Background: People with Emotional Instable Personality (EIP) have a high comorbidity with other mental disorders and a high suicide rate. Previous research has revealed negative attitudes, in the society, toward people with EIP. They are often seen as manipulative, hard to understand and temperamental. Research has shown that this view also exists among health care professionals, who often have negative attitudes and show less empathy for patients with EIP Aim: The purpose of this study was to identify nursing interventions that can promote the quality of life for people with EIP. Method: Systematic literature review was used as a method. Thirty articles were selected for the study and these were sought in Chinal, PubMed and PsycINFO. Analysis and interpretation was done according to qualitative content analysis. Results: Five main categories were identified: Supporting components of caring; Including the patient in the care; Supportive care; Supporting activities and therapies; Supportive care interventions in inpatient care Conclusions: There is a need for more knowledge and greater understanding of people with EIP, in the society as well as in mental health services, in order to enable attitude changes and reduce the risk of further suffering. It is also important for healthcare professionals  to strive for continuity in the care of people with EIP. Patients should also be involved in their own care. It is also important to take a patient's perspective and respond to patients based on their individual needs.

This essay will analyze the protagonist of Arthur Miller’s, Death of a Salesman, Willy Loman, from a psychoanalytical perspective. The purpose is to establish the reason for his suicide. The thesis is that Willy Loman seems to have developed a narcissistic and borderline personality disorder and as a consequence his mentality was affected and that led him to commit suicide. Willy Loman is a self-centered man who has an obsession with success both as a salesman but also as a husband and a father, in such a way that his mental health is questioned. This suggests that his final decision to commit suicide has been affected by some type of mental disorder that derives from his neuroses. Therefore, Willy Loman’s behavior will be investigated by using Freud’s psychoanalytical theory of neuroses and mental disorders.

Background: During an age of fiscal constraint and increasing pressure to provide timely access to effective, efficient and evidence based care, there is an increased need for research to develop empirically based prevention and intervention strategies for complex psychological difficulties which often present during childhood and adolescence. Child and Adolescent Mental Health Services (CAMHS) are under significant pressure to deliver timely access to services, with demand frequently outstripping capacity to deliver. These challenges have highlighted the need for services to ensure that planning supports continued improvement in quality and delivers the best possible outcomes for service users. Systematic Review: A systematic review of the literature on the efficacy of group based interventions for adolescents with features or a diagnosis of Borderline Personality Disorder (BPD) was conducted. Seven articles met the inclusion criteria and underwent detailed quality analysis. All included studies reported a significant improvement in psychopathology and symptoms of distress as well as an improvement in quality of life for both group based interventions and treatment as usual. Overall, the results hold promise for current work with adolescents with BPD and highlight the importance for future research in this developing area. However, more rigorous research is required to identify the active ingredients of treatments for BPD in adolescents with a view to developing standardised treatment protocols. Empirical Study: A Delphi study was conducted to explore perceptions on the relevance, practicalities, importance and feasibility of implementing nationally agreed CAMHS referral criteria from the perspective of clinicians working in CAMHS in the North of Scotland. In addition, the study aimed to explore and gain consensus on possible factors which support clinicians working in specialist services. A three round electronic Delphi survey, an iterative structured process used to gather information and gain group consensus, was completed by twenty-eight clinicians working in CAMHS. Eight open ended questions in Round 1, were analysed using content analyses resulting in ninety-eight statements to be rated by the same group of clinicians in Round 2 and fifteen statements in Round 3. Of the ninety-eight statements, eighty-four reached consensus. Results indicate that the guidelines are viewed by many clinicians as both acceptable and important, however, implementation of the guidelines can present services with significant challenges and have highlighted the importance of services having the correct infrastructure before it is possible to implement the referral criteria in a consistent and meaningful way.

Made available in DSpace on 2015-03-05T19:35:30Z (GMT). No. of bitstreams: 0 Previous issue date: 7 / Nenhuma / Essa Dissertação de Mestrado em Psicologia Clínica focalizou os vínculos afetivos de adolescentes com indicadores de organização de personalidade borderline com seus pais ou cuidadores primários. Foi realizado um estudo qualitativo, baseado em Estudos de Casos Múltiplos. Buscou-se caracterizar e analisar os vínculos afetivos estabelecidos entre estes adolescentes e seus pais, com base em uma leitura psicanalítica. Este volume inclui o relatório da pesquisa realizada, e dois artigos científicos: um de revisão crítica da literatura, e o outro empírico, com a apresentação e discussão dos resultados do estudo. A partir da análise das entrevistas e instrumentos utilizados, foi possível constatar, como aspectos principais, as fragilidades e inconsistências nos vínculos afetivos e histórias de vida permeadas por vivências e representações de abandono, negligência e falta de investimento emocional por parte das figuras parentais. Aspectos transgeracionais apareceram com destaque nas dinâmicas destas famílias, repercu

Borderline Personlighetstörning är en psykiatrisk diagnos som definieras genom symtom som bristande impulskontroll, relationsproblem och självskadeproblem.Flera av dessa symtom är av den karaktären att de förorsakar beteenden som gör att möjligheten till att ge en god omvårdnad försvåras. Syftet med litteraturstudien var att beskriva sjuksköterskors attityder och upplevelser av att vårda patienter som lider av diagnosen BPS.Resultatet analyserades utifrån Evans (2003) modell. Studien har visat vilka utmaningar sjuksköterskan upplever i mötet med patienter med BPS när det gäller relation och omvårdnad.Sjuksköterskorna beskriver negativa attityder och upplevelser i arbetet med patienter med BPS. . Vidare har det framkommit att sjuksköterskorna har föreställningar om egenskaper av farlighet och manipulation när det gäller patienter med BPS. Ett sätt att hantera de svårigheter som finns i omvårdnadsarbetet med patientgruppen har varit att använda sig av avståndstagande från sjuksköterskornas sida, visar studien. Resultatet pekar även på att sjuksköterskorna anser att patienter med BPS har större ansvar för sitt beteende jämfört med andra patientgrupper.Sjuksköterskorna känner dock professionellt ansvar för patientgruppen och upplever en viss optimism när de gäller denna utmanande patientgrupp.För att kunna ge god omvårdnad till patienter med BPS bör sjuksköterskan ha stöd i sin professionalitet i form av behöver ett sammansvetsat och stödjande team, realistiska och tydliga mål, adekvat utbildning och fortlöpande handledning. / Program: Sjuksköterskeutbildning

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

Doctor of Health Science / The public mental health setting wherein clinicians work with clients diagnosed with borderline personality disorder (BPD) provides a continual challenge for clinicians. For many decades a pervasive therapeutic pessimism has surrounded any discussions of attempts to work with clients with BPD with this population being viewed as ‘too difficult’ and ‘impossible to work with’. This pessimism and the ensuing counter therapeutic responses have been well documented in the psychiatric literature. The development of treatments such as dialectical behaviour therapy (DBT), a cognitive-behavioural therapy, for BPD has provided a basis for therapy for which there is increasing evidence of successful outcomes. Despite this evidence, the pervasive pessimism has been slow to lift. A limited literature explores attempts to positively influence clinician responses to this clientele. Within the public mental health service in which this research is based, DBT is well-established as a therapeutic modality. In the course of providing training, consultation and supervision for parts of this service, anecdotal evidence emerged suggesting that the impact of practising as a DBT therapist was greater than anticipated and DBT may provide a tool for facilitating a positive change in clinician responses. Given that this perception is not described in the literature it was appropriate to begin research in this area employing a qualitative methodology. This research explored the experience and impact upon mental health clinicians in a public mental health service undertaking training in DBT and practicing as DBT therapists. In-depth, semi structured interviews were conducted in July 2005 with clinicians practising as DBT therapists. Data analysis revealed a marked shift in perspective from ‘management to treatment’. Participants described positive professional and personal impacts of training and practising as DBT therapists. An enhanced capacity for self-awareness and ‘living life to the full’ was described by a number of participants. This initial research suggests that the practice of DBT by clinicians can generate a positive shift in both personal and professional identities that translates into a more optimistic and humanistic approach to clients diagnosed with BPD. Such a change may represent a significant challenge to the prevailing mental health discourse and practice

The current study examined attachment and borderline features in a sample of adolescents whose mothers have Borderline Personality Disorder (BPD) (n=28) and normative comparison adolescents (n=29) using self-reports of parental attachment and borderline features. Statistical analyses revealed, with marginal significance, that adolescents of mothers with BPD provided lower ratings of parents as sources of support than comparison adolescents, but no difference for parents as facilitators of independence. However, adolescents of mothers with BPD did provide lower ratings of affective quality of parental attachment relationships. Dichotomous group differences were not found in adolescent borderline features. However, every subscale of maternal borderline features was positively correlated with adolescent affective instability. Additionally, maternal affect instability was related to adolescent negative relationships. Adolescent negative relationships were inversely related to ratings of affective quality of attachment relationships. Adolescent identity problems were negatively related to parents as facilitators of independence. Study findings aid in filling the gap in the minimal existing literature on adolescent offspring of women with BPD and yield clinical relevance in targeting prevention and intervention strategies for this group at risk for borderline features.

Individuals with borderline personality disorder (BPD) experience severe and pervasive disturbances in the development of attachment relationships, identity, and emotion regulation. Given these deficits, mothers diagnosed with BPD are likely to experience significant difficulties in parenting their children. The present study examined the effect of maternal BPD and borderline personality features on emotional availability in interactions between mothers with BPD and their 4- to 7-year-old children. In a low socioeconomic status (SES) sample of n = 35 children of mothers diagnosed with BPD and n = 35 normative comparisons, groups were compared on maternal and child emotional availability, and self-reported maternal borderline personality features were assessed across the sample as a whole. No significant differences in emotional availability were found between groups. Across the sample as whole, however, maternal borderline personality features of affective instability, identity disturbance, negative relationships, and self-harm were significantly correlated with maternal intrusiveness and maternal hostility. Maternal borderline personality features of affective instability and negative relationships were significantly associated with maternal sensitivity, child responsiveness, and child involvement. Results are discussed in terms of putative precursors to BPD and preventive interventions.

Borderline personlighetsstörning (BPS) är en psykiatrisk diagnos som kännetecknas av emotionell instabilitet och problem med relationer. Både anhöriga och vårdpersonal uttrycker svårigheter i kontakten med en person som har BPS. Syftet med denna litteraturstudie är att sammanställa och belysa forskning och självbiografier som beskriver hur personer med BPS upplever sin livsvärld. För denna studie användes en kombination av två metoder, en litteraturstudie av empiriska studier och analys av självbiografier. Fyra teman utgör resultatet: hur de upplever affekter, att leva med känslomässig smärta. Deras syn på relationer, hur de upplever diagnosen som användbar eller inte och hur de upplever vårdkontakt. Resultatet kan tillämpas i klinisk praxis. Genom att se självskadebeteende som en copingstrategi för emotionell smärta kan relationen mellan sjuksköterska och patient underlättas. Att möta patienten med respekt, förståelse och en bekräftande attityd är eftersträvansvärt, likaså att hjälpa patienten att hitta bättre strategier för att hantera emotionell smärta. / Borderline personality disorder (BPS) is a psychiatric diagnosis which is characterized by emotional instability and relation problems. Both family members and health care personnel express difficulties in contact with persons with BPS. The purpose of this literature review is to compile and highlight research and autobiographies that describe how people with BPS perceive their life world. For this study a combination of two methods was used, a literature review of empirical studies and analysis of autobiographies. Four themes shows in the result: how they experience their affects, to live with emotional pain. Their view of relationships, how they experience the diagnosis as helpful or not and their contact with healthcare. The results can be applied to clinical practice by viewing deliberate self harm as a coping strategy for emotional pain and by meeting the patient with respect, understandning and a confirming attitude. Helping the person to find better strategies to handle emotional pain is also a way to apply the results of this study on clinical practice.