M.A. / The relatively rapid development of biological approaches to various psychological conditions, has prompted clinicians and researchers to investigate Borderline Personality Disorder more thoroughly. Research has evidenced the uniqueness of Borderline Personality Disorder in terms of description, aetiology and treatment. Of the various aetiologies proposed, the neuropsychological deficit approach is one which is still in its infancy and which may have promise for new treatment strategies. Latest developments delineate neuropsychological deficits in the areas of memory, perception and visuospatial ability. These factors are important for psychotherapeutic purposes. The purpose of this study was to further existing knowledge as regards the aetiology of Borderline Personality Disorder in order to initiate new treatment modalities and management strategies. The study examined whether a battery of neuropsychological tests could detect organic dysfunction in the areas of construction, orientation and attention, memory, perception and concept formation and reasoning in twenty inpatients diagnosed according to DSM-IV criteria, with Borderline Personality Disorder. Two control groups were used, one comprising twenty inpatients diagnosed according to DSM-IV criteria with Personality Disorders from Axis II, Clusters A or C; and the other comprising twenty normal volunteers. Neuropsychological functioning assessed, included measures of attention, construction, visual and auditory-verbal memory, perception, and concept-formation and reasoning. Measurement instruments used in this study included the Digit Symbol subtest of the WAIS-R; Rey Complex Figure; Logical Memory subtest of the WMS-R, Gottschaldt Embedded Figures Test; and the Wisconsin Card Sorting Test. (v) Analysis of variance, multivariate analysis of variance and post hoc tests revealed significant deficits in neuropsychological performance among the borderline personality disorder group and the control group of other personality disorders but not the normal volunteer group. Dysfunction was particularly significant in the areas of attention, visuospatial ability, perceptual organization, and ability to maintain cognitive set. These deficits do not appear to have been attributable to attention deficit disorder, attention deficit hyperactivity disorder, temporal lobe epilepsy, head injury, a concurrent Axis I diagnosis such as major depressive disorder, or current drug and/or alcohol abuse. The observed deficits suggest new ways of understanding the development and maintenance of Borderline Personality Disorder, and provide indications for treatment. In conclusion, it is recommended that full use be made of the measurement instruments used in this study as diagnostic aids to enhance the effectiveness of treatment modalities. It is further recommended that research in this topic be repeated and extended using a larger sample and matched controls.

Research output indicates that a very high percentage op people with depressive disorders do not improve after a period of two years. One can thus assume that poor identification of the symptomatology and the factors involved in the etiology and maintenance thereof could lead to a generalised diagnosis and a less successful intervention. Although the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) has explicit criteria for both Dysthymia and Unipolar Major Depression it is sometimes difficult for clinical therapists to distinguish between them because of/due to the symptom similarities. Against this background the question is often asked whether Dysthymia is entitled to an unique diagnostic status. A few international investigations, as well as the preceding study (Smit 1994) have indicated that they are in fact different disorders. Each of these research findings however only focuses on specific areas of these disorders. The main purpose of the present study is however to identify the differences and similarities between the two depressive groups. An in-depth study was done to get an indication of the different comorbid personality and syndrome disorders as well as the unconscious defence mechanisms these patients tend to use. Two hundred and fifty five patients from the TARA, the H. Moross Centre, Weskoppies Hospital and Vista Private Clinic was evaluated. The DSM-IV was used to distinguish between the subjects of the different groups. Thereafter Hamilton's Depression Rating Scale was applied to get an indication whether the chosen patients weren't too little or too seriously depressed, as this could have influenced the results. The patients were then tested with Millon's Clinical Multi-Axial Inventory II to determine their comorbid personality and syndrome disorders. Finally they were assessed with Ihilevich and Gleser's Defence Mechanism Inventory to establish the defence style they usually unconsciously use. The results indicate that both groups tend to have comorbid anxiety and somatoform disorders. The findings also suggested that the Schizoid, Dependent and Borderline personality disorders would be the best indicators/predictors for the diagnosis of Unipolar Major Depression. According to the results the Dysthymic group had significantly higher measures on the Self-Defeating, Schizoid, Schizotypal, Avoidant, Borderline, Paranoid, Somatoform, Dysthymic, Thought Disorder, Major Depressive, Delusional and Aggressive style sub-scales. The best predictors/indicators for the Dysthymic Depressive Disorder are the Anxiety, Drug dependence, Thought Disorder, Major Depression and Somatoform syndrome disorders, the Anti-Social, Self-Defeating, and Schizotypal personality disorders, as well as the Aggressive, Projective, Intellectual, Intrapunitive and Reversal defence mechanisms. The results also indicate that the Dysthymic males had significantly higher measures than the females on 19 of the 27 subscales. The females subjects of the Unipolar Major Depressive group had significantly higher scores than the males on the Dependent and Somatoform sub-scales, while the males of the Major Depressive group had significantly higher scores than the females of this group on the Anti-Social, Aggressive-Sadistic, Alcohol dependence and Drug dependence sub-scales. One can come to the conclusion that the Dysthymic group (especially the males) are much more affected than the Unipolar Major Depressive group. These findings thus support the view that Dysthymia is entitled to a own unique diagnostic status, at least for a South African population. / Dr. A. Burke

M.A. (Clinical Psychology) / The relatively rapidly development of cognitive-behavioural approaches to various psychological conditions, has prompted clinicians and researchers to investigate the borderline personality disorder more thoroughly. Research has evidenced the uniqueness of the borderline personality disorder in terms of description, etiology and therefore treatment. of the various treatments proposed, the cognitive-behavioural approaches appear to be most effective. Latest developments in this area emphasize cognitive factors such as content-specitic cognitions and Early Maladaptive Schemas. These factors are important tor psychotherapeutic purposes. A hypothesis was formulated which stated broadly that cognitive-behavioural approaches would result in equal treatment efficacy, whether process(schema) or content based, and investigated in the context of a pilot clinical trial with tour subjects. Apart from measures for depression and cognitive processes in the BPD, a depth-of-processing task and a schema questionnaire were utilized in investigation or the hypothesis. These measures, in addition to CB interventions, were applied to a small group or carefully selected BPD's, with a secondary diagnosis or depression. Findings supported the basic hypothesis of the study, and demonstrated that cognitive-behavioural approaches of either content or process typos are equally etricacious in treatment of the borderline porsonality disorder.