The present study will be concerned with the reliability of the Shipley-Hartford Abstraction Scale as an instrument for diagnosis of schizophrenia and personality disorders.

Qualitative research has begun focussing on the experience of change within psychological therapy for individuals with a diagnosis of Emotionally Unstable Personality Disorder (EUPD). However, many individuals do not access therapy but instead utilise other forms of support. This study aimed to develop a holistic theory of change, applicable to but extendable beyond the remit of psychological therapy. Twelve individuals were interviewed using semi-structured format about their experience of change. Five individuals with a diagnosis of EUPD were interviewed alongside seven staff members. A Grounded Theory methodology was used. The key change experience was defined as one of ‘shifting positions’ where the individual began evolving their relationship to themselves, to others and to help. This process was often facilitated by development of safe and trusting relationships and a personal readiness to change. The change process could simultaneously be enhanced and set back by staff and Mental Health Services. This change process mirrors and expands the findings of previous research and offers a change model applicable across settings. Future research should include the perspective of carers and clinical settings should explore how best to support staff to attune to individuals’ needs in order to facilitate change.

Background: There is a paucity of research into Cluster C personality disorders, however there is increasing recognition that they are highly prevalent, associated with significant distress and frequently present alongside co-occurring axis I disorders. Research has led to significant progress in the understanding of the psychological mechanisms and has guided the development of evidence based treatment for borderline personality disorder and therefore it is likely that increased focus on Cluster C personality disorders may lead to similar developments. This thesis aimed to examine and evaluate current research on psychological interventions for the treatment of Cluster C personality disorders. It also sought to explore psychological factors involved in the development and maintenance of cluster C personality disorder. Method: A systematic literature review examining the effectiveness of psychological treatments for cluster C personality disorder identified 16 studies. The empirical study recruited individuals identified by clinicians as meeting criteria for Cluster C personality disorders. Participants completed a range of self-report measures of personality psychopathology, interpersonal problems and axis I disorders and a series of interviews exploring adult attachment style, reflective function, autobiographical memories. These were completed at 2 time points, 4 months apart. Participants also provided responses to a semi-structured qualitative interview to gain insight into their beliefs about their difficulties. Additional information was also gained through participants’ psychiatric notes. Results: The systematic review results indicate that psychological interventions are effective in the treatment of cluster C personality disorders however studies generally focused on cognitive behavioural or psychodynamic approaches. There is a lack of clarity over which treatment components are most effective in treating particular features of cluster C personality disorders. The empirical paper identifies no significant changes in personality psychopathology, anxiety and depressive symptoms, interpersonal problems, reflective function and autobiographical memory across time. Participants demonstrated insecure adult attachment styles. Conclusions: Results from the systematic review and empirical study identify a need for more research to explore the complexity of personality psychopathology and co-occurring axis I and axis II disorders. It is also necessary for research to identify psychological factors involved in the development and maintenance of Cluster C personality disorders in order to guide evidence based treatments. The systematic review highlights the need for research to identify the most effective psychological treatments for cluster C personality disorders and to establish which components of treatment are most effective in targeting particular symptoms associated with cluster C personality disorder.

Suicide attempts and opioid dependence are important clinical issues, as both are associated with a high degree of psychiatric morbidity and elevated risk of mortality. Research has identified a number of risk factors for suicide attempts among the general population, and to a lesser extent, among heroin users. Due to a lack of case-control studies, however, it is still not known to what extent opioid dependence per se is a risk factor for suicide attempts. This thesis comprised the first study to directly examine whether opioid dependence is a unique risk factor of suicide attempts. This thesis examined suicide attempts, associated risk factors, and related comorbidity among an opioid-dependent case group and a non-opioid-dependent control group. A structured interview was used to collect data from 726 opioid-dependent cases and 399 non-opioid-dependent controls. This thesis identified a number of important findings. Firstly, although opioid-dependent individuals were more likely to report lifetime suicide attempts compared to controls, the risk factors were largely the same for both groups. It appeared that opioid-dependent individuals were characterised by a higher likelihood of the same risk factors for suicide attempts, rather than having different risks. Cases appeared to be at increased risk of suicide attempts because of increased levels of multiple risk factors. Secondly, borderline personality disorder (BPD) and impulsivity were identified as important risk markers for suicidal behaviour, especially among opioid-dependent individuals. The study concluded that the treatment of BPD should be prioritised among this group. Third, self-mutilation was identified as a clinically significant problem in its own right, however, when combined with a history of attempted suicide, the psychological dysfunction observed was found to be very high. Fourth, non-fatal opioid overdose and suicide attempts were found to be distinct behaviours. The risk factors for each were completely different. While drug-related risks were associated with non-fatal overdose, the risk markers for suicide attempts were related to the presence of psychological disorders. This thesis has highlighted important areas of concern for clinical interventions as well as for future research to explore. Considering this is the first study of its kind, future research should focus on its replication.

Thesis (Ph. D.)--University of Missouri-Columbia, 2007. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on December 14. 2007) Vita. Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 97-103).

Thesis (Ph. D.)--State University of New York at Binghamton, Department of Psychology, Clinical Psychology, 2009. / Includes bibliographical references.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 66-74). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 104-117). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 104-117). Also available on the Internet.