Objective: To investigate the effectiveness of an adjunctive, community-based, Solution-focused therapy (SFT) group for Borderline Personality Disorder (BPD) in terms of change in clinical symptoms and the subjective experiences of participants. Methods: The study employed a mixed-methods, naturalistic, service-evaluation design in which 9 outpatients with Borderline Personality Disorder (BPD) attended 16-session SFT groups, and were assessed on clinically-relevant outcomes at baseline, 8 sessions and following group completion. Participants provided qualitative information about pre-intervention hopes and were interviewed post-group about their experience of the groups. Repeated-measures ANOVA was used to assess change in clinical symptoms during treatment, and a priori contrasts were conducted to explore significant results. Qualitative data was analysed inductively using semantic-level, thematic analysis as described by Braun and Clarke (2006). Results: Improvements were indicated across all clinical outcomes with the most robust evidence of significant effects for: phobic anxiety; paranoid ideation; psychoticism; interpersonal functioning; and symptom severity. Qualitative analyses indicated that the intervention successfully addressed the hopes of the participants and that they valued: normalisation; acceptance and safety; the opportunity to share and work together; mutual support; an informal and non-directive atmosphere; and assistance with the pursuit of personally meaningful goals. They reported noticing change, progress towards their goals, and a subjective sense that they were coping better and feeling better. Conclusions: The study provides some preliminary evidence for the effectiveness of the intervention and it may represent a more easily-accessible, resource-efficient, less intensive alternative to specialised services. More general implications in relation to approaches to treatment for BPD are discussed.

Background: Individuals with Borderline Personality Disorder [BPD] symptomatology have high rates of self-harm (50-80%). Limited information exists on the most appropriate interventions to prevent recurrent self-harm in this population. Recent reviews on BPD interventions have suggested more research needs to be conducted looking at how individuals experience interventions with the aim of identifying the effective components of interventions. Objectives: The aim of the present study was to examine how individuals with BPD symptomatology experience interventions to prevent self-harm using a qualitative methodology. Methodology: Twelve individuals with BPD symptomatology and past or current self-harm were recruited through therapeutic services, and took part in a semi-structured interview. The interviews were analysed using a grounded theory approach. Findings: The grounded theory identified a core category, an alternative path to self-harm, and two sub-categories, established beliefs and causal factors, and the time course of self-harm. The results were presented using a process model which was indicative of the participants' experiences of interventions. Conclusions: The findings suggest individuals with BPD symptomatology perceive interventions as helping to reduce self-harm when interventions are long-term, consistent, and instant, and the intervention's outcome matches the purpose for the self-harm. The use of interventions appears to be context dependent, specifically being affected by the individual's level of emotional tension, and their cognitive processing during the decision to seek help. For long-term self-harm prevention, multiple interventions are required, and individuals need to be actively maintaining and evaluating these alternative strategies. It is suggested adoption of such a holistic approach could be one avenue for developing collaborative and effective self-harm interventions in clinical practice.

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)

abstract: Those who have borderline personality disorder (BPD), and those who have subclinical levels of BPD features, experience distress and impairment in important life domains, especially in their interpersonal interactions. It is critical to understand the factors that alleviate BPD symptoms in order to help affected individuals lead healthier lives. Rejection sensitivity and sleep disturbance are two factors that may maintain or exacerbate BPD symptoms, yet new research indicates socially supportive relationships are related to symptom remission. While extensive research exists on the interpersonal impairments associated with borderline personality pathology, little research exists on how individuals with BPD or BPD features perceive and experience their social support. The present study examined the relationships between BPD features, perceived social support, sleep quality, and rejection sensitivity in a racially diverse, large sample of primarily college-aged individuals (N = 396). Results indicated that BPD features had a significant positive relationship with self-reported rejection sensitivity and a significant negative relationship with self-reported perceived social support. Additionally, BPD features had a significant positive relationship with sleep disturbance. Sleep disturbance did not moderate the relationship between BPD features and rejection sensitivity as expected; however, the regression of rejection sensitivity on BPD features and sleep disturbance was significant. Finally, sleep disturbance moderated the relationship between BPD features and rejection sensitivity. Results extend and replicate recent research findings on the possible mechanisms that may maintain and alleviate BPD symptoms. Furthermore, the moderating effect of sleep disturbance on perceived social support for those with higher levels of BPD features is unique to this study. / Dissertation/Thesis / Masters Thesis Counseling Psychology 2016

Introduction: Borderline Personality Disorder (BPD) is characterised by deficits in affect and impulse regulation, along with interpersonal difficulties (Lieb et al., 2004). It is thought to develop through a complex relationship between adverse childhood events, such as childhood abuse and genetics. A recent developmental model of BPD and one that is gaining popularity focuses on mentalization. Following their exposition of the mentalizing model of BPD, Bateman and Fonagy developed the Mentalization Based Treatment (MBT) intervention for BPD (Bateman & Fonagy 2006). This intervention includes both group and individual therapy with the focus on the patient’s relationship with the therapist and other members of the group. Promising evidence that MBT interventions are effective for treating symptoms of BPD is beginning to emerge. Methods: First a systematic review examining the prevalence of childhood abuse in BPD patients was conducted. Second, an empirical study of the efficacy of a group-only adaptation of the MBT intervention for BPD, delivered in a routine health service setting. Finally, planned exploratory analyses were conducted in order to ascertain what factors might predict group completion. Results: The results of the systematic review suggested that that emotional abuse (mean prevalence 63%) and emotional neglect (mean prevalence 63.1%) are the most common forms of abuse reported by this population followed by physical neglect (mean prevalence 40.89%) , sexual abuse (mean prevalence 36.9%) and physical abuse (mean prevalence 32.49%). The results of the second study revealed that the HUB is an acceptable treatment to participants, with indicators of treatment efficacy in relation to reducing overall psychiatric symptoms along with specific symptoms including interpersonal sensitivities, depression, phobic anxiety and paranoid ideation. Finally, exploratory analyses suggested that patients who were older and with less histrionic symptoms (as defined by the Personality Disorder Questionnaire-4) were more likely to complete the HUB. Conclusions: These findings demonstrate that a group-only MBT intervention displays promising effectiveness in treating core symptoms of BPD and is acceptable to patients. Further it suggests that group-only MBT interventions are worth continued investigation both into their efficacies and the potential efficiencies associated a group-based intervention.

Clientes com Transtorno de Personalidade Borderline apresentam um alto índice de abandono de terapia. Entender o que ocorre durante as sessões entre terapeuta e cliente com este tipo de transtorno de personalidade pode contribuir para evitar futuros equívocos ou falhas na relação terapêutica, aumentando as chances de continuidade do processo terapêutico e diminuindo a probabilidade de abandono da terapia. O presente estudo teve como objetivo identificar as variáveis que estão relacionadas ao abandono de um caso de Transtorno de Personalidade Borderline. Participou do estudo uma terapeuta de orientação analítico-comportamental, com 12 anos de experiência clínica e uma cliente com 30 anos de idade, casada, sem filhos e com escolaridade superior completo. Um total de 13 sessões foi gravado em áudio, transcrito e categorizado segundo o Sistema Multidimensional para Categorização de Comportamentos da Interação Terapêutica. Foi feita análise sequencial de atraso (Lag sequential analysis). As sessões que compuseram os dados deste estudo foram entre a 9ª e a 22ª sessões, embora a 14ª sessão tenha sido excluída da análise de dados por ter sido uma sessão de casal. Os resultados mostraram que as categorias da terapeuta de maior porcentagem de ocorrência foram Facilitação, Solicitação de Relato e Empatia e as menos frequentes foram, Solicitação de Reflexão\", Aprovação e Recomendação. Reprovação foi a categoria que teve a menor frequência entre as demais categorias da terapeuta. Embora a categoria Interpretação tenha ocorrido em baixa frequência, sua duração foi grande. As categorias de maior porcentagem da cliente foram Relato e Estabelecimento de Relações entre Eventos. E as de menor porcentagem de ocorrência foram: Solicitação, Concordância, Oposição e Melhora. A categoria Metas não ocorreu nenhuma vez. Ao longo das sessões, foi observado um declínio na porcentagem de Estabelecimento de Relações entre Eventos e um aumento em Relato, no que se refere às categorias da cliente. Ao mesmo tempo, foi observada uma diminuição das categorias Empatia, Solicitação de Reflexão e Interpretação da terapeuta. As sequências que mais ocorreram foram Relato\" seguido por Facilitação\" e Facilitação\" seguida por Relato\". O abandono da terapia pareceu estar relacionado a diversos fatores: a) perda de oportunidades de aprovar e solicitar reflexão e interpretar, b) não dar atenção a relatos sobre queixas de doenças, exercendo função de invalidação, c) férias prolongadas da terapeuta e d) não flexibilidade da terapeuta em fazer mais uma sessão domiciliar em um momento de crise, repetindo assim, um comportamento de invalidação / Clients suffering from Borderline Personality Disorder show a high dropout rate in psychotherapy. The understanding of what occurs during the sessions between therapist and client suffering from this type of personality disorder may contribute to prevent future errors and failures, increasing chances of completing the therapeutic process and reducing drop-out probability. The current study had the objective of identifying the variables related to the drop-out in a case of Borderline Personality Disorder. Participated a female behavior-analytic therapist, with 12 years of clinical experience and a female client, 30 years old, married, no children, with a college degree. 13 complete sessions were recorded in video, transcribed and categorized according to the Multidimensional System for Categorization of Behaviors in Therapeutic Interaction. A lag sequential analysis was carried out. Data of this study refer to the 9th through the 22nd sessions, although the 14th session was excluded, since it was a couple session. Outcomes showed that the therapists categories in higher percentages were `Facilitation`, `Request of Report` and `Empathy` and the less frequent percentages were `Request of Reflection`, `Approval` and `Recommendation`. `Disapproval` was the therapists category appearing with lower frequency. Although `Interpretation` occurred in low frequency, it had a long duration. The clients categories with higher percentages were `Report` and `Establishment of Relationship between Events`. The lower percentages of occurrences were: `Request`, `Agreement`, `Opposition` and `Improvement`. The category `Aims` did not occur at any time. Throughout the sessions a decrease in percentage of the client\'s categories `Establishment of Relationship between Events` and an increase in \'Report\' were observed. At the same time a decrease in the therapists categories `Empathy`, `Request for Reflection` and `Interpretation` was noted. Sequences which occurred more frequently were `Report` followed by `Facilitation` and `Facilitation` followed by `Report`. The therapy drop-out seemed to be related to several factors: a) loss of opportunities by the therapist to approve, to request reflection and to interpret; b) lack of attention to reports on complaints of diseases, having an invalidation effect; c) therapists extended vacation and d) therapists refusal to attend an additional home session, in a critical moment, thus repeating the invalidation

Introduction : Le trouble de personnalité limite (TPL) entraîne des conséquences majeures sur le quotidien des personnes qui sont affectées par celui-ci. Une évaluation rigoureuse et fiable du fonctionnement au quotidien des personnes ayant un TPL est essentielle afin d’orienter adéquatement les services de réadaptation. Objectifs : Les objectifs de cette thèse sont de : 1) concevoir un outil de mesure du fonctionnement des personnes ayant un TPL ; 2) valider cet outil de mesure, en vérifiant sa cohérence interne, sa fidélité test-retest et sa validité de construit convergente. Méthode : La conception des dimensions du questionnaire et des échelles de mesure a été faite par une recension des écrits et des consultations auprès de 42 experts (personnes avec un TPL, cliniciens et chercheurs) à l’aide de différentes méthodes (groupes de discussion, méthode d’enquête Delphi). Un prétest qualitatif a été réalisé auprès de huit personnes présentant un TPL. Pour la fidélité test-retest, le nouveau questionnaire a été administré à deux reprises (intervalle de deux semaines), auprès de 36 adultes ayant un TPL. La validité de construit convergente a été obtenue en comparant les scores issus du questionnaire à ceux du World Health Organisation Disability Assessment Schedule (WHODAS 2.0) et de l’Échelle d’évaluation globale du fonctionnement (EGF). Résultats : Le questionnaire autoadministré FAB (Fonctionnement Au quotidien pour le trouble de personnalité Borderline) comporte 38 items divisés en quatre domaines : les activités de base au quotidien, les activités dans la collectivité, les dimensions de l’environnement social et les dimensions internes de la personne. Chaque item est évalué selon deux échelles de cotation : 1) le mode de fonctionnement de la personne et 2) le degré de difficulté perçue. La cohérence interne du FAB est élevée (alpha de Cronbach = 0,88 pour l’échelle 1 et 0,82 pour l’échelle 2). Le FAB montre une fidélité test-retest de très bonne à excellente pour l’échelle 1 (ICC=0,92, IC 95% : 0,85-0,96) et pour l’échelle 2 (ICC=0,87, IC 95% : 0,75-0,93). Les deux échelles de cotation sont modérément corrélées à l’EGF (r=0,48; p=0,003 pour l’échelle 1 et r=0,41; p=0,013, pour l’échelle 2, respectivement) et sont fortement corrélées au WHODAS 2.0 (r=-0,70; p<0,001 pour les deux échelles). Conclusion : Le FAB est un nouveau questionnaire prometteur portant sur des dimensions fonctionnelles touchées par le TPL. Il pourra être un levier de discussion entre les personnes ayant un TPL et les cliniciens pour identifier les cibles prioritaires de changement dans leur fonctionnement quotidien. / Abstract: Introduction: Borderline Personality Disorder (BPD) has a major impact on the daily lives of people affected by it. A rigorous and reliable assessment of the day-to-day functioning of people with BPD is essential to adequately guide rehabilitation services. Objectives: The main objectives of this project are to: 1) to design a tool for measuring the functioning of people with BPD; 2) validate this new measurement tool by verifying its internal consistency, test-retest reliability and convergent construct validity with tools measuring functioning. Methods: The development of the dimensions of the questionnaire and the measurement scale was done through a literature review and consultations with 42 experts (persons with BPD, clinicians and researchers) through various methods (focus groups, Delphi survey). A qualitative pre-test was carried out with eight persons with BPD in order to verify the intelligibility of the questionnaire. For test-retest reliability, the new questionnaire was administered twice, with a two-week interval, to 36 adults with BPD. The convergent construct validity was obtained by comparing the scores from the 36 participants with those obtained from the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the Global Functioning Assessment Scale (GAF), a tool completed by a psychiatrist. Results: The FAB self-administered questionnaire consists of 38 items divided into four areas: basic day-to-day activities, community-based activities, dimensions of the social environment, and internal dimensions of the person. Each item is assessed according to two rating scales: 1) the person's mode of functioning and its impact on health and well-being; 2) the degree of difficulty perceived. The FAB’s internal consistency was high (Cronbach’s alpha of 0.88 for scale 1 and 0.82 for scale 2). The FAB demonstrated very good to excellent test-retest reliability (ICC=0.92, 95% CI: 0.85-0.96). Both scales were moderately correlated with the GAF (r=0.48, p=0.003 and r=0.41, p=0.013) and strongly correlated with the WHODAS 2.0 (r=-0.70, p<0.001 for both scales). Conclusion: The FAB is a promising new questionnaire addressing functional dimensions affected by BPD. It can serve as a trigger for more in-depth discussion between persons with BPD and clinicians to identify targets for change in their daily functioning.

People diagnosed with Borderline Personality Disorder (BPD) have been subjected to stigma and told that their difficulties are untreatable. Although recovery is now understood to be possible for this client group, much controversy exists around whether BPD is, in fact, an illness. The implications of this belief have not yet been explored from the perspective of the client. Furthermore, little research has attempted to deconstruct what constitutes the therapeutic alliance for people diagnosed with BPD and their clinicians from a Personal Construct Psychology (PCP) perspective. The present research study therefore aimed to explore what impacts on the recovery of people diagnosed with BPD. This included investigating the impact of the construct of illness and the therapeutic relationship. The research employed a correlational and non-randomised design, using a cross-sectional approach. The Repertory Grid technique was used among a sample of 20 clients diagnosed with BPD and their clinicians. Relevant questionnaires were also administered to ascertain BPD symptomatology and the perceived quality of the therapeutic relationship. Among findings, a statistically significant correlation is presented for the association between a poor therapeutic relationship and increased BPD symptoms. Evidence (in the form of a borderline significant correlation) is also revealed to suggest that clients diagnosed with BPD construe fewer benefits from psychological therapy when they consider the well-ill construct to be more important (i.e. superordinate). The results provide new information with regard to the treatment of people diagnosed with BPD.

El Trastorno Límite de personalidad (TLP) es un severo trastorno mental, de gran incidencia en la población clínica, el tratamiento actual es básicamente psicoterapéutico y la relación terapeuta-paciente es fundamental para el desarrollo. El problema principal fue definido como ¿qué actitudes están presentes en los psicólogos y psiquiatras en pacientes sobre el trastorno límite de la personalidad en un hospital psiquiátrico de Lima-Perú?, de la cual no existe antecedentes de investigación de ese tipo en el país. El tipo de investigación es aplicativa con diseño no experimental y transversal y el nivel es descriptivo. El instrumento utilizado es una escala tipo Likert de 33 preguntas, prueba creada para fines de esta investigación. La muestra se eligió aleatoriamente. El tamaño de la muestra se calculó utilizando la fórmula de poblaciones finitas, cuantificándola en 47 participantes. Se evaluó los resultados con el programa estadístico SPSS, usando la formula estadística de Chi2. Un tercio de la muestra considera la conducta manipuladora como síntoma importante para el diagnóstico, sobre todo durante la hospitalización. La mayoría de los profesionales reconoce que la actitud hacia estos pacientes es diferente al de otros pacientes con otros diagnósticos. Las sensaciones de frustración y agotamiento emocional son frecuentes entre los profesionales de la salud mental. Los psicólogos tuvieron mayores cogniciones desfavorables sobre el TLP en comparación con los psiquiatras. / Borderline Personality Disorder (BPD) is a severe mental disorder, high incidence in clinical population, the current treatment is basically psychotherapeutic and therapistpatient relationship is essential for development. The main problem was defined as what are the attitudes of psychology and psychiatrists in patients on borderline personality disorder in a psychiatric hospital in Lima, Peru, in which there is no history of such research in that country. The research is not experimental and applicative with cross-sectional design and the level is descriptive. The instrument used is a Likert scale of 33 questions, a questionnaire created for purposes of this investigation. The sample was chosen randomly. The sample size was calculated using the formula of finite populations, quantifying it in 47 participants. The results with the SPSS statistical program was evaluated using Chi2 statistical formula. A third of the sample considered manipulative behavior as an important symptom for the diagnosis, especially during hospitalization. Most professionals recognize that the attitude towards these patients is different from other patients with other diagnoses. Feelings of frustration and emotional exhaustion are common among professionals. Psychologists were more unfavorable cognitions about the BPD compared with psychiatrists. / Tesis

Childhood and adolescent bullying victimization procures mental health issues and dysfunction. Using a longitudinal design from the McMaster Teen study dataset, a semi-parametric group- based trajectory analysis was used to identify distinct patterns of peer victimization across ages 10 to 18. A three-class solution of peer victimization was selected. Most individuals followed a low decreasing trajectory of peer victimization (71.3%). The next largest group followed a moderate decreasing peer victimization trajectory (25.2%), and the smallest group followed a high stable peer victimization trajectory (3.5%). These trajectory groups were used to predict Borderline Personality Disorder (BPD) symptoms and Post-Traumatic Stress Disorder (PTSD) in emerging adulthood (ages 19 to 22). Results indicated that the high stable and moderate decreasing groups differed from the low decreasing group on BPD symptoms; individuals who were bullied by their peers in childhood and adolescence were more likely to have elevated symptoms of BPD in adulthood. However, when controlling for gender and childhood maltreatment, this differentiation only held true for the high stable group. Results also indicated that children and adolescents who followed a high stable trajectory of bullying victimization were more likely to meet PTSD diagnostic criteria in emerging adulthood than those who followed a low decreasing or moderate decreasing trajectory. The implications of the positive associations of childhood and adolescent bullying victimization on BPD symptoms and PTSD are considered via a group socialization theory lens. High levels of bullying victimization are explained as a form of relational trauma. Results suggest that peer relations are powerful enough to lead to subsequent personality pathology, and implications of these associations are examined through a developmental trauma framework. Understanding the developmental impact of childhood and adolescent bullying on BPD symptoms and PTSD provides insight and supports prevention and intervention initiatives at the school level and in clinical practice.