In 2003, Winter, Watson, Gillman-Smith, Gilbert and Acton criticised the DSM-IV’s psychiatric conceptualisation of BPD, proposing a set of alternative descriptions based on Kelly’s (1955) Personal Construct Psychology (PCP) and diagnostic constructs. According to Winter et al. (2003), PCP offers not only a less “pre-emptive” stance towards BPD but is more clinically useful given its intrinsic implications for treatment. This correlational research study aimed to determine whether BPD symptomatology is associated with these proposed characteristics of construing. In addition, it was hypothesised that those with a belief that BPD was a part of their identity and untreatable would display higher levels of hopelessness. Ten participants with an existing diagnosis of BPD completed the following measures: a) Personal Construct Inventory (PCI; Chambers & O’Day, 1984); b) Millon Clinical Multiaxial Inventory, Third Edition, (MCMI-III, Millon, 1994); and c) Beck Hopelessness Scale (BHS; Beck & Steer, 1988). Participants were also asked to complete a repertory grid and a Likert Scale indicating the extent of their belief that: a) BPD is an intrinsic part of them; and b) BPD is a treatable condition. Two of the participants are presented as case examples. The most significant finding related to the hypothesis that greater BPD symptomatology would be associated with a higher degree of change in self-construction over time (‘slot-rattling’). Contrary to our prediction, similarity of construing of the elements ‘Me Now’ and ‘Me in the Past’ was correlated with greater BPD symptomatology. This may indicate a belief among participants that they are unable to change or may represent Kellian hostility. Construing one’s mother and father similarly to one’s therapist was associated with greater BPD symptomatology, as was construing one’s father and partner similarly, suggesting, as hypothesised, that those diagnosed with BPD tend to construe current relationships in the same terms as early relationships. Pre-emptive construing and poorly elaborated self-construction were also found to be associated with increased BPD symptoms as predicted. Content analyses performed on elicited constructs revealed that emotion regulation is the most salient area for participants. While the majority of participants considered that BPD was a part of their identity, most were uncertain as to whether BPD is treatable although these findings were not significantly correlated with levels of hopelessness. Participants’ feedback about their experiences of being diagnosed with BPD raises important ethical questions. Further hypotheses are generated based on the study findings and suggestions are made for a revision of the way in which psychological distress is conceptualized, with a particular emphasis on the utility of the PCP approach towards BPD. Clinical implications, limitations of the study and possibilities for further research are discussed.

The aim of the present study was to further understand psychological well-being (PWB) and future-directed thinking in individuals with a diagnosis of Borderline Personality Disorder (BPD). A cross-sectional mixed design was used with 24 individuals with a diagnosis of BPD and 24 community participants (Controls). Participants were measured on PWB and a measure of future-directed thinking. Future-thoughts provided by participants were also content analysed, and it was hypothesised the BPD Group would have particularly marked deficits within interpersonal future thoughts. Consistent with previous findings (MacLeod et al., 2004), BPD participants had fewer positive future-directed thoughts compared to Controls, in the absence of any differences in negative future-directed thoughts. The BPD Group had significantly lower PWB scores on all six of the Ryff Psychological Well-being dimensions. The Control Group generated significantly more positive future-directed thoughts related to Relations with Others and Recreational activities, as well as more thoughts related to Having/Raising Children than the BPD Group. The findings extend the understanding of BPD individuals by profiling their well-being and describing in more detail their future-directed thinking.

This study investigated the discharge practice of a Community Mental Health Team (CMHT) by examining records (electronic and file) of clients discharged between April 2005 and March 2006. Out of a total of 211 discharged clients a random sample of 20 clients was selected to examine the extent to which records and reasons for discharge adhere to current CMHT policies and guidelines. In addition, a sample of clients who had been engaged by the CMHT for 6 months or less was compared to a sample of clients who have been engaged for 1 year or longer to establish whether these differed in sociodemographic characteristics, diagnoses and extent of service provision. The majority of clients discharged during the specified period consisted of clients engaged for 6 months or less. The sampling process revealed that a proportion of these included clients seen for one-off assessments or duty calls, indicating that there is room for improvement to clarify referral criteria (e.g. to GPs) and the role of the CMHT. Similarly, the examination of recording practice also revealed room for improvement in the closing of care packages electronically and inclusion of required information in discharge letters. Almost 50% of clients in the sample were discharged following a decline of any further intervention the reasons for which it will be important to investigate in the form of an audit or survey of service user’s views. Clients engaged for 6 months or less and 1 year or longer seemed to differ mostly in terms of employment rates, diagnosis and previous inpatient admission and mental health act sections. The findings are discussed in relation to the limitations of this study, implications for the service and further research.

Bakgrund: I det dagliga arbetet träffar sjuksköterskor ofta på personer med psykisk ohälsa. Borderline personlighetsstörning (BPD) är ett sjukdomstillstånd som karaktäriseras av en instabil självbild, impulsivitet, skiftande stämningsläge och stormiga relationer. Sjuksköterskorna har ett stort ansvar vid mötet med människor med olika behov, där sjuksköterskan ska vara en god lyssnare, ha empati, inge hopp, lugn och tröst. Därför är det viktigt att sjuksköterskorna har en medvetenhet kring sitt eget agerande och bemötande. En persons känslomässiga, beteendemässiga och kognitiva delar ligger som grund till hur en attityd utformas. Syfte: Syftet med denna litteraturstudie var att utifrån ABC-modellen beskriva sjuksköterskornas attityder till patienter med Borderline personlighetsstörning, samt att beskriva de inkluderade artiklars datainsamlingsmetod. Metod: En beskrivande litteraturstudie med deduktiv innehållsanalys, baserad på nio kvantitativa och fem kvalitativa artiklar. Sökningarna har gjorts via databaserna PubMed, Cinahl, PsykINFO och Scopus via Gävle Högskolan. Huvudresultat: Resultatet visar att sjuksköterskor har en övervägande negativ attityd mot patienter med BPD. Sjuksköterskor beskriver BPD patienter som manipulativa, oärliga, farliga, oberäkneliga och svåra att arbeta med. Sjuksköterskorna beskriver hur de distanserat sig och undvikt att vårda dessa patienter i den mån det gått på grund av dessa känslor mot BPD patienter. Sjuksköterskorna visade även lite empati och sympati för patienter med BPD. Sjuksköterskor med en positiv attityd mot BPD patienter beskrev hur de kände sig glada att de lagt ner tid på patienten istället för och ge upp. Metodologiska aspekten i den föreliggande studien utgjordes av nio kvantitativa och fem kvalitativa artiklar. Slutsats: Sjuksköterskor upplever sig ha en negativ attityd gentemot patienter med borderline personlighetsstörning. Sjuksköterskorna anser även att denna patientgrupp manipulativ och energiuttömmande. Vidare beskriver sjuksköterskor hur dom distanserar sig mot dessa patienter på grund av irritation, aggressivitet och utpressning hos patienterna. Genom mer kunskap och utbildning för sjuksköterskor som arbetar med patienter med Borderline personlighetsstörning kan en större förståelse uppnås och för att på ett professionellt sätt hantera sina egna känslor och tankar, när olika trängda situationer uppstår. / Background: In the daily work, nurse often meet people with mental illness. Borderline personality disorder (BPD) is a disease state characterized by an unstable self-image, impulsiveness, mood shifting and stormy relationships. Nurses have a great responsibility whit meeting with those people with different needs, where the nurse should be a good listener, have empathy, inspire hope, peace and consolation. Therefore, it is important that nurses have an awareness of their own actions and treatment. A person's emotional, behavioral and cognitive components are the basis for how an attitude designed. Objective: To describe nurses' attitudes towards people with borderline personality disorder according to the ABC-model and to describe the articles data collection methods. Method: A descriptive literature with a deductive content analysis, based on nine quantitative and five qualitative articles, in which the searches were made through the databases PubMed, CINAHL, and Scopus PsychINFO by Gävle University. Main Results: The results show that nurses have a predominantly negative attitude towards patients with BPD. Nurses describe BPD patients as manipulative, dishonest, dangerous, unpredictable and difficult to work with. The nurses describe how they distanced themselves and avoided caring for these patients as little as possible because of these feelings against BPD patients. The nurses also showed little empathy and sympathy for patients with BPD. Nurses with a positive attitude towards the BPD patients described how they felt satisfied that they spent time with the patient rather than give up on them. Methodological aspects in the present study consisted of nine quantitative and qualitative five articles. Conclusion: Nurses feel they have a negative attitude towards patients with borderline personality disorder. The nurses also consider this patient as manipulative and energy exhaustive. Furthermore, nurses describe how they distance themselves from these patients because of the irritability, aggression and blackmail from these patients. Through knowledge and training a greater understanding is achieved for the nurses who work with patients with borderline personality disorder as well as tools given to professionally manage their own emotions and thoughts, when various difficult situations arise.

Bipolar disorder and borderline personality disorder are common psychiatric diagnoses. One is a mood disorder with a strong genetic basis while the other is a disorder of personality commonly related to abusive experiences in childhood. Despite contrasting aetiologies they can be difficult to differentiate because of overlapping clinical presentations and symptoms. Diagnostic accuracy is important because of their polarised treatment approaches: long term treatment with mood stabilizers for bipolar disorder and psychotherapy for borderline personality disorder. A qualitative study of psychiatrists revealed comprehensive knowledge of the diagnostic criteria however, many expressed the view that diagnostic criteria did not assist diagnostic differentiation. These findings were validated in a large electronic survey of UK psychiatrists. A detailed study of actual diagnostic processes revealed that this scepticism appeared to influence actual practice. Clinicians largely ignored diagnostic criteria but continued to give diagnoses. Age and IQ matched women with bipolar disorder, borderline personality disorder and a healthy control group were compared in a series of cognitive tasks. Borderline personality disorder was associated with a failure to establish and maintain reciprocal cooperation in a game theoretic measure of social exchange. This behavioural change was not seen in euthymic bipolar disorder. Borderline personality disorder was also associated with an insensitivity to reward and losses in a risky decision-making task. Using a simple two-choice reaction task post error slowing was significantly amplified in the borderline group despite overall reaction times and error rates being similar in all three groups. Clinical diagnostic practice as revealed in this study is not adequate to reliably differentiate between bipolar disorder and borderline personality disorder. Laboratory measures of social exchange, decision making and post-error slowing highlight fundamental difficulties in borderline personality disorder not seen in euthymic bipolar disorder. These findings support the differentiation of bipolar disorder from borderline personality disorder and offer translational models for developing and evaluating new treatments for borderline personality disorder.

Thesis (Ph. D.)--University of Missouri-Columbia, 2007. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on December 14. 2007) Vita. Includes bibliographical references.

<p>The aim of this paper was to illuminate the effect of mentalizationbased psychotherapy. The patients in the survey group were interviewed before and after treatment with regard to specific symptoms of borderline personality disorder and symptoms of other personality disorders with the semi structured interviews ZAN-BPD and SCID-II. Open interview questions that were worked up in a qualitative manner were as well put to the patients that had received the treatment program. A focus group interview with the staff working with the concept within the frame of the MBT-team of Psychiatry southwest in Stockholm was also carried out. The result shows on a group level between the pre and post measuring a reduction of specific borderline symptoms like impulsivity and cognitive symptoms. Symptoms referring to relations were stable and affective symptoms increased. All of the nine interviewed patients experienced that they to different extent felt more stable after treatment. That was an impression shared of the MBT team personnel. In the discussion part of the paper the discrepancy of the result that were gained from the two semi structured interviews and the questions put to patients and staff are discussed. Of interest to further research would be to study closer if there are common factors in background and comorbidity for the patients that seamed to have most benefit from treatment.</p>

This study was motivated by encounters with persons with repeated suicidality in clinical psychiatry. Their suicide attempts are frequently regarded as manipulative, and the patients are often labelled a “borderline personality disorder”. They cause frustration and are sometimes met with repellent attitudes among clinicians, but clinical experience as well as research shows that their personal history regularly includes severe childhood trauma and often childhood sexual abuse. The first part of the study was undertaken to investigate the frequency of borderline personality disorder among consecutive persons admitted to hospital after a suicide attempt, the experience of adverse life events among them and the motives for the act. The concept and definition of parasuicide was used as inclusion criterion. During the 10 months of the study 81% of all parasuicide inpatients gave their consent to partake, altogether 64 patients, 41 women and 23 men. Standardized instruments were used for assessment of personality disorders, and self-report questionnaires were used to investigate motives and adverse life events. Seven years later, follow-up interviews were conducted with 51 of these persons, 32 women and 19 men. This second part of the study used qualitative methods in the form of thematic open-ended interviews to allow for the patients’ own descriptions of their suicidality and mental health in the years following the suicide attempt. The role of psychiatry in this process was one of the themes in the interview. Use of psychiatric treatment and support during the follow-up period was investigated through a review of the medical charts recorded at the psychiatric clinic. The quantitative part of the study showed that among the parasuicide patients there was a considerable overrepresentation of borderline personality disorder, and that the frequency of adverse life events was much higher in this subgroup. The motives for the parasuicide did not differ between those with borderline personality disorder and the others. Childhood sexual abuse could be identified as the most important factor influencing suicidality and extent of psychiatric treatment after the index parasuicide. The patients’ own descriptions in the follow-up interview were related to the theoretical perspectives of symbolic interactionism, therapeutic alliance, perception of difference, empowerment and the concept of modernity. In the narratives a picture emerges of a psychiatric health care that carries the potential to offer therapeutic relationships, but often fails in its aims. In therapeutic alliances built on personal relationships, characterized by close and frequent encounters and a focus not only the weaknesses but also the strengths of the patient, there was room for personal development. A reliance on therapeutic method instead of a therapeutic alliance with the patient and a lack of a collaborative perspective in therapeutic work set definite hindrances for the therapeutic process, according to the views of the patients. Regardless of the severity of the life experiences and personality dimensions that had lead to the parasuicide, the core prerequisite for subsequent stabilisation was an orientation towards significant others that saw and supported the potential for change and helped redefine the situation. These significant others were sometimes found in the psychiatric health care services, but were mainly found outside of psychiatry. The conclusions of the study are that there is a close correlation between repeated suicidality, borderline personality disorder, female gender and adverse events such as childhood sexual abuse, and that the repeated suicidality is better explained by adverse events such as childhood sexual abuse than by personality disorder. This background seriously challenges repellent attitudes towards these patients. The narratives of the patients pose definite challenges for the therapeutic community to embrace new ways to find working therapeutic alliances after a parasuicide, possibly based around perspectives of empowerment and mutuality. Identifying the processes that helps the person find “the difference that makes a difference” should be in focus of future psychiatric research and at the heart of psychiatric support and treatment after parasuicide, to enable the patients to find their own strengths and resources and in this way be able to leave it all behind.

The aim of this paper was to illuminate the effect of mentalizationbased psychotherapy. The patients in the survey group were interviewed before and after treatment with regard to specific symptoms of borderline personality disorder and symptoms of other personality disorders with the semi structured interviews ZAN-BPD and SCID-II. Open interview questions that were worked up in a qualitative manner were as well put to the patients that had received the treatment program. A focus group interview with the staff working with the concept within the frame of the MBT-team of Psychiatry southwest in Stockholm was also carried out. The result shows on a group level between the pre and post measuring a reduction of specific borderline symptoms like impulsivity and cognitive symptoms. Symptoms referring to relations were stable and affective symptoms increased. All of the nine interviewed patients experienced that they to different extent felt more stable after treatment. That was an impression shared of the MBT team personnel. In the discussion part of the paper the discrepancy of the result that were gained from the two semi structured interviews and the questions put to patients and staff are discussed. Of interest to further research would be to study closer if there are common factors in background and comorbidity for the patients that seamed to have most benefit from treatment.

No description available.