Objective Borderline Personality Disorder (BPD) is a common and serious mental illness, associated with severe emotional dysregulation, a high risk of suicide and self-harm. Those with a diagnosis of BPD often display difficulties with social interaction, making daily life problematic, and sufferers can struggle to form and maintain interpersonal relationships. Childhood trauma is believed to contribute to the development of BPD, however the mechanism by which childhood trauma increases risk for specific symptoms of the disorder is not well understood. Here, we investigate the ability of participants with a diagnosis of BPD to make social judgements and recognise emotions from facial stimuli. We also explore the relationship between childhood trauma, brain structure, and brain activation in response to emotional stimuli. Methods Individuals with a diagnosis of borderline personality disorder, as well as matched healthy controls, were recruited to take part in a neuropsychology study of emotion recognition and social judgement from faces. Participants also underwent a magnetic resonance imaging (MRI) scan, during which data was collected for analysis of brain structure, and brain function in response to emotional faces. In addition, all participants completed a structured clinical interview and the Childhood Trauma Questionnaire (CTQ). Results Individuals with a diagnosis of BPD were less well able to correctly identify facial emotions than healthy control participants (p < 0.001), with a particular deficit in the recognition of disgust (p = 0.001). Those with BPD also had difficulty making appropriate social judgements about others from their faces, and between group differences were greatest for judgements of approachability (p = 0.004) and trustworthiness (p = 0.014). Significant correlations were identified between CTQ scores and performance on both tasks in the BPD group. Although no structural brain differences were noted between the BPD group and healthy controls, we found that brain activation correlated to childhood trauma in midbrain, pulvinar and medial frontal gyrus to fearful (versus neutral) faces. There was a significant association between incidence of abuse in childhood and psychotic symptoms in adulthood. In addition, there was a significant correlation between midbrain activation and reported psychotic symptoms in the BPD group, suggesting a potential relationship between childhood trauma, midbrain activity and the development of psychotic symptoms in those with a diagnosis of BPD. Conclusion Abuse in childhood is associated with impaired social and emotional function, as well as increased activation of a network of brain regions in response to emotional stimuli in BPD. Brain abnormalities in BPD appear to be confined to functional activation changes, rather than structural changes, in regions associated with emotional and social information processing. In addition, childhood trauma is correlated with increased psychotic symptoms in adulthood. These results provide striking evidence for the involvement of childhood adversity in the development of symptoms of BPD, and suggest a possible mechanism by which psychotic symptoms may occur.

This research investigated the psychoanalytic idea of containment in the context of NHS staff responses to a person diagnosed with personality disorder. The aim was to identify what, if any, containment was provided by staff for someone diagnosed with personality disorder by recording staff responses to an assessment and analysing the discourse. The research was undertaken with participants selected to represent a cross section of staff in the organisation and included senior and junior, clinical, administrative and managerial staff. The discourse analysis of the interviews examined defences against containment such as splitting, projective identification and idealisation and the positions people occupied in relation to the material and the researcher, as well as looking for examples of containment. Reflexivity was a key part of the methodology, forms a significant part of the thesis and is used to contribute to the discussion. Reflexivity, findings from the review of the literature and the analysis of the interviews form the basis of the discussion and conclusions. The research showed that containment, in its psychoanalytic sense, is often avoided and defended against. Key difficulties with developing the capacity for containment were found to be: conflict between the personal and professional in staff and anxiety in relation to the power of others in the organisation. Suggestions are made for how changes could be made within the organisation and how this could benefit both staff and people who use services. Changing the approach to containment could save costs as some repeat admissions could be avoided and staff satisfaction enhanced. The conclusions from the research make a contribution to clinical practice in NHS settings, to the psychoanalytic theory of containment and to the methodology of psychoanalytic discourse analysis. Recommendations for further research include more psychoanalytic discourse analysis to identify defences in text and research evaluating reflective staff groups.

Antisocial Personality Disorder (ASPD) is understood as a difficult category to work with in various contemporary mental health settings. Additionally, to date, there is a dearth of research on this topic in Counselling Psychology. Therefore, the aim of this study is to explore how Counselling Psychologists (CoPs) and other Psychological Practitioners (PPs) discursively construct ASPD and to investigate any discursive power games that may be implicated in therapeutic practice accounts. Ten semi-structured interviews were conducted and a Foucauldian Discourse Analysis (FDA) was applied to the data. The findings of the analysis produced five distinct therapeutic subject-positions: “Dangerous to Know”, “Damaged Goods”, “The White Collar Psychopath”, “Resisting to Psychiatric Norms” and “Critical Questioning”. Overall this analysis argues that ASPD is a problematic construct as it is produced by these participants as multiple, power laden and opaque. Additionally, these therapeutic subject-positions highlight how ASPD is variously produced in specific therapeutic contexts, such as medium secure units and private practice/ corporate environments. Such findings may contribute to raising awareness among CoPs and other PPs by making visible the power relations and contextual influences implicated in particular ASPD therapeutic accounts. Finally, it is also proposed that this Foucauldian gaze may be applied in other practice areas, to enable critical thinking in relation to potential uses of psychological knowledge, practice and research.

M.A. / The relatively rapid development of biological approaches to various psychological conditions, has prompted clinicians and researchers to investigate Borderline Personality Disorder more thoroughly. Research has evidenced the uniqueness of Borderline Personality Disorder in terms of description, aetiology and treatment. Of the various aetiologies proposed, the neuropsychological deficit approach is one which is still in its infancy and which may have promise for new treatment strategies. Latest developments delineate neuropsychological deficits in the areas of memory, perception and visuospatial ability. These factors are important for psychotherapeutic purposes. The purpose of this study was to further existing knowledge as regards the aetiology of Borderline Personality Disorder in order to initiate new treatment modalities and management strategies. The study examined whether a battery of neuropsychological tests could detect organic dysfunction in the areas of construction, orientation and attention, memory, perception and concept formation and reasoning in twenty inpatients diagnosed according to DSM-IV criteria, with Borderline Personality Disorder. Two control groups were used, one comprising twenty inpatients diagnosed according to DSM-IV criteria with Personality Disorders from Axis II, Clusters A or C; and the other comprising twenty normal volunteers. Neuropsychological functioning assessed, included measures of attention, construction, visual and auditory-verbal memory, perception, and concept-formation and reasoning. Measurement instruments used in this study included the Digit Symbol subtest of the WAIS-R; Rey Complex Figure; Logical Memory subtest of the WMS-R, Gottschaldt Embedded Figures Test; and the Wisconsin Card Sorting Test. (v) Analysis of variance, multivariate analysis of variance and post hoc tests revealed significant deficits in neuropsychological performance among the borderline personality disorder group and the control group of other personality disorders but not the normal volunteer group. Dysfunction was particularly significant in the areas of attention, visuospatial ability, perceptual organization, and ability to maintain cognitive set. These deficits do not appear to have been attributable to attention deficit disorder, attention deficit hyperactivity disorder, temporal lobe epilepsy, head injury, a concurrent Axis I diagnosis such as major depressive disorder, or current drug and/or alcohol abuse. The observed deficits suggest new ways of understanding the development and maintenance of Borderline Personality Disorder, and provide indications for treatment. In conclusion, it is recommended that full use be made of the measurement instruments used in this study as diagnostic aids to enhance the effectiveness of treatment modalities. It is further recommended that research in this topic be repeated and extended using a larger sample and matched controls.

Personality disorder is common amongst individuals accessing mental health services, with research into its aetiology and impact on services increasing in recent years. This thesis has two parts. The first is a systematic review of the neuropsychological functioning among forensic samples with diagnoses of psychopathy and antisocial personality disorder (ASPD). Five databases were searched for cross-sectional studies exploring cognitive functioning in psychopathy and ASPD. Twelve studies were reviewed and indicated that individuals with psychopathy and ASPD demonstrate deficits in executive functions, attention, and memory, and that there are some differences in neuropsychological performance between the two disorders. The second part is an empirical study exploring factors that may influence mental health staff attitudes towards individuals with personality disorder. The study found that staff personality traits, emotion regulation style, empathy and job satisfaction were related to attitudes to personality disorder. Empathy and job burnout predicted attitudes, with higher scores on empathy and lower levels of burnout being related to positive attitudes to personality disorder. Implications for the findings of the systematic review and empirical study are discussed. Further research is required in both areas.

Research output indicates that a very high percentage op people with depressive disorders do not improve after a period of two years. One can thus assume that poor identification of the symptomatology and the factors involved in the etiology and maintenance thereof could lead to a generalised diagnosis and a less successful intervention. Although the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) has explicit criteria for both Dysthymia and Unipolar Major Depression it is sometimes difficult for clinical therapists to distinguish between them because of/due to the symptom similarities. Against this background the question is often asked whether Dysthymia is entitled to an unique diagnostic status. A few international investigations, as well as the preceding study (Smit 1994) have indicated that they are in fact different disorders. Each of these research findings however only focuses on specific areas of these disorders. The main purpose of the present study is however to identify the differences and similarities between the two depressive groups. An in-depth study was done to get an indication of the different comorbid personality and syndrome disorders as well as the unconscious defence mechanisms these patients tend to use. Two hundred and fifty five patients from the TARA, the H. Moross Centre, Weskoppies Hospital and Vista Private Clinic was evaluated. The DSM-IV was used to distinguish between the subjects of the different groups. Thereafter Hamilton's Depression Rating Scale was applied to get an indication whether the chosen patients weren't too little or too seriously depressed, as this could have influenced the results. The patients were then tested with Millon's Clinical Multi-Axial Inventory II to determine their comorbid personality and syndrome disorders. Finally they were assessed with Ihilevich and Gleser's Defence Mechanism Inventory to establish the defence style they usually unconsciously use. The results indicate that both groups tend to have comorbid anxiety and somatoform disorders. The findings also suggested that the Schizoid, Dependent and Borderline personality disorders would be the best indicators/predictors for the diagnosis of Unipolar Major Depression. According to the results the Dysthymic group had significantly higher measures on the Self-Defeating, Schizoid, Schizotypal, Avoidant, Borderline, Paranoid, Somatoform, Dysthymic, Thought Disorder, Major Depressive, Delusional and Aggressive style sub-scales. The best predictors/indicators for the Dysthymic Depressive Disorder are the Anxiety, Drug dependence, Thought Disorder, Major Depression and Somatoform syndrome disorders, the Anti-Social, Self-Defeating, and Schizotypal personality disorders, as well as the Aggressive, Projective, Intellectual, Intrapunitive and Reversal defence mechanisms. The results also indicate that the Dysthymic males had significantly higher measures than the females on 19 of the 27 subscales. The females subjects of the Unipolar Major Depressive group had significantly higher scores than the males on the Dependent and Somatoform sub-scales, while the males of the Major Depressive group had significantly higher scores than the females of this group on the Anti-Social, Aggressive-Sadistic, Alcohol dependence and Drug dependence sub-scales. One can come to the conclusion that the Dysthymic group (especially the males) are much more affected than the Unipolar Major Depressive group. These findings thus support the view that Dysthymia is entitled to a own unique diagnostic status, at least for a South African population. / Dr. A. Burke

Aims. Understandings of recovery in borderline personality disorder are limited. Research has suggested that people with borderline personality disorder may not identify with some general mental health recovery principals. It is also not clear if there are differences in perceptions of recovery between people with borderline personality disorder and staff members. The study set out to explore and understand perceptions of recovery in borderline personality disorder and identify which factors are most important. Design and Method. A Q methodology design was used, incorporating 58 statements on recovery that participants were required to sort, in order of how important they felt they were to recovery. An opportunity sample (N= 22) was recruited, consisting of 6 people with a diagnosis of borderline personality disorder and 16 staff members, from various services within the North West of England. Results. Principal component factor analysis with a varimax rotation revealed three factors, representing distinct viewpoints from 19 participants. The dominant viewpoint placed importance on reducing features and symptoms specific to borderline personality disorder. The second viewpoint was concerned with universal, humanistic recovery principals and the third viewpoint saw relationships, both with the self and with others as most important to recovery. Conclusions. Views on recovery in personality disorder are similar to general mental health recovery principals but there also may be recovery views which are more specific to the borderline personality disorder diagnosis. Areas for further research include the extent to which recovery is a transdiagnostic concept and the extent to which recovery values are influenced by therapy models and service requirements.

Previous research suggests there are a number of variables that are associated with the expression of schizotypal personality disorder (SPD) symptoms. Such variables include childhood trauma, depression and anxiety, substance use, normal-range personality traits, ethnicity, and gender. However, research to date has not examined all of these variables in a single study to determine how they may be interrelated or differentially related to SPD symptom domains. Of particular interest is the association of these variables as explained by the diathesis-stress model. This study utilized a convenience sample of 298 undergraduate students to examine a continuous range of scores for symptoms of SPD and how the interrelation of biological factors such as gender and ethnicity and psychosocial factors and stressors such as childhood trauma and personality traits, specifically neuroticism and extroversion, influence the expression of SPD symptoms. It was predicted that anxiety, depression, stress, and childhood trauma would positively correlate to SPD symptoms. It was also hypothesized that neuroticism and substance use would positively correlate to schizotypal traits and extroversion would be negatively correlated to schizotypal traits as measured by the Schizotypal Personality Questionnaire-Brief. It was further hypothesized that psychosocial stressors would be moderated by the aforementioned biological factors.

Antisocial Personality Disorder (APD) represents a controversial diagnoses which has gone through many revisions over the past 25 years and is scheduled to be revised again for the DSM IV. A comprehensive survey was composed of APD criteria from the DSM II, DSM III, DSM III-R, PCL-R, Psychopathic Personality Disorder, and Dyssocial Personality Disorder. The survey was completed by 321 forensic psychiatrists based on which criteria they believed to be the most prototypical of antisocial personality. The results identified four factors: irresponsibility, unstable self image, and unstable relationships; manipulation and lack of guilt; aggressive behavior; and nonviolent juvenile delinquency. A diagnostic set composed of the most prototypical criteria was proposed for the DSM IV diagnosis of APD.

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