciação entre os diagnósticos de TAB e TPB, mas que necessitam ser melhor explorados e compreendidos através de futuros estudos. / Introduction: Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) have clinical features in common that often make it difficult differential diagnosis , and may result in inadequate therapeutic indications. Thus , it is important to expand knowledge diagnosis on these mental disorders in order to identify markers that make clear the differences. The history of early stress associated with individual vulnerability to develop mental disorders can be a difference factors between BD and BPD , as its association with clinical and neuroendocrine responses. Objective: To assess and compare patients with BD and BPD seeking indicators of differential diagnosis, related to factors associated with its etiology and pathogenesis, symptoms and neuroendocrine markers. Methodology: The study sample consisted of 51 women , distributed in 3 groups: patients diagnosed with BD (n=16) and BPD (n=20) and healthy controls (n=15). We confirm the diagnosis with SCID I and SCID II; and semi-structured interview for delineating the socio-demographic and clinical features. Severity of psychiatric symptoms was assessed using the Beck instruments for assessment of anxiety , depression , hopelessness and suicidal ideation, as scales of impulsivity and manic symptoms. The history of early stress was investigated by the Childhood Trauma Questionnaire (CTQ), and classified according to subtypes emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. The functioning of the hypothalamic- pituitary- adrenal (HPA) axis was evaluated by measurement of basal plasma cortisol. Results were analyzed in a second time according to the presence or absence of early stress. Results: A sample of patients with diagnoses of BD and BPD were analyzed and showed significant differences in relation to age and treatment time , higher in BD. The analysis of psychiatric symptoms indicating greater severity of anxiety, impulsivity, depression, hopelessness and suicidal ideation in the group BPD. The history of early life stress has been identified as the most prevalent and significantly worse in patients than in healthy controls, in scores of CTQ total emotional abuse, emotional neglect and physical neglect, which also differentiated the diagnostic groups and were higher BPD compared BD. From the presence of early life stress the subtypes physical neglect differed significantly , indicating higher severity when associated with the BPD. The endocrine evaluation indicated differences between diagnoses BD and BPD compared to healthy controls , with lower levels of cortisol presented by patients. The presence of early stress in patients with BD showed significant difference with lower cortisol levels compared to controls. Cortisol measured in patients with BPD was significantly lower compared to controls in the presence of emotional neglect and physical neglect. Cortisol was significantly correlated and opposite in diagnostic groups with sexual abuse , being a Pearson correlation negative in BD, and positive BPD. The presence of early stress associated with the diagnosis of BPD also showed a significant negative correlation of cortisol with physical neglect. Discussion: Considering the need for a multifactorial analysis, differential diagnosis between BD and BPD can be facilitated by analysis of psychiatric symptoms and history of early life stress. The diagnosis of BPD is associated with more severe symptoms of anxiety, impulsivity, depression, hopelessness and suicidal ideation, as well as the increased prevalence and severity of history of early life stress in general and in relation to subtypes emotional abuse, emotional neglect, and especially , physical neglect when present in greater severity . The functioning of the HPA axis measured by cortisol suggests differentiate the diagnosis and association with early stressful experiences in BD and particularly with a history of physical neglect in BPD. Conclusion: Thus, the integrated analysis of the parameters related to psychopathology, stress and neuroendocrine function provide early indicators useful in differentiating between diagnoses of BD and BPD, but these need to be better explored and understood by future studies.

Borderline Personality Disorder (BPD), as defined by the DSM-IV-TR (APA, 2000), is a multifaceted mental illness characterized by pervasive instability of interpersonal relationships, self-image, affect and behavior. Despite a growing consensus that the etiological basis of BPD stems from a combination of biological vulnerability and an early developmental history characterized by invalidation, abuse and/or neglect (e.g., Clarkin, Marziali, & Munroe-Blum, 1991; Linehan, 1993), the reasons for the diversity of troubling symptoms (e.g., self-injury, suicidality, mood reactivity, relationship difficulties) remain unclear. Psychopathology theorists differ in their conceptualization of the fundamental problems (e.g., impulsivity vs. identity disturbance vs. emotion dysregulation) underlying BPD and further research is needed to clarify which features are central to the maintenance of the difficulties associated with the disorder. In the current research, the some of the tenets of Linehan’s (1993) biosocial theory of BPD and the core constructs implicated in her conceptualization of the disorder were explored empirically in several samples of undergraduate university students. According to the biosocial theory, difficulties regulating emotions represent the core pathology in the disorder and contribute causally to the development and expression of all other BPD features. The emotional dysregulation is proposed to emerge from transactional interactions between individuals with biological vulnerabilities (i.e., a highly arousable temperament, sensitive to both positive and negative emotional stimuli) and specific environmental influences (i.e., a childhood environment that invalidates their emotional experience). The theory asserts that the dysregulation affects all aspects of emotional responding, resulting in (i) heightened emotional sensitivity, (ii) intense and more frequent responses to emotional stimuli, and (iii) slow return to emotional baseline. Furthermore, Linehan proposed that individuals with BPD lack clarity with respect to their emotions, have difficulties tolerating intense affect, and engage in maladaptive and inadequate emotion modulation strategies. As a result of their dysfunctional response patterns during emotionally challenging events , individuals with BPD fail to learn how to solve the problems contributing to these emotional reactions. In accordance with this theory, a number of hypotheses were tested. First, it was hypothesized that the interaction between temperamental sensitivity and an adverse childhood environment would predict BPD features over and above that predicted by either construct independently. Second, it was hypothesized that BPD traits would be predicted by high levels of emotional dysregulation (affect lability), problems across different aspects of emotional experience (e.g., intensity, awareness, clarity), and deficits in emotion regulation skills (e.g., poor distress tolerance, self-soothing). Based on the initial findings of the research, a series of competing hypotheses were tested that addressed the nature of the emotional, cognitive and motivational mechanisms that may underlie maladaptive behavior in BPD more directly. Prior to testing these hypotheses, it was important to select a set of measures that would best represent these constructs within an undergraduate population. The purpose of Studies 1a and 1b (N = 147 and N = 56, respectively) was to determine the reliability and validity of a series of self-report measures that assess BPD features and to select one questionnaire with high sensitivity (percentage of cases correctly identified) and high specificity (percentage of noncases correctly identified) as a screener for BPD within undergraduate students by comparing the results of the questionnaires against a “gold standard” criterion diagnosis of BPD (as assessed by two semi-structured interviews: DIB-R and IPDE-I). The second goal of these studies was to conduct a preliminary exploratory analysis of the association of scores on the BPD measures and constructs that have been hypothesized to be relevant to the development and maintenance of BPD symptoms (e.g., “Big Five” personality factors, emotional experience, impulsivity). Overall, the findings of Studies 1a and 1b indicated that screening for BPD in an undergraduate population is feasible and there are several questionnaires that may help in the identification of participants for future studies. Specifically, the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD; Zanarini et al., 2003), International Personality Disorder Examination DSM-IV Screening Questionnaire (IPDE-S; Loranger, 1999) and Borderline Personality Questionnaire (BPQ; Poreh et al., 2006) were all found to be internally consistent and valid screening measures. Furthermore, the results of correlation and regression analyses between dimensions of the “Big Five” and scores on the BPD measures were consistent with previous findings in the literature that BPD is associated with higher scores on neuroticism, lower scores on agreeableness, and to a lesser degree, lower scores on conscientiousness and extraversion. The similarity in results between the current and past studies suggested that individuals in the present samples showed characteristics consistent with that seen in both clinical and nonclinical populations with BPD traits. The results also provided support for the notion that individuals with BPD have a lower threshold (i.e., greater sensitivity) for both sensory and affective stimuli, as well as higher amplitude of emotional response (i.e., greater reactivity) to such stimuli. Furthermore, the findings suggested that those with BPD traits may lack understanding of their emotional state, may be unable to effectively regulate their emotional state, and that their impulsive behavior may be driven by negative affect. The purpose of Study 2 (N = 225) was to test some of the specific tenets of Linehan’s (1993) biosocial theory. The results suggested that BPD traits are associated with numerous dimensions of temperament [e.g., higher levels of negative affect; lower levels of positive affect; lower levels of effortful control; low sensory threshold (i.e., greater sensitivity) for both sensory and affective stimuli; ease of excitation (i.e., greater reactivity to sensory and affective stimuli)] and childhood environment (e.g., authoritarian parenting style, invalidating parenting, neglect, abuse). An examination of the interactions between dimensions of temperament and childhood environment suggested that interactions between (i) ease of excitation (greater reactivity to sensory and affective stimuli) and environment and (ii) trait negative affect and environment, predicted BPD symptoms over and above the temperament and environment variables alone. The results also suggested that a number of other factors are associated with BPD symptoms, including: increased attention to (or absorption in) emotional states, poor emotional clarity, affect lability (particularly anger), poor distress tolerance, and negative urgency (impulsive behavior in the context of negative affect). The association between BPD symptoms and difficulties identifying feelings seemed to be mediated by affect lability and negative urgency. Self-soothing and self-attacking did not predict BPD traits over and above the other variables. Wagner and Linehan (1999) also proposed that the intense emotions (and emotional dysregulation) experienced by those with BPD interferes with cognitive functioning and effective problem solving, resulting in poor decisions and the observed harmful behaviors. Other researchers have suggested that the repetitive, self-damaging behavior occurring in the context of BPD may reflect impairments in planning and failure to consider future consequences (e.g., van Reekum et al., 1994). Proponents of this view suggest that individuals with BPD show greater intensity and lability in their emotional response to their environment because they are unable to inhibit or moderate their emotional urges (i.e., impulsivity is at the core of the disorder). The purpose of Study 3 (N = 220) was to characterize decision making in an undergraduate sample of individuals with BPD traits and to ascertain the relative contribution of individual differences in the following areas to any deficits identified in decision making: emotional experience (e.g., increased affective reactivity or lability); reinforcement sensitivity (e.g., sensitivity to reward and/or punishment); impulsivity; executive functioning (measured by an analogue version of the Wisconsin Card Sorting Test); and reversal learning. Decision making was assessed using modified versions of two Iowa Gambling Tasks (IGT-ABCD and IGT-EFGH; Bechara, Damasio, Damasio, & Anderson, 1994; Bechara, Tranel, & Damasio, 2000) that included reversal learning components (i.e., Turnbull et al., 2006). The results of Study 3 showed that participants in the BPD group demonstrated deficits in decision-making as measured by the IGT-ABCD but not on the IGT-EFGH. The results [interpreted in the context of reinforcement sensitivity models, the somatic marker hypothesis (Damasio, 1994) and the “frequency of gain” model e.g., Chiu et al. 2008)] suggested that decision making under uncertainty may be guided by gain-loss frequency rather than long-term outcome for individuals with BPD traits. The results failed to show consistent associations between BPD symptoms and performance on either version of the IGT. Individual differences in emotional experience, executive functioning or reversal learning did not account for the decision-making problems of the BPD group on the IGT-ABCD.

Neuropsychological deficits may perpetuate the risk and chronicity of psychiatric disorder. Borderline Personality Disorder, characterized by significant suicide risk, intense affect and behavioural dysregulation, is frequently associated with the executive function (EF) deficits of decision making and inhibitory control. However, the role of inhibitory control on decision making remains poorly understood. This study examined the relationships among working memory, cognitive and motor inhibitory control, and IGT decision-making performance in 41 women with BPD and 41 healthy controls. Associations among EF and suicide risk were also explored. Experimental tasks included the Iowa Gambling Task, Digit Span, Stroop and Stop Tasks, and Raven’s Matrices. Only IGT decision-making deficits distinguished BPD subjects from healthy controls. Weaker yet normal range IQ and EFs in BPD women did not explain their disadvantageous IGT performance. Contrary to expectations, IGT deficits in BPD women did not predict any suicidal risk; however, intact interference control was as sensitive to suicidal risk as was depression. Normal interference control was associated with a reduction in suicide risk. While IGT decision making may be a marker for BPD, Stroop interference control is more sensitive to suicide risk and may represent a vulnerability for suicide that exists beyond psychiatric diagnosis.

Dans Creep show, un narrateur présente ses creeps, les malades de son entourage, des schizophrènes inadéquatement nommés, afin de les ramener à la vie par ses mots. En se souvenant de certains moments où la folie se manifestait à lui, il veut déterrer ses ensevelis, les faire parler en leur prêtant son écriture. Dans un récit morcelé pouvant évoquer une galerie de portraits en mouvement, les protagonistes sont présentés comme des monstres, des rêveurs ou des sources d’inspiration selon le moment relaté par un narrateur affecté qui se replonge littéralement dans un passé s’échelonnant entre l’enfance et l’âge de dix-huit ans. Portant autant sur la maladie mentale que sur la honte et la peur des mots, Creep show est un texte sur le silence et l’impuissance, sur l’incapacité de nommer adéquatement la folie ; il s’agit d’un court récit de dix-sept scènes encadrées par un prologue et un épilogue où l’écriture d’un traumatisme se vit comme une histoire d’amour. L’essai intitulé “Je est des autres.” De l’esthétique borderline chez Marie-Sissi Labrèche décrit la genèse d’une esthétique « borderline ». Dans une approche à la fois psychanalytique et narratologique, fondée sur les concepts de la mélancolie, du kitsch et de la crypte, l’analyse tente de montrer quel type de construction thématique et formelle soutient cette esthétique. À partir d’éléments représentatifs de l’univers de Marie-Sissi Labrèche (la question de la limite, la pulsion de mort, le rapport au corps et l’instabilité), l’essai s’intéresse à la façon dont la narratrice de Borderline (2000) donne à lire une identité sédimentaire, un autoportrait masqué-fêlé, où « Je est [des] autre[s] ». En regard de ces éléments, l’hypothèse d’une machine textuelle fonctionnant – thématiquement et formellement – dans et par l’instabilité et l’altérité oriente la réflexion vers l’idée d’une écriture du trauma qui pourrait représenter une tentative de réappropriation identitaire passant par l’esthétique dite « borderline ». / In Creep show, the narrator presents his creeps – some family members who are schizophrenics and inadequately appointed – and revives them by its words. By remembering certain moments when the insanity showed itself to him, he wants to dig up the buried and make them speak by lending them his writing. In a split narrative, which could evoke a collection of portraits in movement, the protagonists are presented as monsters, dreamers or sources of inspiration according to the narrator who literally dives back into the past. Presenting mental illness as the shame and the fear of the words, Creep show is a novel about silence and about the importance to understand adequately the insanity; it is a short narrative of seventeen scenes where the writing of a traumatism is experienced as a love story. The essay entitled “Je est des autres.” De l’esthétique borderline chez Marie-Sissi Labrèche describes the genesis of a “borderline” aesthetic. In a psychoanalytical and narratological approach established on the concepts of the melancholy, the kitsch and the crypt, the analysis tries to show which type of thematic and formal construction supports this aesthetic. With representative elements of the universe of Marie-Sissi Labrèche (the question of the limit, the death drive, the body obsession and the instability), the essay is interested in the way the narrator of Borderline ( 2000 ) offers a reading of the sedimentary identity and a misleading self-portrait. According to these elements of reflection, the hypothesis of a textual machine working in and by the instability (and the otherness) leads the analysis to the idea that writing the trauma could represent an attempt at reclaiming identity through the aesthetic called “borderline”.

La représentation que se font les patients souffrant d’un trouble de personnalité limite (TPL) de leur expérience de tristesse est un domaine de recherche important tant pour la conceptualisation du trouble que pour son traitement. Ces patients sont connus pour vivre une grande détresse qui se manifeste à travers divers symptômes (Bland, Williams, Scharer, & Manning, 2004). Un nombre élevé de patients présentant un TPL se suicident (Paris, 2002), font au moins une tentative de suicide au cours de leur vie (Oldham, 2006) et s’automutilent (p.ex., Brown, Williams, & Collins, 2007). La recherche sur la souffrance du TPL s’entend sur un paradoxe : ces patients souffrent beaucoup, mais ils vivent peu de tristesse. Leur souffrance prend une forme distincte en qualité, celle-ci demandant à être davantage étudiée empiriquement et théoriquement. L’objectif de cette thèse est d’explorer la représentation de la tristesse de participants souffrant d’un TPL. Alors qu’à notre connaissance aucune étude n’a encore poursuivi cet objectif spécifique, différentes pistes de réflexion ont été soulevées dans la documentation scientifique pour expliquer la nature de la souffrance du TPL en ce qui a trait au tempérament, au fonctionnement mental, à la dépression, à l’organisation de la personnalité et aux événements traumatiques. La première étude de cette thèse vise à réfléchir théoriquement et cliniquement à la tristesse, afin d’en raffiner la définition, entre autres par opposition à la détresse. Elle propose une distinction tant au plan métapsychologique que phénoménologique de ces deux expériences, en se basant sur des théories évolutionnistes des émotions et sur différentes conceptions psychanalytiques du fonctionnement mental et des relations objectales. Une vignette clinique illustre cette réflexion. La seconde étude vise à explorer, par une démarche qualitative, les principaux thèmes abordés par des participants souffrant d’un TPL lorsqu’ils racontent des épisodes de tristesse. Sept participants avec un diagnostic de TPL évalué à l’aide du SCID-II (First, Gibbon, Spitzer, & Williams, 1997) ont participé à une entrevue semi-dirigée visant le rappel de deux épisodes relationnels de tristesse. Suivant la méthode d’analyse phénoménologique interprétative (Smith, 1996), une analyse thématique de quatorze épisodes de tristesse a été effectuée conjointement par deux candidates au doctorat pour décrire la représentation de la tristesse de ces participants. Cinq thèmes ont été identifiés : 1) agression, 2) relation brisée par l’autre, 3) affectivité négative indifférenciée, 4) soi défectueux et 5) débordement. Les résultats suggèrent que la représentation de la tristesse du TPL n’est pas associée à la perte, mais plutôt à l’impression d’avoir été endommagé par une attaque infligée par quelqu’un d’autre. Il s’agit d’une expérience peu mentalisée que l’individu semble tenter de réguler dans la sphère interpersonnelle. Cette expérience ne représenterait pas de la tristesse à proprement parler. Les conclusions ont permis d’élaborer une nouvelle hypothèse de recherche : l’expérience de tristesse des patients souffrant d’un TPL ne correspond pas à la tristesse proprement dite, mais à une forme de détresse interpersonnelle impliquant à la fois des déficits du fonctionnement mental et une organisation particulière de la personnalité. Les implications cliniques et théoriques sont discutées. / The exploration of the phenomenology of sadness in patients with Borderline Personality Disorder (BPD) is relevant to the understanding of the pathology and to its treatment. BPD patients tend to experience distress intensely and frequently, and inefficient attempts at regulating this emotional experience is known to be associated with symptoms, such as suicidal or parasuicidal gestures (Bland, Williams, Scharer, & Manning, 2004; Brown, Williams, & Collins, 2007; Oldham, 2006; Paris, 2002). The literature on psychological suffering in BPD reveals an apparent contradiction: these patients experience a large amount of suffering, but they appear to not experience sadness. The nature of their suffering seems to be distinct from sadness, and has yet to be more fully explored empirically and theoretically. The present thesis aims at exploring the phenomenology of sadness in BPD. To our knowledge, no research has specifically attempted to investigate this particular topic, but some etiological pathways for understanding BPD suffering have been explored: temperament, mental functioning, depression, personality organization and traumatic events. The first study proposes a theoretical and clinical investigation of the concept of sadness and defines it in opposition to distress. This distinction between sadness and distress focuses on phenomenological and metapsychological perspectives, and is in line with evolutionary theories of emotion and psychoanalytic formulations on mental functioning and object relationships. A case study illustrates this investigation. The second study aims at exploring the phenomenology of sadness through an investigation of the major themes that BPD participants talk about when they are asked to recall episodes of sadness. Seven individuals with a diagnosis of BPD on the SCID-II (First, Gibbon, Spitzer, & Williams, 1997) participated in a semi-structured interview. Following the Interpretative Phenomenological Analysis principles (Smith, 1996), a thematic analysis of 14 transcripts was performed by two doctoral students in order to outline the representation of sadness of BPD participants. Five themes were found: 1) aggression, 2) relationship broken off by the other, 3) undifferentiated negative affect, 4) self being defective, and 5) overwhelming experience. The results suggest that ‘sadness’ in those episodes is not associated with a representation of loss, but with a state of being ‘damaged’ by the aggression and/or the breaking off of the relationship inflicted by the other. This is a non-mentalized experience that the participants tend to regulate in the interpersonal field. This experience should not be conceptualized as sadness proper. In conclusion, a new hypothesis emerges: the experience of sadness for BPD patients is not really sadness, but a form of interpersonally-focused distress. This emotional experience is characterized by a deficit in mental functioning and by a particular personality organization. Clinical and theoretical implications are discussed.

Neuropsychological deficits may perpetuate the risk and chronicity of psychiatric disorder. Borderline Personality Disorder, characterized by significant suicide risk, intense affect and behavioural dysregulation, is frequently associated with the executive function (EF) deficits of decision making and inhibitory control. However, the role of inhibitory control on decision making remains poorly understood. This study examined the relationships among working memory, cognitive and motor inhibitory control, and IGT decision-making performance in 41 women with BPD and 41 healthy controls. Associations among EF and suicide risk were also explored. Experimental tasks included the Iowa Gambling Task, Digit Span, Stroop and Stop Tasks, and Raven’s Matrices. Only IGT decision-making deficits distinguished BPD subjects from healthy controls. Weaker yet normal range IQ and EFs in BPD women did not explain their disadvantageous IGT performance. Contrary to expectations, IGT deficits in BPD women did not predict any suicidal risk; however, intact interference control was as sensitive to suicidal risk as was depression. Normal interference control was associated with a reduction in suicide risk. While IGT decision making may be a marker for BPD, Stroop interference control is more sensitive to suicide risk and may represent a vulnerability for suicide that exists beyond psychiatric diagnosis.

Syftet med denna studie var att belysa vilka omvårdnadsåtgärder vårdpersonal på en slutenpsykiatrisk avdelning angav vara av betydelse för patienter med emotionellt instabil personlighetsstörning (EIP). Metod För att svara på syftet i denna studie valdes metoden kvalitativ innehållsanalys av halvstrukturerade intervjuer med 6 vårdare som arbetade på slutenpsykiatriskavdelning med speciell inriktning mot vård av personer med EIP. Resultat Genom innehållsanalys av intervjuerna framkom tre teman med tillhörande subteman. Tema 1: Att hantera utåtagerande symptom, subteman: Att hantera splitting, Att hantera ångest, utspel och självskada. Tema 2: Att arbeta tillsammans för att nå omvårdnadsmål, subteman: Enhetligt förhållningssätt, Struktur i omvårdnaden. Tema 3: Att bygga upp en individ, subteman: Att skapa en tillitsfull relation, Att rusta patienten för utskrivning, Tid som en faktor i omvårdnaden, Att vara tillgänglig för patienterna, Självförtroendets del i ökad hälsa, En inre trygghet är en grund för positiv utveckling, Omvårdnaden utförs i ett medmänskligt samspel. Slutsats Som svar på denna studies syfte att belysa vilka omvårdnadsåtgärder vårdpersonalen på en slutenpsykiatrisk avdelning angav vara av betydelse för patienter med emotionellt instabil personlighetsstörning, är svaret de subteman som framkom genom analysen. / The Ame of this study was to investigate what the caregivers of an in-patient ward would say was important for the care of patients diagnosed with borderline personality disorder (BPD). The Method that was used was qualitative content analysis of face-to-face semi structured interviews with six caregivers of an in-patient ward that was specialized in caring for BPD patients. The Result of the content analysis emerged into three themes with subthemes. Theme number one was: To handle symptoms, the subthemes were To handle splitting, To handle acting out behaviors, anguish and self mutilations. Theme number two was: Working together to reach care-giving goals, the subthemes where: Unanimous attitudes, Structured care-giving. Theme number three was: To strengthen a person, the subthemes where: To create trust in the care-relationship , To prepare the patient for the transcription, Recovery takes time, To be available, Incising self-confidence for grater health, An inner confidence as a ground for personal grout. The care is set in an interpersonal relationship. The Conclusion was that the subthemes reflected what was important in the care of patients diagnosed with BPD.