The application of diagnostic thresholds plays an important role in the classification of mental disorders. Despite their importance, many diagnostic thresholds are set arbitrarily, without much empirical support. This paper seeks to introduce and analyze a new empirically based way of setting diagnostic thresholds for a category of mental disorders that has historically had arbitrary thresholds, the personality disorders (PDs). I analyzed data from over 2,000 participants that were part of the Methods to Improve Diagnostic Assessment and Services (MIDAS) database. Results revealed that functional outcome scores, as measured by Global Assessment of Functioning (GAF) scores, could be used to identify diagnostic thresholds and that the optimal thresholds varied somewhat by personality disorder (PD) along the spectrum of latent severity. Using the Item response theory (IRT)-based approach, the optimal threshold along the spectrum of latent severity for the different PDs ranged from θ = 1.50 to 2.25. Effect sizes using the IRT-based approach ranged from .34 to 1.55. These findings suggest that linking diagnostic thresholds to functional outcomes and thereby making them less arbitrary is an achievable goal. This study has introduced a new and uncomplicated way to empirically set diagnostic thresholds while also taking into consideration that items within diagnostic sets may function differently. Although purely an initial demonstration meant only to serve as an example, by using this approach, there exists the potential that diagnostic thresholds for all disorders could one day be set on an empirical basis.

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 Personality Disorder (BPD) has been previously conceptualized as an extreme variant of normal personality traits, captured by continuous indices. A previous study successfully developed and validated a self-report BPD measure, the Minnesota Borderline Personality Disorder Scale (MBPD). I conducted two studies aimed at providing further validation for this measure. Results from Study 1 (clinical sample of substance users) indicated that MBPD exhibited strong positive correlations with measures of convergent validity (self-report and diagnostic measures). Additionally, the MBPD showed similar correlations with external correlates as those of the convergent validity measures, in addition to incremental utility in predicting these external correlates above and beyond negative affect. Third, a Receiver Operating Characteristic (ROC) curve analysis indicated that diagnostic accuracy of the MBPD was excellent for differentiation between BPD and non-BPD individuals. Likewise, Study 2 (non-clinical sample of undergraduate students followed over 6 months) showed strong correlations with an index of convergent validity (self-report measure), similar correlations with external correlates as that of the convergent validity index, and incremental predictive utility. Finally, in this study, the MBPD exhibited high rank-order stability, but significant mean-level and individual-level change over time. These data suggests that these scales are measuring the same latent construct of BPD, providing further evidence for the construct validity of the MBPD.

Syftet med denna studie var att undersöka grundutbildade sjuksköterskors upplevelser av sin kunskap för att bemöta och vårda patienter med borderline personlighetsstörning samt undersöka vilka kunskaper de önskade att grundutbildningen skulle ge. Sju legitimerade sjuksköterskor utan specialisering inom psykiatri som arbetar i Mellansverige deltog i studien. Studien hade en deskriptiv design med kvalitativ ansats. Det insamlade materialet analyserades med kvalitativ innehållsanalys. Studiens huvudresultat visade att sjuksköterskorna tyckte att psykiatriutbildningen gav en bra teoretisk grund men att den inte alltid överensstämmer med praktiken. De saknade fördjupning och några av dem uttryckte att kursen kändes föråldrad. Det fanns en önskan från sjuksköterskorna att förlänga psykiatrikursen samt möjlighet att fördjupa sig inom vissa områden. De upplevde att psykiatrikursen inte förberett dem tillräckligt för att bemöta och vårda patienter med borderline personlighetsstörning och då patienter med personlighetsstörning utgör en stor patientgrupp är det viktigt att de finns med i utbildningen. Sjuksköterskorna tyckte att det borde vara obligatoriskt att ha verksamhetsförlagd utbildning i sjuksköterskeutbildningen då det var den som förberett dem bäst inför att arbeta med psykiskt sjuka. Slutsatsen av denna studie var att den nuvarande psykiatrikursen inte är tillräcklig vid bemötandet av patienter med borderline personlighetsstörning. / The aim of this study was to investigate the basic trained nurses’ perceptions of their knowledge to respond to and care for patients with borderline personality disorder and explore what skills they wanted the undergraduate education to provide. Seven registered nurses without specialization in psychiatry and working in central Sweden participated in the study. The study had a descriptive design with qualitative approach. The collected material was analyzed by qualitative content analysis. The main result of the study revealed that the nurses felt that psychiatric training provided a good theoretical basis but that it does not always match reality. It lacked depth and some of them expressed that the course was outdated. There was a desire from the nurses to extend the psychiatry course and the opportunity to immerse themselves in certain areas. They felt that the psychiatry course did not prepare them adequately to face and care for patients with borderline personality disorder and because patients with personality disorders are a large patient population, it is important that they are represented in the education. The nurses thought there should be mandatory to have clinical training in nursing as it was the one who prepared them better for working with the mentally ill. The conclusion of this study was that the psychiatry course is not sufficient for treatment of patients with borderline personality disorder.

Awareness due to increase crime has highlighted the occurrence of immense personal and social problems. Problems resulting from disorders such as Schizophrenia, Alzheimer's and Dissociative Identity Disorder (DID) are less common but have a profound impact on all of us. Research has shown that 97% of people with severe abuse and life trauma before the age of nine, develop DID. The objective of this study was to investigate (from the perspectives of therapists) the experience of people diagnosed with Dissociative Identity Disorder (DID) in the workplace. A qualitative research design was used to capture the essence of the individual's experience thereby enabling the researcher to develop an understanding from the participant's point of view. In this study seven therapists were interviewed and each completed a questionnaire. This was the basis used to demonstrate the typical behaviour of DID in the workplace. The results indicated that DIDs cope to a certain extent but tend to switch (switching) personalities when exposed to trauma, stress or events that triggers past life trauma. Defense mechanisms and switching can have a negative influence on the organisation and its employees, but most of all on the DID. If professional treatment is available, the condition can be fully cured. Most patients treated were female, averaged 29 years of age, were single, and had experienced some kind of abuse. Patients experienced problems directly related to DID, such as lack of concentration, attention deficiency and memory loss, depression, migraine and constant headaches. Their behaviour is inconsistent and unpredictable, and they experience relationship problems. Results show that DIDs can hold relatively senior positions but tend to change jobs on a regular basis. Although this condition can be differentiated from other Psychological conditions, most DIDs have previously been misdiagnosed. A Psychological-based paradigm is mostly used to diagnose the condition. Recommendations to the organisation (especially to the HR department) and recommendations for future research were made. / Thesis (M.Com. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2004.

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.

No description available.

Anger rumination, or persistently dwelling on feelings of anger, is associated with borderline personality disorder (BPD) and related features, such as aggressive behavior and cognitive distortions. To develop more effective treatments, it is crucial to understand why individuals with BPD engage in anger rumination despite its negative outcomes. The activation of energy associated with anger, as well as feelings of justification and validation, may be experienced in the short-term as rewarding. This may prevent individuals with BPD from attempting to reduce their rumination. Functional magnetic resonance imaging (fMRI) and behavioral methods were utilized to examine this theory in a sample of women diagnosed with BPD (n=13) and healthy controls (n=15). In an initial session, all participants were an administered a diagnostic interview for BPD, as well a series of self-report measures. In a second session, all participants completed an essay-writing task prior to the fMRI scan. All participants were provided with identical, highly critical feedback about their essays from a supposed essay evaluator. In response to this interpersonal provocation, participants with BPD demonstrated higher activation in brain regions associated with self-conscious reactivity to errors (insula, ventrolateral prefrontal cortex). Subsequent directed provocation-focused thought, compared to neutral-focused thought, produced greater activation in regions previously associated with anger rumination (dorsomedial prefrontal cortex, lateral orbitofrontal cortex) across groups. As hypothesized, anger rumination, relative to neutral-focused thought, produced greater activation in brain regions associated with reward and pleasure (nucleus accumbens) for the BPD group only. No significant differences were observed for self-focused thought. Following the directed rumination task, participants completed a competitive reaction time task that provides an opportunity for participants to act aggressively, supposedly against their essay evaluator. The BPD group demonstrated significantly higher levels of aggressive behavior; however, no significant group differences emerged in neural functioning during the task. These findings suggest that anger rumination may be positively reinforcing for individuals with BPD, which has implications for treatment approaches.

Very little research has examined the role of personality in important life outcomes and support needs of adults with intellectual disabilities. This exploratory study includes a sample of 102 community-dwelling adults with intellectual and developmental disabilities, and begins to evaluate the relative contributions of general personality and personality disorder as it they concern their adaptive functioning, Axis I psychopathology symptoms, and residential and vocational supports. Observer ratings of personality disorder and Five Factor Model and Reiss Profile general personality functioning were obtained from direct service providers who knew the participants well, and archival file data (e.g., IQ, adaptive functioning scores, medications prescribed, and diagnoses) were collected after informed consent and assent were obtained from the participants. The results suggest that both personality and personality disorder, relate the intensity of supports required, the number of psychiatric medications prescribed, maladaptive behavior, and the amount of Axis I psychopathology exhibited by the participants. Results of the study are discussed with reference to implications for service delivery and planning and future research.

The current study provides convergent, discriminant, and incremental validity data for a measure of schizotypia from the perspective of the Five-Factor Model (FFM) of general personality structure. Nine schizotypia facet scales were constructed as maladaptive variants of respective facets of the FFM (e.g., Aberrant Ideas as a maladaptive variant of FFM Openness to Ideas). On the basis of data from 143 undergraduates the convergent validity of these nine facet scales was tested with respect to 11 established measures of schizotypia and the respective facets of the FFM. Discriminant validity was tested with respect to other personality disorders and facets from other FFM domains. Incremental validity was tested with respect to the ability of the FFM schizotypia facet scales to account for variance in two established measures of schizotypia, after variance accounted for by respective FFM facets and other established measures of schizotypia were first removed. The findings support the validity of these new facet scales as measures of schizotypia and as maladaptive variants of the FFM.