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

How can the same object become split when viewed by different groups of observers? What is the relationship between conflict and consensus, and the ritual and the rational? I interrogate these questions through the case of narcissistic personality disorder (NPD) in Germanophone Europe and North America. I interviewed forty-five practitioners from Germany, Austria, Switzerland, the US and Canada. These conversations were semi-structured and ethnographically inflected. I attempted to take the informant’s perspective earnestly and to read any available works by that author in advance of the interview. To gain a sense of how science differed when not immediately concerned with the treatment of patients, I included an assessment specialist and a social-personality psychologist. Non-expert practitioners, who had not published any books or articles on pathological narcissism, were included to test whether theory is solely alluring to the academician or if it holds sway over the psychotherapist on the street. These respondent pools were matched as closely as possible across the two contexts to facilitate comparison. Approximately six psychotherapeutic schools emerged as important amongst my respondents. After a brief introduction to the different psychotherapies, I begin with the native understandings of NPD or pathological narcissism. These definitions and the wide range of narcissistic patients seen pose the puzzle: How can these definitions be so disparate, and all ostensibly be concerned with NPD as a clinical or scientific object? My concern is less oratorical and more earthy: What precisely do practitioners do? Opening with assessment (Ch. 5), we find some common signs. Diagnostic procedures may employ different technological mixes, but ultimately all follow a single pattern. Chapter 6 addresses empathy and the therapeutic alliance. The notion of a minimal medical model underlying all treatment types I encountered was unearthed despite many methods’ active denial of the ‘medical model.’ The patient-practitioner boundary is, however, far from the final frontier. Conceptualisation helps to guide the ways in which clinicians interact with one another, and ultimately the broader science of psychopathology. Chapter 8 addresses the ways in which different classificatory schemes relate to one another, and how this helps to shape the science of narcissism. What ultimately emerges is a story of (1) the minor differences of narcissism and (2) the narcissism of minor differences. The narcissism (2) can be said to obscure the (1) minor differences. Competition is inherent in the process at multiple levels: between models for both students and patients (attention-space), and through scientific exchange and the effort to gain evidence for one’s theory. I suggest that science serves less to find the best description or explanation for pathological narcissism, and more to legitimate one’s conceptualisation. Evidence of this sort gives a theoretical school means to command more financial and attentional resources. Psychotherapeutic technology is, however, path dependent, limiting the distance between any two methods.

The predominant model of general personality structure is arguably the Five Factor Model (FFM), consisting of the five broad domains of neuroticism, extraversion, openness, agreeableness, and conscientiousness. The FFM of personality disorder (FFMPD) has proposed maladaptive variants at both poles of the FFM. The purpose of the current study was to identify a subset of FFMPD scales, utilizing factor analysis, that illustrate, and provide a potential measure of, the bipolarity present in the FFMPD. All of the FFMPD scales were administered to 443 community participants recruited from Amazon Mechanical Turk. Bipolarity was evident in a series of factor analyses of subsets of FFMPD scales, with the exception of openness. The current study also demonstrated that the presence of bipolarity is impaired by a number of concerns, including the presence of non-diametric scales, bloated specific factors, general factor of personality disorder, and occupation of interstitial space.

Psychopathy is not a diagnostic category, however theories of psychopathy have been discussed throughout psychological history. While the construct of psychopathy is associated with important psychological outcomes, there are inconsistencies in the literature with regard to correlates, etiology and treatment. These inconsistencies suggest that there may be several subtypes of psychopathy. This paper discusses the heterogeneity of psychopathy and considers the existence of psychopathic traits in nonclinical populations. Measures of etiology (Behavioral Activation System and Behavioral Inhibition System; Gray, 1985), psychopathy (Levenson's psychopathy measure; Levenson, Keihl, & Fitzpatrick, 1995) and anxiety (State Trait Anxiety Inventory; Speilberger, Gorsuch & Lushene, 1970) were used in Model based cluster analysis to investigate the existence of subtypes analogous to primary and secondary psychopathy in college students. Four clusters emerged with cluster profiles differing in theoretically coherent ways. Two of the clusters were representative of subclinical primary and secondary psychopathy and the other two represented non-psychopathic groups. Research (Buss, 1961, Dodge, 1991) regarding aggression discriminates between two types of aggression: instrumental and hostile. The current study considered whether the subjects in clusters created by psychopathy data differ in terms of the types of aggression used. As expected, the Psychopathic Traits groups used more aggression than the Non-psychopathic Traits groups, and the Primary Psychopathic Traits group used more instrumental aggression than the Secondary Psychopathic Traits group. Overall, these results support the existence of subclinical subtypes of psychopathy that resemble, in meaningful ways, hypothetical clinical variants. The results also suggest that subtyping may have clinical and forensic utility in risk assessment.

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 Personality Disorder (BPD) is one of the more common personality disorder diagnoses observed in psychiatric inpatients and outpatients. Previous studies have found that individuals with BPD may be expected to experience difficulties throughout their lifetimes and they may repeatedly return for psychological treatment. Whereas previous studies have attempted to identify various factors related to relapse in other chronically recurring disorders such as depression, schizophrenia, and substance abuse, studies examining factors associated with relapse in BPD, and personality disorders in general, are absent from the scientific literature. This exploratory study examined whether specific risk and protective factors (dynamic and/or static) identified from the general relapse literature were associated with diagnostic relapse in BPD. Results revealed that variables related to an increased likelihood for BPD relapse included: substance abuse or Major Depressive Disorder, higher Neuroticism, and lower Conscientiousness. In addition, having a steady work or school status after remission was found to protect against a BPD relapse in the presence of various risk factors. Although this study has several limitations, these results provide some of the first insights to the processes of relapse and continued remission in BPD patients. Continued research efforts in this area can help to identify individuals who are at a greater risk for BPD relapse and potentially to design effective relapse-prevention strategies for the treatment of BPD.

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.

Our conceptualization and empirical understanding of the course of depression is beginning to change. This is largely a result of recent epidemiological and clinical data that suggest depression has a chronic course for many individuals. Treatment studies for chronic depression have found that response rates are consistently less robust than in studies of acute, episodic depression. As is such, investigators have begun to examine factors that impede treatment response among these patients. One such factor is the presence of comorbid Axis-II personality disorders. This study examined the moderating effects of Depressive Personality Disorder (DPD) on treatment outcome among 680 outpatients with chronic depression. Results suggest that DPD did not serve as a prognostic indicator of worse outcome after 12 weeks of treatment or at last observation carried forward. This was a secondary analysis of the data presented by Keller and colleagues (Keller, McCullough, Klein, Arnow, Dunner, & Gelenberg, 2000).