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

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

Introduction : Le trouble de personnalité limite (TPL) entraîne des conséquences majeures sur le quotidien des personnes qui sont affectées par celui-ci. Une évaluation rigoureuse et fiable du fonctionnement au quotidien des personnes ayant un TPL est essentielle afin d’orienter adéquatement les services de réadaptation. Objectifs : Les objectifs de cette thèse sont de : 1) concevoir un outil de mesure du fonctionnement des personnes ayant un TPL ; 2) valider cet outil de mesure, en vérifiant sa cohérence interne, sa fidélité test-retest et sa validité de construit convergente. Méthode : La conception des dimensions du questionnaire et des échelles de mesure a été faite par une recension des écrits et des consultations auprès de 42 experts (personnes avec un TPL, cliniciens et chercheurs) à l’aide de différentes méthodes (groupes de discussion, méthode d’enquête Delphi). Un prétest qualitatif a été réalisé auprès de huit personnes présentant un TPL. Pour la fidélité test-retest, le nouveau questionnaire a été administré à deux reprises (intervalle de deux semaines), auprès de 36 adultes ayant un TPL. La validité de construit convergente a été obtenue en comparant les scores issus du questionnaire à ceux du World Health Organisation Disability Assessment Schedule (WHODAS 2.0) et de l’Échelle d’évaluation globale du fonctionnement (EGF). Résultats : Le questionnaire autoadministré FAB (Fonctionnement Au quotidien pour le trouble de personnalité Borderline) comporte 38 items divisés en quatre domaines : les activités de base au quotidien, les activités dans la collectivité, les dimensions de l’environnement social et les dimensions internes de la personne. Chaque item est évalué selon deux échelles de cotation : 1) le mode de fonctionnement de la personne et 2) le degré de difficulté perçue. La cohérence interne du FAB est élevée (alpha de Cronbach = 0,88 pour l’échelle 1 et 0,82 pour l’échelle 2). Le FAB montre une fidélité test-retest de très bonne à excellente pour l’échelle 1 (ICC=0,92, IC 95% : 0,85-0,96) et pour l’échelle 2 (ICC=0,87, IC 95% : 0,75-0,93). Les deux échelles de cotation sont modérément corrélées à l’EGF (r=0,48; p=0,003 pour l’échelle 1 et r=0,41; p=0,013, pour l’échelle 2, respectivement) et sont fortement corrélées au WHODAS 2.0 (r=-0,70; p<0,001 pour les deux échelles). Conclusion : Le FAB est un nouveau questionnaire prometteur portant sur des dimensions fonctionnelles touchées par le TPL. Il pourra être un levier de discussion entre les personnes ayant un TPL et les cliniciens pour identifier les cibles prioritaires de changement dans leur fonctionnement quotidien. / Abstract: Introduction: Borderline Personality Disorder (BPD) has a major impact on the daily lives of people affected by it. A rigorous and reliable assessment of the day-to-day functioning of people with BPD is essential to adequately guide rehabilitation services. Objectives: The main objectives of this project are to: 1) to design a tool for measuring the functioning of people with BPD; 2) validate this new measurement tool by verifying its internal consistency, test-retest reliability and convergent construct validity with tools measuring functioning. Methods: The development of the dimensions of the questionnaire and the measurement scale was done through a literature review and consultations with 42 experts (persons with BPD, clinicians and researchers) through various methods (focus groups, Delphi survey). A qualitative pre-test was carried out with eight persons with BPD in order to verify the intelligibility of the questionnaire. For test-retest reliability, the new questionnaire was administered twice, with a two-week interval, to 36 adults with BPD. The convergent construct validity was obtained by comparing the scores from the 36 participants with those obtained from the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the Global Functioning Assessment Scale (GAF), a tool completed by a psychiatrist. Results: The FAB self-administered questionnaire consists of 38 items divided into four areas: basic day-to-day activities, community-based activities, dimensions of the social environment, and internal dimensions of the person. Each item is assessed according to two rating scales: 1) the person's mode of functioning and its impact on health and well-being; 2) the degree of difficulty perceived. The FAB’s internal consistency was high (Cronbach’s alpha of 0.88 for scale 1 and 0.82 for scale 2). The FAB demonstrated very good to excellent test-retest reliability (ICC=0.92, 95% CI: 0.85-0.96). Both scales were moderately correlated with the GAF (r=0.48, p=0.003 and r=0.41, p=0.013) and strongly correlated with the WHODAS 2.0 (r=-0.70, p<0.001 for both scales). Conclusion: The FAB is a promising new questionnaire addressing functional dimensions affected by BPD. It can serve as a trigger for more in-depth discussion between persons with BPD and clinicians to identify targets for change in their daily functioning.

El Trastorno Límite de personalidad (TLP) es un severo trastorno mental, de gran incidencia en la población clínica, el tratamiento actual es básicamente psicoterapéutico y la relación terapeuta-paciente es fundamental para el desarrollo. El problema principal fue definido como ¿qué actitudes están presentes en los psicólogos y psiquiatras en pacientes sobre el trastorno límite de la personalidad en un hospital psiquiátrico de Lima-Perú?, de la cual no existe antecedentes de investigación de ese tipo en el país. El tipo de investigación es aplicativa con diseño no experimental y transversal y el nivel es descriptivo. El instrumento utilizado es una escala tipo Likert de 33 preguntas, prueba creada para fines de esta investigación. La muestra se eligió aleatoriamente. El tamaño de la muestra se calculó utilizando la fórmula de poblaciones finitas, cuantificándola en 47 participantes. Se evaluó los resultados con el programa estadístico SPSS, usando la formula estadística de Chi2. Un tercio de la muestra considera la conducta manipuladora como síntoma importante para el diagnóstico, sobre todo durante la hospitalización. La mayoría de los profesionales reconoce que la actitud hacia estos pacientes es diferente al de otros pacientes con otros diagnósticos. Las sensaciones de frustración y agotamiento emocional son frecuentes entre los profesionales de la salud mental. Los psicólogos tuvieron mayores cogniciones desfavorables sobre el TLP en comparación con los psiquiatras. / Borderline Personality Disorder (BPD) is a severe mental disorder, high incidence in clinical population, the current treatment is basically psychotherapeutic and therapistpatient relationship is essential for development. The main problem was defined as what are the attitudes of psychology and psychiatrists in patients on borderline personality disorder in a psychiatric hospital in Lima, Peru, in which there is no history of such research in that country. The research is not experimental and applicative with cross-sectional design and the level is descriptive. The instrument used is a Likert scale of 33 questions, a questionnaire created for purposes of this investigation. The sample was chosen randomly. The sample size was calculated using the formula of finite populations, quantifying it in 47 participants. The results with the SPSS statistical program was evaluated using Chi2 statistical formula. A third of the sample considered manipulative behavior as an important symptom for the diagnosis, especially during hospitalization. Most professionals recognize that the attitude towards these patients is different from other patients with other diagnoses. Feelings of frustration and emotional exhaustion are common among professionals. Psychologists were more unfavorable cognitions about the BPD compared with psychiatrists. / Tesis

Personality pathology, especially antisocial personality disorder (ASPD), often occurs in patients with methamphetamine use disorder (MAUD). However, little is known about potential risk factors for this dual diagnosis, and the impact of this comorbidity on both the severity of MAUD and levels of functional impairment. Casting light on such phenomena may aid in early identification of treatment targets, assist in the management of patients in this particular population, and contribute to development of treatment strategies. This crosssectional study described and compared sociodemographic, clinical and childhood trauma correlates in patients with a dual diagnosis of MAUD and ASPD (MAUD+ASPD) and those with MAUD without ASPD (MAUD-ASPD). The contribution of sociodemographic and childhood trauma variables in predicting membership of the MAUD+ASPD group was also investigated. A sample of 62 adult patients with a primary diagnosis of MAUD took part in the study. A sociodemographic questionnaire was completed and well established diagnostic measures of ASPD (The Mini-International Neuropsychiatric Interview; MINI) and MAUD (Structured Clinical Interview; SCID - 5) were used to determine diagnostic status. Illness severity was evaluated with the Yale-Brown Obsessive Compulsive scale (adapted for MAUD) (Y-BOCS-du) and functional impairment was assessed with the Sheehan Disability Scale (SDS). Histories of exposure and severity of childhood trauma (CT) were measured using the CTQ-SF. Of the 62 participants, 14 (23%) had MAUD and had MAUD+ASPD whereas 48 (77%) had MAUD without ASPD (MAUD-ASPD). Bivariate analyses found significant group differences in terms of gender (df =1) = 8.05; p =< 0.01), language (df = 2) = 7.12; p = 0.03), and level of physical neglect (F(1, 60) = 2.33; M = 9.85; SD = 4.23; p = 0.04). The MAUD+ASPD group members were mostly male (N = 9; 64%), English-speaking and with histories of increased physical neglect. Logistic regression suggested that male gender (beta = 1.08; OR = 8.65; p = 0.01) and English language (beta = 1.55; OR = 11.38; p = 0.03) significantly predicted ASPD comorbidity. There were no significant differences in clinical severity or functional impairment between the MAUD+ASPD and MAUD-ASPD groups. In conclusion, this study indicated that male gender and having English as a first language are associated with MAUD+ASPD but other sociodemographic variables, CT histories and clinical severity and impairment were not. Men who use MA are thus more prone to antisocial behaviour, which complicates their substance use condition. Treatment approaches for MAUD may benefit from developing adaptations that cater for challenges specific to comorbid ASPD. Additionally, the finding regarding first language warrants further investigation. Recommendations for future research are suggested.

Childhood and adolescent bullying victimization procures mental health issues and dysfunction. Using a longitudinal design from the McMaster Teen study dataset, a semi-parametric group- based trajectory analysis was used to identify distinct patterns of peer victimization across ages 10 to 18. A three-class solution of peer victimization was selected. Most individuals followed a low decreasing trajectory of peer victimization (71.3%). The next largest group followed a moderate decreasing peer victimization trajectory (25.2%), and the smallest group followed a high stable peer victimization trajectory (3.5%). These trajectory groups were used to predict Borderline Personality Disorder (BPD) symptoms and Post-Traumatic Stress Disorder (PTSD) in emerging adulthood (ages 19 to 22). Results indicated that the high stable and moderate decreasing groups differed from the low decreasing group on BPD symptoms; individuals who were bullied by their peers in childhood and adolescence were more likely to have elevated symptoms of BPD in adulthood. However, when controlling for gender and childhood maltreatment, this differentiation only held true for the high stable group. Results also indicated that children and adolescents who followed a high stable trajectory of bullying victimization were more likely to meet PTSD diagnostic criteria in emerging adulthood than those who followed a low decreasing or moderate decreasing trajectory. The implications of the positive associations of childhood and adolescent bullying victimization on BPD symptoms and PTSD are considered via a group socialization theory lens. High levels of bullying victimization are explained as a form of relational trauma. Results suggest that peer relations are powerful enough to lead to subsequent personality pathology, and implications of these associations are examined through a developmental trauma framework. Understanding the developmental impact of childhood and adolescent bullying on BPD symptoms and PTSD provides insight and supports prevention and intervention initiatives at the school level and in clinical practice.

No description available.

Major depression disorder (MDD) is a complex and chronic disease that ranks fourth as cause of disability worldwide. About 14 million adults in the USA are believed to have MDD, and an estimated 75 % attempt suicide making MDD a major public health problem. Neuroticism has been recognized as an endophenotype of MDD; however, few genome-wide association (GWA) analyses of neuroticism as a quantitative trait have been reported to date. The aim of this study is to identify genome-wide genetic variants affecting neuroticism using a European sample. A linear regression model was used to analyze the association with neuroticism as a continuous trait in the Netherlands Study of Depression and Anxiety and Netherlands Twin Registry population-based sample of 2,748 individuals with Perlegen 600K single nucleotide polymorphisms (SNPs). In addition, the neuroticism-associated genes/loci of the top 20 SNPs (p < 10-4) were examined with anti-social personality disorder (ASPD) in an Australian twin family study. Through GWA analysis, 32 neuroticism-associated SNPs (p < 10-4) were identified. The most significant association was observed with SNP rs4806846 within the TMPRSS9 gene (p = 7.79 × 10-6) at 19p13.3. The next best signal was in GRIN2B gene (rs220549, p = 1.05 × 10-5) at 12p12. In addition, several SNPs within GRIN2B showed borderline associations with ASPD in the Australian sample. In conclusion, these results provide a possible genetic basis for the association with neuroticism. Our findings provide a basis for replication in other populations to elucidate the potential role of these genetic variants in neuroticism and MDD along with a possible relationship between ASPD and neuroticism.