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.

Thesis (D.Psyc.(Clin.))--University of Wollongong, 2008. / Typescript. Includes bibliographical references: leaf 70-81.

The term splitting is defined as a process of formation of mental aggregates linked incompatible experiences producing numerous divisions in mental apparatus. Current findings indicate that psychological splitting in schizophrenia is likely specifically presented on a neural level as disrupted organization in neural communication. This disrupted neural communication likely underlies deficits in mental processing described by various neuroscientific concepts such as theories of disturbed connectivity, corollary discharges and dynamic complexity. In this context, a purpose of the theoretical part of the dissertation is to describe basic neuroscience theories that complementarily reflect interrelated processes between mind and brain underlying disturbances of mental integration that likely present a neural representation of the splitting. A purpose of the first part of the empirical research was to examine relationships between psychological process of splitting and disturbed cognitive and affective functions in schizophrenia. A sample of patients with borderline personality disorder (BPD) was used as a control group in this study. Methods: In the clinical study, we have assessed 30 patients with schizophrenia and 35 patients with BPD. The symptoms of splitting were measured using self- reported...

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In this dissertation, the author provides an account of his therapeutic interaction and experience, as an intern clinical psychologist, in working with a patient in psychotherapy who was eventually diagnosed with a “factitious disorder”. This study descriptively addresses how the therapeutic interaction impacted upon the therapist’s thinking of the process both diagnostically and in terms of therapeutic goals. This study consists of a single case, qualitative research design. It concerns the interactions and experiences of the therapist with a specific patient (diagnosed with a factitious disorder) in the context of a multidisciplinary academic hospital setting. The study aims to be predominantly descriptive of this therapy, and as such employs the psychological phenomenological method of Giorgi (1985) in order to provide a specific description of the situated structure of the therapy. As such, this study is able to contribute to the sparse psychological and therapeutic information available on factitious disorders. There are few detailed accounts of actual therapeutic interactions – specifically from a psychological perspective – for patients diagnosed with factitious disorders. The specific description of the situated structure of the therapy is also compared to the available literature on factitious disorders. Although the aim of this study was not evaluative in nature, the author does provide some tentative comments on the aetiology and therapeutic considerations for factitious disorders – with regards to this particular case. The author suggests a strong link to personality and character deficits underlying factitious behaviour. The author further suggests the importance of acknowledging the “sick role”; allowing for “face-saving” strategies; providing consistency (on behalf of the therapist); and the setting of rigid, overt, therapeutic boundaries in the psychotherapeutic treatment of factitious disorders. / Dissertation (MA (Clinical Psychology))--University of Pretoria, 2005. / Psychology / unrestricted

Bakgrund: Borderline personlighetsstörning är en komplex diagnos som även kan medföra ett flertal samsjukligheter så som depression och ångest. Patientgruppen påtalar vikten av respekt, förståelse och bekräftelse i mötet med hälso-och sjukvårdspersonal. Det framkommer även att patienter med borderline personlighetsstörning upplever stigmatisering och diskriminering från olika kontexter i samhället, bland annat från hälso- och sjukvårdspersonal. Syfte: Syftet med litteraturstudien var att belysa hälso- och sjukvårdspersonalens upplevelser och erfarenheter som kan förklara den upplevda stigmatiseringen av patienter med borderline personlighetsstörning. Metod: En allmän litteraturstudie. Resultat: Det identifieras negativa attityder hos hälso- och sjukvårdspersonal i interaktionen med patienter med borderline personlighetsstörning. Det framkommer att det finns en bristande kunskap samt bristande riktlinjer i vårdandet av patientgruppen. Hälso- och sjukvårdspersonal uttrycker också rädsla och oro samt irritation och frustration i vårdrelationen. Slutsats: Hälso- och sjukvårdspersonal och sjuksköterskor i synnerhet påtalar att bristande utbildning och riktlinjer gör det svårt i interaktionen med patienter med borderline personlighetsstörning. Känslor av sårbarhet och rädsla yttrar sig till följd av patienternas manipulativa och uppmärksamhetssökande beteenden. Även irritation och frustration var något personalgruppen upplevde då behandlingsprocessen gick mycket långsamt och i emellanåt stod still. / Background: Borderline personality disorder is a complex diagnosis that can also cause a number of comorbidity´s such as depression and anxiety. The patient group emphasizes the importance of respect, understanding and confirmation in the meeting with health care professionals. It also emerges that patients with borderline personality disorder experience stigmatization and discrimination from different contexts in society, including from healthcare professionals. Objective: The purpose of the literature study was to elucidate the health professionals' experiences that can explain the perceived stigmatizaton of patients with borderline personality disorder. Method: A general literature study. Results: Negative attitudes of health professionals are identified in the interaction with patients with borderline personality disorder. It appears that there is a lack of knowledge and guidelines in the care of the patient group. Healthcare professionals also express fears and anxieties as well as irritation and frustration in the care relationship. Conclusion: Healthcare professionals and nurses in particular argue that lack of education and guidelines make it difficult in the interactions with patients with borderline personality disorder. Feelings of vulnerability and fear commented due patients' manipulative and attention-seeking behaviors. Even irritation and frustration were something personal group experienced when the treatment process went very slow and occasionally stood still.

Bakgrund: Personer med diagnosen borderline personlighetssyndrom (BPS) återkommer ofta i slutenvårdspsykiatrin. Patienterna har problem med emotioner, kognitioner och relationsproblem där särskilt separationsångest skapar oro och konflikter med vårdpersonalen. Vårdpersonal kan ha svårt att bemöta patienter med BPS på grund av patienternas beteende, och det är därför av vikt att utöka kunskapen om hur patienter med BPS upplever den psykiatriska vården. Denna litteraturstudie ämnar sammanställa befintlig kunskap om hur patienter med BPS upplever den psykiatriska vården.  Syfte: Att belysa patienter med borderline personlighetssyndroms upplevelser av bemötande inom psykiatrisk vård.  Metod: En systematisk kvalitativ litteraturstudie utfördes enligt Howell Major och Savin-Badens (2010) metod. Tolv artiklar med högre vetenskaplig kvalitet hittades och analyserades. Resultat: Två huvudteman framkom: Upplevelsen av en stigmatiserande vård och upplevelsen av ett humant bemötande. Resultatet visade på i huvudsak negativa upplevelser av psykiatrisk vård där okunnighet hos personalen, bristande information och bristande kunskap kring diagnosen var framträdande. De positiva upplevelserna speglades i ett bemötande som gav patienterna förståelse, hopp och tillit från en engagerad personal.   Slutsats: Negativa attityder kan påverka vården och stödet för patienter med BPS, därför bör vården för dessa patienter innehålla förståelse, hopp och tillit för att återhämtning skall uppnås. Ansvaret hos sjuksköterskan är att handleda personalgruppen genom svårigheter för att tillgodose omvårdnaden. / Background: People diagnosed with borderline personality disorder (BPD) often return to inpatient psychiatry. Patients have problems with emotions, cognitions and relationship problems where separation anxiety in particular creates anxiety and conflicts with the care staff. Nursing staff may find it difficult to treat patients with BPD due to patients' behaviour, and it is therefore important to expand knowledge about how patients with BPD experience psychiatric care. This literature study aims to compile existing knowledge about how patients with BPD experience psychiatric care. Aim: The aim was to explore patients with borderline personality disorder's experiences of treatment in psychiatric care.  Method: A systematic qualitative literature study was conducted based on the Howell Major and Savin-Baden (2010) method. Twelve scientific articles of higher scientific standard were found and analysed. Results: Two main themes emerged: The experience of a stigmatizing care and the experience of a humane treatment. The included studies showed mainly negative experiences of psychiatric care where ignorance, lack of information and lack of knowledge about the diagnosis among staff were prominent. The positive experiences were reflected in a treatment that gave patients understanding, hope and trust from a committed staff. Conclusion: Negative attitudes can affect care and support of patients with BPS, therefore the care for these patients should include hope and confidence to achieve recovery. The nurse's responsibility is to guide the health care professionals through difficulties, with the aim to provide the best psychiatric nursing care for this patient group.

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 & 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.

Le diagnostic du trouble de personnalité limite (TPL) à l’adolescence est sujet de controverse chez certains chercheurs et cliniciens. Pour plusieurs, les symptômes présentés chez les jeunes ayant un TPL ressemblent au fonctionnement normal à l’adolescence. Le diagnostic est alors retardé à l’âge adulte, décalant la mise en place d’un traitement. L’objectif de cette recension systématique de la littérature est d’examiner les symptômes permettant la différenciation d’une population adolescente avec un TPL de celles ayant un autre diagnostic ou non psychiatrisée. En tout, 17 études sur les 4 789 titres initialement identifiés rencontrent les critères d’inclusion et sont analysées. Cette recension systématique considère plusieurs symptômes diversifiés : troubles internalisés et externalisés, suicide, erreurs de mentalisation, schémas mésadaptés et diagnostics comorbides. Plusieurs symptômes distinguant de façon statistiquement significative les adolescents avec un TPL ont pu être observés en les comparant à trois groupes contrôles : les adolescents non psychiatrisés, ceux avec un autre trouble de personnalité et ceux ayant un autre diagnostic. Finalement, un patron de symptômes a pu également être observé entre les adolescents suicidaires ayant un TPL et ceux sans ce diagnostic. / The diagnosis of borderline personality disorder (BPD) in adolescence is controversial among some researchers and clinicians. For many, the symptoms presented in young people with BPD resemble normal functioning in adolescence. The diagnosis is then delayed in adulthood, postponing the treatment. The aim of this systematic review of the literature is to investigate the symptoms that can differentiate an adolescent population with BPD from one with another diagnosis and/or without any psychiatric issues. In all, 17 studies out of the 4,789 titles initially identified met the inclusion criteria and were analyzed. This systematic review considers diverse symptoms: internalized and externalized disorders, suicide, mentalization errors, maladaptive schemas and comorbid diagnoses. Several symptoms significantly differentiated adolescents with BPD from three control groups teenagers: non-psychiatric, with another personality disorder and with another diagnosis. Finally, a pattern of symptoms could also be observed between suicidal adolescents with BPD and suicidal youth without it.