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 California, San Diego and San Diego State University, 2003. / Vita. Includes bibliographical references (leaves 97-111).

The present study aimed to investigate adolescents’ experiences of a therapeutic inpatient service utilising mentalization-based treatment (MBT) for borderline personality disorder (BPD) features, including deliberate self-harm. A qualitative research approach was chosen and eight adolescents were interviewed on their experiences. Interviews were analysed using interpretative phenomenological analysis (IPA; Smith, Flowers & Larkin, 2009). The analysis resulted in five superordinate themes and 17 corresponding subordinate themes. Adolescents described having felt uncontained, uncontainable and misunderstood, particularly prior to their admission. They talked about a process of seeking containment from others which in some cases led to their admission. Participants described feeling contained and understood in the inpatient service and developing a healthier relationship with self and others. Finally, they talked about their recovery as a long and challenging journey and expressed hope for the future. The study concluded that therapeutic inpatient treatment utilising MBT was experienced as beneficial by adolescents, though methodological limitations were acknowledged. Clinical implications were drawn and recommendations for future research were made.

The objective of this study was to explore personal experiences of change of people diagnosed with borderline personality disorder (BPD) who had partaken in psychological therapy. The aim was to develop the first model of change grounded in service user experience so that this could inform recovery-oriented practice in relation to this client group. A constructivist grounded theory design was chosen. Eight people with a diagnosis of BPD who had completed group-based therapy programmes or were currently attending a peer support group were interviewed about their experiences of change using a semi-structured, open-ended format. An initial model was developed and refined through triangulation with three published accounts of experiences of change in the context of a BPD diagnosis. ‘Discovering “new ways of being” in interpersonal space’ was conceptualised as the core process underpinning pertinent activities and experiences relating to change in people diagnosed with BPD. This interactive, relational process was facilitated in environments that were felt to be both containing and open to conflict. It involved increasing levels of self-disclosure, information exchange, exploration of mental states, experimentation with new behaviours and the consolidation of new ways of being. The core process appeared to extend beyond the therapeutic setting if supported through a relationship with a secure base. Regardless of therapeutic allegiance, effective interventions for people diagnosed with BPD might share a common core change process. Further research is required into change processes in the context of individual psychological therapies and negative therapeutic experiences.

Psychopathy and alexithymia are disorders with many conceptual similarities. For example, Factor 1 of the Psychopathy Checklist - Revised (PCL-R; Hare, 1991) contains items like shallow affect and lack of empathy, which seem to map on to the construct of alexithymia. Additionally, both psychopaths and alexithymics display striking differences from others in their use of language, especially affective language. The two areas of interest in the present study were (a) occurrence and co—occurrence of psychopathy and alexithymia in a sample of female inmates, and (b) the relationship between affective language and these two disorders. Psychopathy and alexithymia were assessed in 37 women offenders incarcerated in a Burnaby Correctional Centre, using the PCL-R and the Toronto Alexithymia Scale ( TAS; Taylor, Ryan & Bagby, 1985). Each subject was presented with a short written scenario designed to elicit an emotional response, and asked to describe the feelings of the characters in the story. Their taped responses were analyzed for measures of affect. Base rates of both disorders were comparable to those in similar samples, ( 30% of the inmates were diagnosed as psychopathic; 33% as alexithymic) but the coxnorbidity rate was only 8%. There was a significant correlation between alexithymia scores and PCL—R Factor 2 scores — the factor assessing antisocial behaviour. Multiple regression analysis revealed that the TAS and PCL-R were both predictive of violence. This relationship between the PCL-R and violence is well substantiated; that the TAS also predicts violence is a newer finding. Alexithymics spoke more slowly, used fewer total words overall and fewer affective words, and displayed less emotion in their voices than did nonalexithymics. Psychopaths could not be identified by any vocal measures except a slight tendency to speak faster than nonpsychopaths. Although both disorders are characterized’ by affective impoverishment, the verbal expressions of affect were very different in psychopaths and alexithymics. The psychopaths were adept at convincing raters of an emotional investment they did not feel; alexithymics could not disguise their lack of appropriate emotional response.

The aim of this project was to study the phenomenology of auditory hallucinations in Indians. The sample investigated consisted of thirty adult Indian males domiciled in the Durban area, attending neuroclinics, who had been diagnosed as having suffered from a psychosis and who had experienced auditory hallucinations. The patients were examined by the author and in addition relevant data was extracted from their case files. This included religion, previous diagnosis, age at onset of illness and present age, mother tongue, language of daily usage, language of hallucinations, source of hallucinations, comprehensibi1ity of hallucinations, content of hallucinations, patient's initial reaction to hallucinations, time when hallucinations were experienced, media of transmission, direction of voices and whether the patient had consulted a traditional healer. The findings were that a significant majority of patients: 1) described their hallucinations as being voices coming from supernatural beings (84%). 2) did not attribute their hallucinations to being voices belonging to their deceased ancestors (88%). 3) did not attribute their hallucinations to voices which were being relayed by technical transmitting apparatuses (88%) . 4) diagnosed as suffering from schizophrenia initially, found their hallucinations to be distressful (89%) whereas 80% of the patients diagnosed as suffering from manic depressive psychosis found their hallucinations to be pleasant. 5) did not ascribe their hallucinations to animals (100%). 6) had visited a traditional healer (100%). Hallucinations were generally thought by the majority of patients to have occurred as a result of being possessed by spirits and that the possession had occurred following some "evil" done to them by enemies, rivals, or other persons who wanted the patient to come to harm. Their belief in spirits was derived both from religion and from folk-lore. Its connection with auditory hallucinations arose from the notion that evil spirits can invade human beings causing abnormal behaviour and also symptoms of mental illness including auditory hallucinations. All the patients had visited traditional healers presumably to exorcise the spirits that had possessed them. The Durban Indian community has been reported to be a deculturing community with many of its members adopting Western cultural attitudes and values. The following factors (religion, language grouping, and beliefs derived from folk-lore), specific to Indian culture, appear to have an important influence in shaping some aspects of the phenomenology of auditory hallucinations of psychotic Indian males. / Thesis (M.Med.)-University of Natal, Durban, 1985.

Psychopathy is a complex personality disorder denned by a constellation of affective and behavioral characteristics. There is accumulating behavioral evidence suggesting that the condition is associated with impairments in affective, cognitive, and language functions. However, relatively little is known regarding the neural systems underlying these abnormalities. The present thesis is comprised of five experiments designed to elucidate and characterize the abnormal functional architecture underlying these abnormalities in psychopathic criminals. In Experiments 1 and 2, functional magnetic resonance imaging (fMRI) was used to elucidate the neural systems underling abnormal semantic and affective processes in these individuals. In Experiments 3, 4 and 5, event-related potentials (ERPs) were used to characterize the temporal features of cognitive and language functions in psychopaths. The results from Experiment 1 revealed that compared to control participants, psychopaths performed more poorly and failed to showed the appropriate neural differentiation between abstract and concrete stimuli during a lexical decision task. These deficits were located in the right anterior superior temporal gyrus. The results from Experiment 2 indicated that psychopaths, relative to control participants, showed less activation for processing affective stimuli than for neutral stimuli in several neural regions, including the right amygdala/hippocampal formation, left parahippocampal gyrus, ventral striatum, and in the anterior and posterior cingulate. Psychopaths did show greater activation for processing affective than for neutral stimuli in regions located outside the limbic system, including bilateral inferior frontal gyrus. These latter data suggesting that psychopaths used different neural systems than did controls for performing the task. The results from Experiments 3 and 4 indicated that psychopathy is associated with abnormalities in the P3 ERP component elicited by target stimuli during visual and auditory oddball tasks. In addition, the psychopaths' ERPs to visual and auditory target stimuli were characterized by large fronto-central negativities in the 350-600 millisecond time window. These fronto-central ERP negativities are similar to those observed for patients with temporal lobe damage. In Experiment 5, using a standard sentence processing paradigm, no group differences were observed between psychopaths and nonpsychopaths in the amplitude of the N400 potential elicited by terminal words of sentences that were either congruent or incongruent with the previous sentence context. These results indicate that the abnormal fronto-central ERP negativities observed in previous studies of language function in psychopaths are not related to processes involved in the generation of the N400. Taken together, these data suggest that one of the cardinal abnormalities in psychopathy is abnormal semantic processing of conceptually abstract information and affective information and that these abnormalities are related to the function of neural circuits in the anterior temporal lobes and lateral frontal cortex.

Alcohol abuse/dependence frequently co-occurs with antisocial personality disorder (ASPD) and conduct disorder (CD). Furthermore, crime studies have generally found that alcohol is involved in over 50% of violent crimes, and experimental studies support the notion that acute alcohol consumption indirectly increases the likelihood of aggressive and disinhibited behaviors in the laboratory. However, the mechanisms underlying alcohol's association with such behaviors remain unclear. The goals of this thesis were therefore to further elucidate potential mechanisms underlying (a) alcohol-induced aggressive, disinhibited behaviors and (b) the high comorbidity between delinquent, aggressive behaviors (characterizing CD/ASPD) and alcohol misuse/abuse/dependence. Thus, four studies were conducted, focusing on individual differences in the physiological response to alcohol intoxication. Specifically examined was the elevated heart rate (HR) response to alcohol, which is thought to reflect an increased sensitivity to alcohol-induced reward. / Results of Study I indicated that high HR Responders to alcohol self-reported increased multiple year delinquency (physical aggression, theft, and destruction of property), as well as more alcohol consumption and an increased positive subjective feeling following intoxication, as compared to low HR Responders. Furthermore, a high HR response was related to increased extraversion, disinhibition, boredom susceptibility, and total sensation seeking. Study II revealed that Aggressive Sons of Male Alcoholics (Agg-SOMAs) had the highest intoxicated HR response, and reported the most alcohol consumption, as compared to Non-Agg-SOMAs, or Agg - or Non-Agg - Non-SOMAs. Studies III and IV revealed that intoxicated high HR responders exhibited the most physical aggression (assessed by the Taylor Aggression Paradigm), as well as the most behavioral disinhibition (assessed by the Go/No-Go task) as compared to sober high HR Responders, or sober/intoxicated low HR responders. / In summary, individuals with a high HR response to alcohol appear to have an increased propensity for multiple addictive, disinhibited and aggressive behaviors. This determines a phenotype of both potential heuristic and clinical importance. These findings are discussed within the context of a hypothetical model of (a) the high comorbidity between alcohol use/misuse and aggression/ASPD, and (b) the increased likelihood of alcohol-induced aggressive, disinhibited behaviors.

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.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.