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).

Bakgrund: Borderline personlighetsstörning karaktäriseras av stark impulsivitet, långvariga känslor av tomhet, självskadebeteende och destruktiva relationer. Suicidrisken uppskattas till 8-10%. Orsaken till borderline personlighetsstörning är ej helt känd men studier har visat att barndomstrauma och negativa händelser i livet kan vara en bidragande faktor till insjuknade. Majoriteten, 75%, av de som utvecklar borderline personlighetsstörning är kvinnor. Syfte: Syftet med litteraturstudien var att beskriva kvinnors upplevelser av att leva med borderline personlighetsstörning. Metod: En litteraturstudie genomfördes där kvalitativa och kvantitativa artiklar granskades. Resultat: Författarna hittade ett samband mellan barndomstrauma och kvinnornas upplevelse av låg självkänlsa, skam och identitetsförvirring. Ångest var något som vanligen präglade kvinnornas liv och detta var ofta grunden till självskadebeteende och självmordstankar. Samtidigt som kvinnorna längtade efter närhet och att bli älskade fanns ändå en rädsla för att bli utnyttjade och svikna. I mötet med vårdpersonal upplevde kvinnorna att de ofta inte blev tagna på allvar och kände sig mest till besvär. Slutsats: Kvinnor med borderline personlighetsstörning lever på gränsen mellan liv och död och har ett starkt behov av stabila relationer och omgivningar. För att kunna bemöta dessa kvinnor på rätt sätt krävs det större kunskap om sjukdomen hos vårdpersonal. / Background: Borderline personality disorder is characterized by high impulsivity, long-lasting feelings of emptiness, self-injury and destructive relationships. The disease has a high suicide risk, estimated to 8-10%. The cause of borderline personality disorder is yet unknown, but studies have shown that childhood trauma and negative life events may be a contributing factor to illness. The majority of those who develop borderline personality disorder are women. Aim: The aim of the literature review was to describe women’s experience of living with borderline personality disorder. Method: A literature review was conducted in which qualitative and quantitative articles were examined. Results: The authors found a correlation between childhood trauma and women's experience of low self-esteem, shame, and identity confusion. Anxiety was something that usually characterized the lives of women and this was often the basis for self-harm and suicidal thoughts. While women were longing for closeness and to be loved, there was still a fear of being exploited and betrayed. In the meeting with the nursing staff the women felt they often were not taken seriously and felt mostly a nuisance. Conclusion: Women with borderline personality are living on the edge between life and death and have a strong need for stable relationships and surroundings. To respond to these women correctly it requires more knowledge of the disease among health professionals.

Theories embedded within evolutionary neurobiology offer useful frameworks within which to understand cognitive impairment in schizophrenia (SCZ). The current research invokes the Dual Trends Theory (DTT), an evolutionary model that posits that neural architecture develops along two separate pathways: the dorsal ‘archicortical’ trend and the ventral ‘paleocortical’ trend. Although various lines of research converge to suggest that SCZ is associated with dorsal trend impairment in the context of relative ventral trend sparing, one persistent inconsistency exists. Specifically, individuals with SCZ routinely show impairment on tasks of action inhibition (AI; the ability to inhibit a pre-planned movement), a function routinely shown to be mediated by the inferior frontal gyrus, a key structure of the ventral trend. Here we argue that conventional tasks of AI conflate AI per se with response conflict (CON) demands, a function shown to be mediated by the anterior cingulate cortex, a key structure of the dorsal trend. We define CON as any aspect of a task that increases the difficulty of deciphering or interpreting the meaning of task stimuli (e.g., greater perceptual similarity between imperative task stimuli). The current research administered novel AI tasks in order to independently examine increases in CON and increases in the prepotency to respond to a pre-planned movement (PREP; considered a more fundamental measure of AI). Consistent with study hypotheses, individuals with Schizoprenia-spectrum disorders (specifically schizotypy) failed to show compensatory response time (RT) slowing when confronted with increasing CON demands yet showed proportional RTs, relative to healthy control participants, as PREP demands increased. These findings were interpreted as reflecting impairment in their ability to detect and/or decipher CON. More broadly, these findings suggest that cognitive abnormalities in SCZ may represent disproportionately impaired dorsal trend circuitry.

Syftet med föreliggande systematiska litteraturstudie var att belysa brister i omvårdnaden av patienter med borderline personlighetsstörning (BPS) och vad bristerna beror på. Vid Högskolan Dalarnas fulltextdatabas Elin och PsycInfo söktes vetenskapliga fulltextartiklar som omfattade BPS och omvårdnad. Av 35 artiklar valdes 14 ut varav 9 kvalitativa och 5 kvantitativa. Dessa artiklar kvalitetsprövades med 28 kriterier från granskningsmallar modifierade efter Forsberg och Wengström (2003), Willman, Stoltz och Bahtsevani (2006). Av artiklarna framkom att den viktigaste aspekten i omvårdnaden utgjordes av personalens patientbemötande. Faktorer av betydelse var personalens bristfälliga bemötande, avsaknad av kunskap och empati samt uppfattningen att patienter med BPS är svåra att behandla. Denna studie siktade till att öka omvårdnadspersonalens förståelse för gott bemötande och bibringa en vidare syn på patienter med BPS så att de inte förbises och går förlorade på grund av brister i vården.