Assignment (MA)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: Adherence to medical regimes and the difficulties associated with patient adherence are well documented. Furthermore, non-adherence with prescribed medication is ubiquitous. Regarding HIV, strict adherence to combination highly active antiretroviral therapy regimes is a prerequisite for immunological reconstitution. Certain factors have been identified as predicting non-adherence. However, the role of personality variables on adherence has been neglected, specifically with regards to personality pathology. Moreover, there is a high rate of comorbidity between HIV and Axis II disorders, including BPD. Despite controversy, the DSM-IV-TR identifies nine fundamental criteria required for the diagnosis of BPD to be made. These criteria are considered separately in an attempt to elucidate their potential role on non-adherence. Clinically, it is likely that the criteria interact to create a gestalt effect, further complicating adherence. / AFRIKAANSE OPSOMMING: Patient voldoening ter mediese aanbevele en die probleme geassosier daarmee is goed gedokumenteer. En verder is dit allerdags dat patlente nie met hul voorgeskrewe medikasie voldoen nie. In verband met MIV, streng voldoening tot HAART is a voorvereiste vir immunologiese hersamestelling. Sekere faktore is geidentifiseer wat voldoening en die teenoorgestelde daarvan voorspel. Alhoewel, die rei van persoonlikheid veranderlikes op voldoening is nie in ag geneem nie, spesifiek in verband met persoonlikheid patologie. Bowenal, is daar n hoe frekwensie van komorbiditeit tussen MIV en As II steurings, insluitend BPO. Ten spyte van kontroversie, die OSM-IV-TR identifiseer nege fundementele kriteria, waarvan vyf teenwoordig moet wees vir n diagnose van BPO. Hierdie kriteria word individueel bespreek in n poging om hulle impak op patiente voldoening te illustreer. Klinies is dit heel moontlik dat daar interaksie is tussen die kriteria wat n gestalt effek sal skep, wat voldoening weer verder sal kompliseer.

People with Borderline Personality Disorder (BPD) have a particular difficulty in forming and maintaining close relationships. The Relational Affective Model (Mizen, 2014) proposes that intimate relationships activate claustro-agoraphobic anxieties as the person alternately seeks and flees emotional closeness. The therapeutic relationship is a specialised kind of intimate relationship in which claustro-agoraphobic anxieties are likely to be activated in a process which psychoanalysis understands as transference. The understanding and working through of this transference is the mutative factor proposed in psychodynamic therapies. This study explored participants' mental representation of the internal psychic space of the other. Ten people with a diagnosis of BPD were asked to describe themselves and significant others, including their therapist in order to understand more about (1) their mental representations of the internal space of the other; (2) their relationship with their therapist with reference to internal space. and (3) the implications for the Relational Affective Model and clinical understanding of BPD. Using a mixed qualitative methodology four broad but distinct ways of describing internal space states emerged: positive, negative, nondescript and merged, which I have termed Alpha, Omega, Non-Alpha and Merged. Case study analyses for the four participants who provided interviews at the beginning and end of their treatment were conducted to attempt to highlight any changes in the internal space states identified. A thematic analysis of therapist descriptions indicated participants were positively engaged with their therapist. Negative internal space (Omega) descriptions of self and mother did not transfer to the relationship with the therapist in the early stages of therapy. The implications for the Relational Affective Model are considered.

Introdução: A psicopatia sempre foi associada a comportamentos imorais e frieza emocional, além de risco de reincidência criminal. Embora a frieza dos psicopatas seja bem estabelecida, não há consenso sobre o nível de discernimento moral desses indivíduos, existindo teorias propondo que eles não apresentam desenvolvimento moral adequado enquanto outras propõem que o que lhes falta é querer agir, não saber discernir o certo do errado. Já quando analisamos a relação entre essas três variáveis, psicopatia, imoralidade e frieza, os dados são ainda mais díspares, não existindo consenso sobre a necessidade ou não da presença de emoções para o amadurecimento moral. O estudo de sujeitos infratores encarcerados é interessante nesse contexto, uma vez que permite o controle de variáveis de confusão envolvidas nessa inter-relação, como influências ambientais, vivência criminal, grau de psicopatia, uso de drogas e QI. Em se tratando de jovens infratores, há ainda a vantagem de se estudar uma amostra homogênea quanto à idade. Objetivos: Verificar se existe correlação entre os níveis de maturidade moral e os graus de frieza emocional e de psicopatia, tomando por base uma população de jovens em medida sócio-educativa de internação na Fundação Casa. Adicionalmente, verificar a capacidade de previsão de reincidência da tradução brasileira do PCL-R. Esperou-se correlação inversa significante entre o escore da Psychopathy Checklist Revised (PCL-R) e reatividade autonômica e nível de julgamento moral. Quanto a estas duas últimas variáveis, estabelecemos como hipótese a independência entre ambas. Acreditamos ainda que infratores reincidentes iriam diferir de primários no grau de psicopatia. Métodos: Trinta jovens em medida sócio-educativa foram submetidos a avaliação: a) do grau de psicopatia com a escala PCL-R, separando fator 1 (ligado às relações interpessoais e frieza) e fator 2 (ligado a estilo de vida criminal, comportamentos antissociais); b) do nível de maturidade moral com o Socio-moral Objective Measure (SROM-SF); c) da frieza emocional, refletida na resposta psicofisiológica aferida pela atividade elétrica da pele (AEP) diante de estímulos visuais eliciadores de respostas afetivas provenientes do International Affective Picture System (IAPS). Resultados: Encontrou-se relação direta entre o fator 1 do PCL-R e a latência de resposta autonômica (teste de Spearman, p<0,005), e entre o fator 2 e o maior controle vagal (teste de Spearman, p<0,005). Não houve correlação entre a maturidade moral e o nível de psicopatia (teste de Spearman, p>0,05) ou frieza emocional (teste de Spearman, p>0,05). Os escores no PCL-R diferenciaram as populações de reincidentes e primários (teste t, p=0,0006). Conclusões: Conforme previsto, houve relação significativa entre o grau de psicopatia e a frieza emocional psicofisiologicamente aferida pela AEP. Além disso, a previsão de independência entre AEP e julgamento moral também se confirmou. Diferentemente da hipótese inicial, o grau de psicopatia não apresentou correlação com o nível de julgamento moral. Adicionalmente, verificou-se que a tradução brasileira do PCL-R demonstrou consistência ao prever a reincidência criminal na amostra estudada. / Background: Psychopathy has always been associated with immoral behavior and callousness. Although the latter characteristic is well established for psychopaths, there is no consensus regarding the level of moral discernment of these individuals: some theories suggest that they lack appropriate moral development, whilst others, that they lack only the willing to act properly. Regarding the relationship of these three variables - psychopathy, immorality and callousness - data is even less consistent. Thus, it is important to investigate incarcerated offenders, since studies with such population allow one to control for variables that may confound this inter-relationship, such as environmental influences, criminal experience, psychopathy, drug use and IQ. The investigation of juvenile offenders has additional advantages, as they form a homogeneous sample regarding age. Objectives: To verify the correlation between level of moral judgment, callousness and psychopathy in juvenile offenders incarcerated in Fundação Casa. We also wished to verify the risk prediction of the Brazilian version of the Psychopathy Checklist Revised (PCL-R). We expected to find inverse correlations between PCL-R scores and electrodermal activity and moral judgment level. Regarding the last two variables, we expected that they should be independent from each other. Finally, we expected that primary offenders would be different from recidivist ones. Methods: Thirty incarcerated young offenders were evaluated regarding: a) the degree of psychopathy according with scores on the scale PCL-R, split between factor 1 (which reflects interpersonal relationships and coldness) and factor 2 (reflecting criminal lifestyle, antisocial behaviors), b) level of moral judgment level as assessed with the Socio-moral Objective Measure-Short Form (SROM-SF), c) emotional callousness as measured through psychophysiological responses (electrodermal activity EDA) to visual stimuli from the International Affective Pictures System (IAPS). Results: We found a direct relationship between factor 1 of the PCL-R and latency of EDA response (Spearman test, p<0,005), and between factor 2 and greater vagal control (Spearman test, p<0,005). No significant relationship was found between moral maturity and level of psychopathy or callousness (Spearman test, p>0,05). PCL-R scores were able to distinguish primary from recidivist offenders (t test, p=0,0006). Conclusions: As predicted, there was a significant correlation between psychopathy levels and callousness as measured through EDA. Moreover, we also confirmed the prediction that there would be no relationship between EDA and moral judgment. However, different from what we expected, psychopathy level did not show any significant relationship with moral judgment. Additionally, it was found that the Brazilian version of the PCL-R demonstrated consistency in predicting recidivism in the sample studied.

Introdução: Ao longo da história, as parafilias foram ora consideradas patologias, ora não consideradas. O Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) estabeleceu a distinção entre parafilias e Transtornos Parafílicos (TP), sendo que apenas os TP foram considerados doenças. Por outro lado, a associação entre sintomas obsessivos e parafilias já foi cogitada por muitos autores. Porém, a falta de melhores definições dos sintomas parafílicos dificultava tais estudos. Objetivos: Avaliar a presença de TP e/ou parafilias em mulheres e a possível associação com transtorno obsessivo-compulsivo (TOC) e/ou com transtorno de personalidade obsessivocompulsiva (TPOC). Casuística e Métodos: As alunas (N=190) foram avaliadas por meio de questionários anônimos e autorresponsivos de TOC, TPOC, parafilias e TP. Para o TOC foi utilizada a escala de Yale-Brown. Para as demais variáveis foram utilizadas escalas baseadas no DSM-5, segundo o qual indivíduos parafílicos com comportamentos exibicionistas, frotteuristas, voyeuristas e pedofílicos são considerados portadores de TP porque, por definição, seus impulsos são realizados com quem não consentiu ou não tem capacidade de consentir essas práticas sexuais. Porém, se o indivíduo preenche os critérios para estas parafilias e não tem o respectivo comportamento nem sofrimento, ele terá a respectiva parafilia, mas não o TP. Resultados: As fantasias parafílicas mais frequentes foram: pelo menos uma parafilia (53,2%), Voyeurismo (30,2%) e Fetichismo (25,4%). As parafilias mais frequentes foram: pelo menos uma parafilia (24,5%), Voyeurismo (9%) e Fetichismo (8,5%). Quanto aos TP, os mais frequentes foram: pelo menos um TP (13,8%), Voyeurista (6,9%), do Masoquismo (3,7%) e Frotteurista (3,7%). O TOC subclínico (Yale-Brown entre 8 e 15) foi estatisticamente significativo quando associado a fantasias parafílicas, enquanto o TOC (Yale-Brown >= 16) quando associado a parafilias e TP. O TPOC foi estatisticamente significativo quando associado a fantasias, parafilias e TP. Conclusões: A intensidade dos sintomas de TOC foi diretamente relacionada à intensidade dos sintomas parafílicos, enquanto que o TPOC foi relacionado a fantasias parafílicas, parafilias e TP. Devido a limitações metodológicas como a ausência de instrumentos padronizados validados, os resultados obtidos nesta pesquisa foram considerados traços de associação / Introduction: Throughout history, paraphilias have been at times considered pathologies or not. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) established the distinction between paraphilias and Paraphilic Disorders (PD), with only PD considered as a disease. On the other hand, the association between obsessive symptoms and paraphilias has been considered by many authors. However, the lack of better definitions for paraphilic symptoms made such studies more difficult. Objectives: To assess the presence of PD and/or paraphilias in women and its possible association with obsessive-compulsive disorder (OCD) and/or with obsessive-compulsive personality disorder (OCPD). Case Series and Methods: Students (N=190) were assessed by means of anonymous, self-reported questionnaires on OCD, OCPD, paraphilias and PD. For OCD, the Yale-Brown scale was used. For the other variables scales based on DSM-5 were used, according to which paraphilic individuals with exhibitionistic, frotteuristic, voyeuristic, and pedophilic behaviors were considered as having PD, since, by definition, their impulses are carried out with non-consenting individuals or those unable to consent with such sexual practices. However, if the individual meets the criteria for such paraphilias but does not have the respective behavior or distress, he/she will have said paraphilia, but not PD. Results: The most frequent paraphilic fantasies were: at least one paraphilia (53.2 %), Voyeurism (30.2 %) e Fetishism (25.4 %). The most frequent paraphilias were: at least one paraphilia (24.5 %), Voyeurism (9 %) e Fetishism (8.5 %). As regard to PD, the most frequent were: at least one PD (13.8%), Voyeurist (6.9 %), of Masochism (3.7 %) and Frotteurist (3.7 %). Sub-clinical PD (Yale-Brown between 8 and 15) was statistically significant when associated with paraphilic fantasies, whereas OCD (Yale-Brown >= 16) when associated with paraphilias and PD. OCPD was statistically significant when associated with fantasies, paraphilias, and PD. Conclusions: The intensity of OCD was directly related to the intensity of paraphilic symptoms, whereas OCPD was related to paraphilic fantasies, paraphilias, and PD. The results point to traits of association between these clinical conditions, which recommends research in this direction

Bakgrund: Borderline personlighetsstörning (Emotionellt instabil personlighetsstörning, IPS) förkommer i samhället och visar sig på olika sätt. Sjukdomen är omfattande och komplex, vilket utgör att personer har svårt att få en bra sjukdomsbild som kan medför växling i sjukdomsinsikt.   Sjukdomen kan medföra en ökad risk för samsjuklighet vilket kan leda till konsekvenser som sviktande förmåga till egenvård och för tidig död. Syfte: Syftet med studien är att beskriva personers upplevelser av att leva med borderline. Metod: Metoden som används i denna studie är en kvalitativ forskningsmetod i form av en litteraturanalys av självbiografier. Resultat: Analysprocessen resulterade i två teman; Leva i ständiga känslostormar och att behöva och erhålla stöd för att klara vardagen samt fem subtema; känsla av både befrielse och skam, känsla av frustration och ilska, känsla av förtvivlan och otrygghet, att behöva mer stöd och att erhålla stöd. Diskussion: Resultatet visar hur att leva med borderlinediagnos är en utmaning och generellt innebär att leva med denna diagnos ständiga utmaningar och omvärderingar. Eftersom idag ges personer en framträdande roll i sin vård och ska därmed vara delaktiga i sin vård så måste olika aspekter av hur de upplever att leva med sin sjukdom, som att leva i ständiga känslostormar och behov av mer stöd, beaktas. / Background: Borderline personality disorder occurs in society and shows itself in different ways. The disease is extensive and complex, which means that persons with this disease can find it difficult to have a right disease insight, which can lead to varying disease insight. The disease can lead to an increased risk of co-morbidity that can lead to consequences such as failing ability to self-care and premature death. Purpose: The purpose of the study is to describe people's experiences of living with borderline. Method: The method used in this study is a qualitative research method in the form of a literature analysis of autobiographies. Result: The analysis process resulted in two themes; Living in constant emotional storms and the need of both support and to receive support, so as to cope with everyday life.  Five sub-themes; sense of both liberation and shame, sense of frustration and anger, sense of despair and insecurity, the need of more support and receiving support. Discussion: The result shows how living with borderline diagnosis is a challenge and generally means living with this diagnosis constant challenges and revaluations. Since today people are given a prominent role in their care and should therefore be more actively involved in their care, different aspects of how they feel to live with their illness, such as living in constant emotional storms and the need for more support must be taken into account.

Introdução: A psicopatia sempre foi associada a comportamentos imorais e frieza emocional, além de risco de reincidência criminal. Embora a frieza dos psicopatas seja bem estabelecida, não há consenso sobre o nível de discernimento moral desses indivíduos, existindo teorias propondo que eles não apresentam desenvolvimento moral adequado enquanto outras propõem que o que lhes falta é querer agir, não saber discernir o certo do errado. Já quando analisamos a relação entre essas três variáveis, psicopatia, imoralidade e frieza, os dados são ainda mais díspares, não existindo consenso sobre a necessidade ou não da presença de emoções para o amadurecimento moral. O estudo de sujeitos infratores encarcerados é interessante nesse contexto, uma vez que permite o controle de variáveis de confusão envolvidas nessa inter-relação, como influências ambientais, vivência criminal, grau de psicopatia, uso de drogas e QI. Em se tratando de jovens infratores, há ainda a vantagem de se estudar uma amostra homogênea quanto à idade. Objetivos: Verificar se existe correlação entre os níveis de maturidade moral e os graus de frieza emocional e de psicopatia, tomando por base uma população de jovens em medida sócio-educativa de internação na Fundação Casa. Adicionalmente, verificar a capacidade de previsão de reincidência da tradução brasileira do PCL-R. Esperou-se correlação inversa significante entre o escore da Psychopathy Checklist Revised (PCL-R) e reatividade autonômica e nível de julgamento moral. Quanto a estas duas últimas variáveis, estabelecemos como hipótese a independência entre ambas. Acreditamos ainda que infratores reincidentes iriam diferir de primários no grau de psicopatia. Métodos: Trinta jovens em medida sócio-educativa foram submetidos a avaliação: a) do grau de psicopatia com a escala PCL-R, separando fator 1 (ligado às relações interpessoais e frieza) e fator 2 (ligado a estilo de vida criminal, comportamentos antissociais); b) do nível de maturidade moral com o Socio-moral Objective Measure (SROM-SF); c) da frieza emocional, refletida na resposta psicofisiológica aferida pela atividade elétrica da pele (AEP) diante de estímulos visuais eliciadores de respostas afetivas provenientes do International Affective Picture System (IAPS). Resultados: Encontrou-se relação direta entre o fator 1 do PCL-R e a latência de resposta autonômica (teste de Spearman, p<0,005), e entre o fator 2 e o maior controle vagal (teste de Spearman, p<0,005). Não houve correlação entre a maturidade moral e o nível de psicopatia (teste de Spearman, p>0,05) ou frieza emocional (teste de Spearman, p>0,05). Os escores no PCL-R diferenciaram as populações de reincidentes e primários (teste t, p=0,0006). Conclusões: Conforme previsto, houve relação significativa entre o grau de psicopatia e a frieza emocional psicofisiologicamente aferida pela AEP. Além disso, a previsão de independência entre AEP e julgamento moral também se confirmou. Diferentemente da hipótese inicial, o grau de psicopatia não apresentou correlação com o nível de julgamento moral. Adicionalmente, verificou-se que a tradução brasileira do PCL-R demonstrou consistência ao prever a reincidência criminal na amostra estudada. / Background: Psychopathy has always been associated with immoral behavior and callousness. Although the latter characteristic is well established for psychopaths, there is no consensus regarding the level of moral discernment of these individuals: some theories suggest that they lack appropriate moral development, whilst others, that they lack only the willing to act properly. Regarding the relationship of these three variables - psychopathy, immorality and callousness - data is even less consistent. Thus, it is important to investigate incarcerated offenders, since studies with such population allow one to control for variables that may confound this inter-relationship, such as environmental influences, criminal experience, psychopathy, drug use and IQ. The investigation of juvenile offenders has additional advantages, as they form a homogeneous sample regarding age. Objectives: To verify the correlation between level of moral judgment, callousness and psychopathy in juvenile offenders incarcerated in Fundação Casa. We also wished to verify the risk prediction of the Brazilian version of the Psychopathy Checklist Revised (PCL-R). We expected to find inverse correlations between PCL-R scores and electrodermal activity and moral judgment level. Regarding the last two variables, we expected that they should be independent from each other. Finally, we expected that primary offenders would be different from recidivist ones. Methods: Thirty incarcerated young offenders were evaluated regarding: a) the degree of psychopathy according with scores on the scale PCL-R, split between factor 1 (which reflects interpersonal relationships and coldness) and factor 2 (reflecting criminal lifestyle, antisocial behaviors), b) level of moral judgment level as assessed with the Socio-moral Objective Measure-Short Form (SROM-SF), c) emotional callousness as measured through psychophysiological responses (electrodermal activity EDA) to visual stimuli from the International Affective Pictures System (IAPS). Results: We found a direct relationship between factor 1 of the PCL-R and latency of EDA response (Spearman test, p<0,005), and between factor 2 and greater vagal control (Spearman test, p<0,005). No significant relationship was found between moral maturity and level of psychopathy or callousness (Spearman test, p>0,05). PCL-R scores were able to distinguish primary from recidivist offenders (t test, p=0,0006). Conclusions: As predicted, there was a significant correlation between psychopathy levels and callousness as measured through EDA. Moreover, we also confirmed the prediction that there would be no relationship between EDA and moral judgment. However, different from what we expected, psychopathy level did not show any significant relationship with moral judgment. Additionally, it was found that the Brazilian version of the PCL-R demonstrated consistency in predicting recidivism in the sample studied.

<p> </p><p><strong>Background:</strong> Self-injury can be defined as deliberate harm one's own body without conscious intent to commit suicide. These patients need skilled care. <strong>Purpose:</strong> Illuminate nursing staff attitudes and treatment of patients with self-injury behaviour for individuals diagnosed with borderline personality disorder. <strong>Method:</strong> A general literature study has been made. Based on the objective was a literature search in various databases with ten relevant articles were selected and reviewed. <strong>Results:</strong> The results were presented along four main categories: a challenging patient population, health professionals perceptions, attitudes before and after education and Attitude of health professionals when they feel they can help. The results show that some staff working with patients with self-injury behaviour may find that this can be a challenging patient group. Training and regular supervision of health workers is a positive change in attitude and response. <strong>Discussion:</strong> Through training and mentoring for health professionals obtain the knowledge required to get a different understanding of patients with self-injury behaviour. This may change their attitude that can lead to better care.<strong> Conclusions:</strong> These patients are unique individuals with special needs. Through education one can obtain the knowledge required to understand these patients, who in turn may lead to the nursing staff is able to maintain respect and understanding for these people.</p><p> </p>

Bakgrund: Borderline personlighetsstörning är en vanlig sjukdom på alla vårdinrättningar och många sjuksköterskor möter dessa patienter dagligen. I omvårdnaden av dessa patienter behöver sjuksköterskan använda sig av dagliga händelser för att försöka lära patienten att lita på andra människor. Sjuksköterskans uppgift är att försöka lotsa patienten genom vardagen.  Syfte: Syftet med studien är att belysa sjuksköterskors upplevelser av att möta personer med borderline personlighetsstörning. Metod: Metoden som använts är en litteraturöversikt där vetenskapliga artiklar använts som grund för resultatet.  Resultat: Resultatet visar att många sjuksköterskor önskar mer kunskap om störningen och de tror att många av de problem som omger patienten beror på hur organisationen och strukturen på avdelningen fungerar. Sjuksköterskorna skulle vilja ha bättre struktur på hur de ska vårda dessa patienter och vill att arbetsplatsen ska ha samma mål med omvårdnaden. Detta presenteras i fem teman som påverkar hur bra mötet blir: Handledning/Organisation, Relationer, Erfarenheter, Attityder och Utbildning samt Empati. / Background: Borderline personality disorder is a common disease in all nursing units and many nurses meet patients with Borderline personality disorder in their daily work. The nursing care of these patients require that the nurse uses everyday events to make the patient begin to trust other people. Nurse’s job is to try to guide the patient through everyday life. Aim: The aim of this study is to examine how nurses experience their meeting with patients with borderline personality disorder. Method: The method used is a literature study in which scientific articles are used as a base to the results. Result: The result shows that many nurses want to have more knowledge about the disorder and they think that a lot of the problems surrounding these patients depend on how the organisation and structure in the units work. The nurses would like to have better structure to handle these patients and need the working units to have the same goals with the care. This is presented in five themes that affect the burnout of the meeting: Tutoring/Organization, Relationship, Experiences, Attitudes and Education, and Empathy.

A major burn is one of the most severe traumas a person can experience, and recovery can be a protracted process. The principal aim was to increase the knowledge base regarding factors related to return to work and health-related quality of life (HRQoL) after burns. Patients treated at the Uppsala Burn Center between 2000 and 2007 were included on a consecutive basis. Assessments were made at hospitalization, and thereafter and included a home visit 2 to 7 years after injury. The psychometric properties of the generic HRQoL instrument EQ-5D were investigated. The results support the use of EQ-5D as an adjunct to burn-specific assessments of HRQoL. Most former patients exhibited a good HRQoL at 2 to 7 years postburn. Not working at the time of injury and having PTSD at 12 months, as well as having low scores on the EQ VAS at 12 months, were related to a worse EQ VAS score at 2 to 7 years after injury. The majority of former patients had returned to work 2 to 7 years postburn. Time to return to work was predicted by length of hospital stay and a personality disorder diagnosis. Predictors for not returning to work were length of stay and having any anxiety or substance use disorder prior to injury. Those who were not back at work reported lower generic and burn-specific health, and exhibited more psychiatric morbidity at follow-up than those who were working. The latter group exhibited HRQoL that was comparable to that of the general population. Participants emphasized their own psychological resources and capabilities as facilitators in the process of returning to active work. The findings suggest that an early and systematic approach for assessing recognized risk factors enhances the possibility of discovering patients at risk of developing problems during postburn adaptation.

Background: Self-injury can be defined as deliberate harm one's own body without conscious intent to commit suicide. These patients need skilled care. Purpose: Illuminate nursing staff attitudes and treatment of patients with self-injury behaviour for individuals diagnosed with borderline personality disorder. Method: A general literature study has been made. Based on the objective was a literature search in various databases with ten relevant articles were selected and reviewed. Results: The results were presented along four main categories: a challenging patient population, health professionals perceptions, attitudes before and after education and Attitude of health professionals when they feel they can help. The results show that some staff working with patients with self-injury behaviour may find that this can be a challenging patient group. Training and regular supervision of health workers is a positive change in attitude and response. Discussion: Through training and mentoring for health professionals obtain the knowledge required to get a different understanding of patients with self-injury behaviour. This may change their attitude that can lead to better care. Conclusions: These patients are unique individuals with special needs. Through education one can obtain the knowledge required to understand these patients, who in turn may lead to the nursing staff is able to maintain respect and understanding for these people.