<p> </p><p>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 <em>affekter</em>, att leva med känslomässig smärta. Deras syn på <em>relationer</em>, hur de upplever <em>diagnosen </em>som användbar eller inte och hur de upplever <em>vårdkontakt</em>. 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.</p><p> </p> / <p>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 <em>affects, </em>to live with emotional pain. Their view of <em>relationships</em>, how they experience the <em>diagnosis </em>as helpful or not and their <em>contact with healthcare</em>. 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.</p>

Objective: To investigate the effectiveness of an adjunctive, community-based, Solution-focused therapy (SFT) group for Borderline Personality Disorder (BPD) in terms of change in clinical symptoms and the subjective experiences of participants. Methods: The study employed a mixed-methods, naturalistic, service-evaluation design in which 9 outpatients with Borderline Personality Disorder (BPD) attended 16-session SFT groups, and were assessed on clinically-relevant outcomes at baseline, 8 sessions and following group completion. Participants provided qualitative information about pre-intervention hopes and were interviewed post-group about their experience of the groups. Repeated-measures ANOVA was used to assess change in clinical symptoms during treatment, and a priori contrasts were conducted to explore significant results. Qualitative data was analysed inductively using semantic-level, thematic analysis as described by Braun and Clarke (2006). Results: Improvements were indicated across all clinical outcomes with the most robust evidence of significant effects for: phobic anxiety; paranoid ideation; psychoticism; interpersonal functioning; and symptom severity. Qualitative analyses indicated that the intervention successfully addressed the hopes of the participants and that they valued: normalisation; acceptance and safety; the opportunity to share and work together; mutual support; an informal and non-directive atmosphere; and assistance with the pursuit of personally meaningful goals. They reported noticing change, progress towards their goals, and a subjective sense that they were coping better and feeling better. Conclusions: The study provides some preliminary evidence for the effectiveness of the intervention and it may represent a more easily-accessible, resource-efficient, less intensive alternative to specialised services. More general implications in relation to approaches to treatment for BPD are discussed.

Background: Personality Disorder treatment is a contentious subject in health care. Despite available research concerning the diagnosis itself and also available treatments, there is little research regarding treatment thresholds or defining how treatment decisions can be formulated. This problem has been identified by clinicians, patients, supervisors and specific organisations, particularly linked to recent healthcare changes associated with austerity measures. Research Question: How can mental health care staff use a formulated decision process concerning therapeutic interventions for people with PD, when considering the recent service changes and rationalisation of available treatments? Methods: An Action Research study has been conducted over a four year period, using predominantly qualitative methods including: a hermeneutic literature review (n=144 papers), patient questionnaires (n=15) and Interpretive Phenomenological Analysis (IPA) of clinician and supervisor semi-structured interviews (n=10). Results: Difficulties have been found when making decisions with people who either do not accept their diagnosis and/or do not accept the current evidence-based treatments for personality disorder. Other challenges have been identified regarding the patient/clinician relationship, the level of distress the patient presents with, and also the clinician view concerning the individual, the diagnosis, and the available treatments. The IPA produced five super-ordinate themes related to decision-making regarding treatment choices for people with personality disorder, including: difficulties with boundary management, diagnostic stigma, a focus upon time, metacognitive ability, and the potential for iatrogenic harm. Conclusions: Multiple factors require consideration when examining treatment choices for people with a personality disorder, concerning the patient's individual symptom profile, needs, attitude towards treatments; the clinician's profession, attitudes, opinions, and wellness on the day of the assessment, and also the treatments available within the locality. A diagram has been presented summarising these formulation factors. Recommendations have been made based upon the results, analysis, synthesis and discussion sections, indicating potential practice changes and areas for future research.

Background: Individuals with Borderline Personality Disorder [BPD] symptomatology have high rates of self-harm (50-80%). Limited information exists on the most appropriate interventions to prevent recurrent self-harm in this population. Recent reviews on BPD interventions have suggested more research needs to be conducted looking at how individuals experience interventions with the aim of identifying the effective components of interventions. Objectives: The aim of the present study was to examine how individuals with BPD symptomatology experience interventions to prevent self-harm using a qualitative methodology. Methodology: Twelve individuals with BPD symptomatology and past or current self-harm were recruited through therapeutic services, and took part in a semi-structured interview. The interviews were analysed using a grounded theory approach. Findings: The grounded theory identified a core category, an alternative path to self-harm, and two sub-categories, established beliefs and causal factors, and the time course of self-harm. The results were presented using a process model which was indicative of the participants' experiences of interventions. Conclusions: The findings suggest individuals with BPD symptomatology perceive interventions as helping to reduce self-harm when interventions are long-term, consistent, and instant, and the intervention's outcome matches the purpose for the self-harm. The use of interventions appears to be context dependent, specifically being affected by the individual's level of emotional tension, and their cognitive processing during the decision to seek help. For long-term self-harm prevention, multiple interventions are required, and individuals need to be actively maintaining and evaluating these alternative strategies. It is suggested adoption of such a holistic approach could be one avenue for developing collaborative and effective self-harm interventions in clinical practice.

Borderline Personality Disorder (BPD) is a major health problem and is associated with considerable psychosocial distress and impairment, resulting in a high degree of morbidity and a significant impact on the mental health system. Patients with BPD are difficult to treat clinically, the main issue being engaging the patient and then maintaining the relationship. Patients with BPD constitute 10-20% of psychiatric inpatients, utilise a large amount of mental health resources and have a 10% successful suicide rate. Therefore, it is essential that attention is given to improving effectiveness of treatment approaches for patients with BPD, including engagement. The purpose of the study was to explore and describe the lived world of patients with BPD in order to develop supporting guidelines to improve non-compliance of patients with BPD. The objective of the study was to develop guidelines to improve compliance, which is expected to minimise self-harm risks and improve the quality of the patients’ lives. A qualitative, phenomenological methodology was chosen because it is particularly well suited to study human experiences of health (LoBiondo-Wood & Haber, 2011:141). It is a design that emphasizes discovery through interpreting meaning as opposed to quantification and prediction. Understanding and interpretation of data was thus the hallmark of the research design. This phenomenological study examined human experiences through the descriptions provided by the people involved, i.e. lived experiences. Data collection was done using recorded interviews guided by a semi-structured interview schedule. Memos collected during interviews supplemented the data. Data analysis was hallmarked by constant comparison, contextualisation and description of emerging themes. The main findings, described in three main themes, were the importance of the relationship with the clinician, the overwhelming feelings experienced by the patients and the sense of futility in treatment. These were all linked to the lack of hope the patient felt regarding their clinician, ever being able to manage their continuously oscillating emotions and the purpose of treatment. The findings led to the construction of guidelines to foster initial and continued engagement in treatment with patients with BPD. The guidelines covered issues of clinical practice and management input. / Health Studies / D. Litt. et Phil. (Health Studies)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este trabalho tem como objetivo analisar a estruturação do diagnóstico de Transtorno de Personalidade. Inicialmente, o trabalho percorre o território conceitual com o qual, desde sua origem na passagem do século XVIII para o XIX, a psiquiatria procurou nomear, explicar e compreender as personalidades consideradas anormais. Em seguida promove-se uma discussão acerca das concepções de personalidade, normalidade e patologia que circunscrevem a categoria, orientada a partir do estudo de seus diferentes modelos diagnósticos presentes no DSM-5. Por fim busca-se compreender a relevância atual do diagnóstico de transtorno de personalidade através da análise de alguns exemplos de seu uso em contextos médico, legal e literário. O objetivo é o de entrever o lugar ocupado por esse diagnóstico, especialmente o do tipo Antissocial, no imaginário cultural presente. / This work analyzes the processes through which the diagnosis of personality disorder has been structured. First, it covers the conceptual territory through which, from its origin in the passage of the eighteenth century to the nineteenth, psychiatry sought to name, to explain and to understand the so called abnormal personalities. This first step is followed by comments on the concepts of personality, normality and pathology that take part in the construction of this psychiatric category as it exists today. In order to do this, the structure of different diagnostic models present in the DSM-5 is analyzed. Finally, we seek to understand the current relevance of the diagnosis of personality disorder by taking into consideration examples of its use in medical, legal and literary contexts, in order to shed some light over the place occupied by this diagnosis, especially the anti-social type, in todays cultural landscape.

abstract: Those who have borderline personality disorder (BPD), and those who have subclinical levels of BPD features, experience distress and impairment in important life domains, especially in their interpersonal interactions. It is critical to understand the factors that alleviate BPD symptoms in order to help affected individuals lead healthier lives. Rejection sensitivity and sleep disturbance are two factors that may maintain or exacerbate BPD symptoms, yet new research indicates socially supportive relationships are related to symptom remission. While extensive research exists on the interpersonal impairments associated with borderline personality pathology, little research exists on how individuals with BPD or BPD features perceive and experience their social support. The present study examined the relationships between BPD features, perceived social support, sleep quality, and rejection sensitivity in a racially diverse, large sample of primarily college-aged individuals (N = 396). Results indicated that BPD features had a significant positive relationship with self-reported rejection sensitivity and a significant negative relationship with self-reported perceived social support. Additionally, BPD features had a significant positive relationship with sleep disturbance. Sleep disturbance did not moderate the relationship between BPD features and rejection sensitivity as expected; however, the regression of rejection sensitivity on BPD features and sleep disturbance was significant. Finally, sleep disturbance moderated the relationship between BPD features and rejection sensitivity. Results extend and replicate recent research findings on the possible mechanisms that may maintain and alleviate BPD symptoms. Furthermore, the moderating effect of sleep disturbance on perceived social support for those with higher levels of BPD features is unique to this study. / Dissertation/Thesis / Masters Thesis Counseling Psychology 2016

Introduction: Borderline Personality Disorder (BPD) is characterised by deficits in affect and impulse regulation, along with interpersonal difficulties (Lieb et al., 2004). It is thought to develop through a complex relationship between adverse childhood events, such as childhood abuse and genetics. A recent developmental model of BPD and one that is gaining popularity focuses on mentalization. Following their exposition of the mentalizing model of BPD, Bateman and Fonagy developed the Mentalization Based Treatment (MBT) intervention for BPD (Bateman & Fonagy 2006). This intervention includes both group and individual therapy with the focus on the patient’s relationship with the therapist and other members of the group. Promising evidence that MBT interventions are effective for treating symptoms of BPD is beginning to emerge. Methods: First a systematic review examining the prevalence of childhood abuse in BPD patients was conducted. Second, an empirical study of the efficacy of a group-only adaptation of the MBT intervention for BPD, delivered in a routine health service setting. Finally, planned exploratory analyses were conducted in order to ascertain what factors might predict group completion. Results: The results of the systematic review suggested that that emotional abuse (mean prevalence 63%) and emotional neglect (mean prevalence 63.1%) are the most common forms of abuse reported by this population followed by physical neglect (mean prevalence 40.89%) , sexual abuse (mean prevalence 36.9%) and physical abuse (mean prevalence 32.49%). The results of the second study revealed that the HUB is an acceptable treatment to participants, with indicators of treatment efficacy in relation to reducing overall psychiatric symptoms along with specific symptoms including interpersonal sensitivities, depression, phobic anxiety and paranoid ideation. Finally, exploratory analyses suggested that patients who were older and with less histrionic symptoms (as defined by the Personality Disorder Questionnaire-4) were more likely to complete the HUB. Conclusions: These findings demonstrate that a group-only MBT intervention displays promising effectiveness in treating core symptoms of BPD and is acceptable to patients. Further it suggests that group-only MBT interventions are worth continued investigation both into their efficacies and the potential efficiencies associated a group-based intervention.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este trabalho tem como objetivo analisar a estruturação do diagnóstico de Transtorno de Personalidade. Inicialmente, o trabalho percorre o território conceitual com o qual, desde sua origem na passagem do século XVIII para o XIX, a psiquiatria procurou nomear, explicar e compreender as personalidades consideradas anormais. Em seguida promove-se uma discussão acerca das concepções de personalidade, normalidade e patologia que circunscrevem a categoria, orientada a partir do estudo de seus diferentes modelos diagnósticos presentes no DSM-5. Por fim busca-se compreender a relevância atual do diagnóstico de transtorno de personalidade através da análise de alguns exemplos de seu uso em contextos médico, legal e literário. O objetivo é o de entrever o lugar ocupado por esse diagnóstico, especialmente o do tipo Antissocial, no imaginário cultural presente. / This work analyzes the processes through which the diagnosis of personality disorder has been structured. First, it covers the conceptual territory through which, from its origin in the passage of the eighteenth century to the nineteenth, psychiatry sought to name, to explain and to understand the so called abnormal personalities. This first step is followed by comments on the concepts of personality, normality and pathology that take part in the construction of this psychiatric category as it exists today. In order to do this, the structure of different diagnostic models present in the DSM-5 is analyzed. Finally, we seek to understand the current relevance of the diagnosis of personality disorder by taking into consideration examples of its use in medical, legal and literary contexts, in order to shed some light over the place occupied by this diagnosis, especially the anti-social type, in todays cultural landscape.

Introdução: A literatura aponta um envolvimento cada vez maior de jovens com a delinquência e a criminalidade. Nos últimos anos, as pesquisas com população forense têm buscado estudar a etiologia do comportamento antissocial. Neste contexto a avaliação neuropsicológica tem sido cada vez mais utilizada como recurso para a investigação da correlação entre conduta infracional e déficits cognitivos. Este estudo investigou o desempenho cognitivo de jovens infratores reincidentes e não reincidentes em tarefas relacionadas às funções executivas. Método: 38 jovens infratores com idade média de 18 anos (±0,23) foram divididos em dois grupos: Grupo 1: Infratores Primários (n=17) e Grupo 2: Infratores Reincidentes (n=21). Para a avaliação clínica utilizou-se os seguintes instrumentos: Mini-International Neuropsychiatric Interview (MINI); Psychopathy Checklist Revised (PCL-R) e os testes neuropsicológicos: Semelhanças; Fluência Verbal, Stroop Color Test, Cubos, Vocabulário, Dígitos, Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT) e índice de quociente de inteligência estimado (QI). Resultados: Os grupos foram pareados quanto à idade e escolaridade. O grupo de reincidentes (Grupo 2) mostrou maior pontuação na escala PCL-R (p=0,05) corroborando a tese de que traços de psicopatia são maiores entre infratores reincidentes. Nas provas neuropsicológicas de fluência verbal, TMT, Stroop, WCST, semelhanças e vocabulário, os grupos não se diferenciaram estatisticamente. Já na avaliação da execução de tarefas que exigem planejamento viso-espacial e QI estimado, o grupo 2 apresentou desempenho superior (p <0,01). Por outro lado, o grupo dos primários (grupo 1) apresentou maior eficiência (p=0,04) em tarefas relacionadas à amplitude atencional auditiva. Conclusões: O estudo permitiu identificar que as variáveis neuropsicológicas não são por si só, consistentes para discriminar aspectos cognitivos entre jovens infratores primários e reincidentes / Background: According to the literature, juvenile delinquency is a growing problem in many countries, which has increased researches with forensic population seeking for the etiology of antisocial behavior. In this context, neuropsychological evaluation is usually used as an important tool to investigate the correlation between conduct behavior and cognitive deficits. The present research compared executive functions between recidivist juvenile offenders and non-recidivist ones. Methods: 38 young offenders with 18 years old of average (±0,23) were divided in two groups: Group 1: Primary Offenders (n=17) and Group 2: Recidivist Offenders (n = 21), both evaluated through the following tools: Mini-International Neuropsychiatric Interview (MINI), Psychopathy Checklist Revised(PCL-R) and the neuropsychological tests: similarities, verbal fluency, Stroop Color Test, block design, vocabulary, digit span, Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT) and intelligence coefficient estimated (IQ). Results: The groups were controlled regarding age and scholarship. The recidivist group (group 2) showed higher scores at the PCL-R (p = 0,05) corroborating the theory that psychopathic traits are higher in these offenders. The groups reveal no statistical difference in the following neuropsychological test: verbal fluency, TMT, Stroop, WCST, similarities and vocabulary. However, group 2 presented better ability in activities requiring perceptual organization (p< 0,01), and also had higher estimated IQ (p< 0,02). In the other hand, group 1 performed better in tasks related to auditory sequencing and short-term memory (p=0,04). Conclusion: The results indicate that neuropsychological variables alone are not sufficient to discriminate between recidivist and norecidivist young offenders