Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: Dept. of Human Genetics. Bibliography: leaves (175)-199. Also available online via the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 211-220). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 211-220). Also available on the Internet.

The principal intention of this study was to explore the heuristic value of the story of the alchemical vessel in understanding borderline conditions and pursuing their psychotherapy. It establishes the pertinence of the case study as a method of exploring the content and process of psychotherapy. The essential nature of story-telling is examined and the hypothesis is made that psychotherapy, borderline conditions, the myth of the alchemical vessel and the case study all reflect instances of story-telling. Towards the end of examining their mutual reflection, and thus heuristic value, elements of Jungian theory, the phenomenology of borderline conditions and case material are examined. Through the examination of certain shared themes which emerge from the story of the alchemical vessel and the material of psychotherapy it is established that there is indeed a metaphoric resonance between the different stories. Furthermore this resonance is useful in that it provides a secure vantage point as well as guidance towards effecting transformation for the client. The validity of the metaphoric resonance is examined and areas of weakness highlighted. Some suggestions are made concerning further research.

Background: The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness has been collecting detailed clinical data since 1996 on a national sample of people who commit homicide, including psychiatric reports prepared for court. From 1996-2006, the Inquiry was notified of 5808 homicides in England and Wales. A diagnosis of personality disorder was made in 16% (406) of cases in psychiatric reports prepared for court. Given prevalence figures of 50-90% for personality disorder in the offender population in general, it seems likely that this is an underestimation in this population. Aims: Estimate the prevalence of personality disorder in a national case series of homicide perpetrators with court reports. Investigate any variables associated with the diagnosis of personality disorder in court reports, and with specific dimensions of personality disorder. Explore potential reasons for the lack of attribution of a personality disorder diagnosis in reports. Method 600 court reports were analysed using the PAS-DOC, a document derived version of the Personality Assessment Schedule. Those with a diagnosis of personality disorder in reports were compared with those without on a number of sociodemographic, clinical, and criminological variables Focus groups and semi structured interviews were conducted with Forensic Psychiatrists with a range of experience to explore attitudes towards personality disorder. Results: The prevalence of personality disorder in this sample was 56.3% (95% CI 52.3% - 60.3%). Perpetrators with previous violent offences and substance misuse were more likely to be diagnosed with personality disorder by report writers. Severe personality disorder was significantly associated with prior convictions for any violent offences and with a stranger as a victim. Complex personality disorder was associated with a family or spouse as a victim, and negatively associated with a stranger as a victim. A number of themes emerged in the focus groups and semi-structured interviews to explain the discrepancy between the identified prevalence of personality disorder and its diagnosis made by report writers. These included issues surrounding classification, comorbid mental illness, ethical issues regarding court, recommendations for verdict and disposal, treatability, service provision, training and stigma. Conclusions: Personality disorder is underdiagnosed in psychiatric reports prepared for court. Reasons for this and the implications from both a clinical and ethical perspective are discussed.

Borderline and schizotypal personality constructs were compared as predictors of dissociation for 971 nonclinical university undergraduates who completed 11 self-report behavior inventories. Structural equation modeling and multiple regression were used to (a) test the hypothesis that the quantitative interaction of borderline and schizotypal constructs would be the strongest predictor of dissociation and (b) evaluate each construct alone as well as their additive effect for prediction of dissociation. The interaction hypothesis was rejected; the quantitative interaction was only a substantively trifling and statistically nonsignificant predictor of dissociation. In a commonality analysis, the additive borderline and schizotypal effect was equivalent to schizotypy alone and marginally larger than the borderline effect alone for the prediction of dissociation. However, all three effects separately were substantial predictors; thus, dissociation is an untenable discriminator for the borderline and schizotypal constructs. Finally, when schizotypy was compared directly to the borderline construct such that the common variance was distributed dependent upon comparative predictive power (i.e., beta weights), schizotypy was greatly superior to the borderline construct for dissociative predictability. Consequently, reconsideration of the existing paradigm that dissociation is more strongly associated with the borderline construct than with schizotypy is warranted. / Department of Psychological Science

Borderline Personality Disorder (BPD) is a serious psychiatric disorder characterised by turbulent interpersonal relationships, impaired self image, impulsivity, and a recurrent pattern of unstable affect which is usually evident by early adulthood. It has a community prevalence rate of two per cent, and approximately nine per cent of people diagnosed with BPD commit suicide. This suggests that BPD has one of the highest lethality rates of all psychiatric disorders. The course of the disorder shows a steady improvement over the course of early adulthood with the majority of cases remitting by middle age. This positive but incomplete long-term recovery is thought to be a naturalistic outcome that is independent of treatment effect. The reported study sought to test selected components of a multidimensional developmental neuropsychological model of executive functioning in BPD. The model proposed that BPD is characterised by impairments to four neuropsychological executive functions. These include working memory, response inhibition, affective-attentional bias, and problem-solving. The model further proposed that impaired executive functioning in BPD occurs as a result of the failure of ‘experience-dependent’ maturation of orbitofrontal structures. These structures are closely associated with the development of the ‘cognitive executive’. The study incorporated a cross-sectional design to analyse data from a BPD group, a Depressed Control Group, and a Medical Control Group. The overall findings of the study returned limited support for the original hypotheses. There was no evidence of deficits in working memory, response-inhibition, or problem-solving. In contrast, the BPD group returned some evidence of deficits in affective-attentional bias. Therefore, the results suggest that executive functioning remains largely intact in BPD. This also suggests that people with BPD have the working memory resources necessary to facilitate abstract cognition, have the capacity to effectively plan and execute future-oriented acts, and are able to perform appropriate problem-solving functions. These problem-solving returns are also particularly significant because a number of the tasks utilised in the study are known to be associated with so-called ‘frontal-executive’ function. These unremarkable findings challenge the view that people with BPD might experience some form of subtle neurological impairment associated with frontal-lobe compromise. The Stroop measure of affective-attentional bias provided the only supportive evidence for the proposed model, and these findings can be accounted for by at least two different explanations. The first suggests that BPD might be characterised by a hypervigilant attentional set. The specific cause of hypervigilance in BPD is unknown, but some candidate factors appear to be the often-reported abuse histories of borderlines, insecure attachment histories, and deficits in parental bonding. The second interpretation suggests that the Stroop findings reflect a form of ‘response conflict’ in which BPD participants experience difficulties overriding tasks that rely on the enunciation of automatic neural routines. As a result of these findings, further research on the role of arousal, priming, hypervigilance, and response-conflict in BPD is required. It is likely that the Stroop findings reflect a basic, ‘hard-wired’ attentional mechanism that consolidates by early adolescence at the latest. As a result, the Stroop findings have implications for both the prevention and treatment of BPD. A number of prevention strategies could be developed to address the attentional issues identified in the present study. These include assisting children to more effectively regulate arousal and affect, and assisting parents to communicate affectively with children in order to enhance self-regulation. The treatment implications suggest that interventions directed at affective-attentional processes are required, and further suggest the need for new pharmacotherapies and psychological treatments to modify dysfunctional attentional process. Affective neuroscience will have an increasingly important role to play in the understanding of BPD, and the next quarter century is likely to witness exciting advances in understanding this most problematic of disorders.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2004. / Also held in print (72 leaves, 30 cm.) in Akoranga Theses Collection (T 616.858520651 CHR)

This research aims to open up for critical discussion the effects of the discourses employed by mental health professionals in relation to the diagnosis of BPO, with a view of questioning the discursive practices available within a South African context. This discussion will situate identified discourses in relation to the subjects and objects to which it refers in an attempt to identify and interrogate dominant discourses which circulate to oppress and discriminate against female 'others' within the mental health setting. This discussion will serve to challenge mainstream, traditional psychology by questioning the utility of deploying these concepts within a South African context as well as the effects this deployment may have. A discourse analytic methodology is employed to identify the constructions of BPO by five mental health professionals working within a government setting. The analysis aims at interrogating the broader role of the identified discourses in supporting institutions, preserving power relations and transmitting ideological practices. Ultimately the aim of the research is to open up for critical debate, through the example of psychology and psychiatry's treatment of BPO; constituted as 'other', the possibility that there may be deleterious consequences for the wholesale acceptance of traditional psychological understandings by mental health professionals working within a South African context. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in