Lai, Ching Man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (p. 96-121). / Abstracts in English and Chinese. / List of Figures --- p.vii / List of Tables --- p.viii / Chapter Chapter 1: --- Introduction and Literature Review / Origin of the Construct of BPD --- p.2 / BPD in the DSM Nomenclature --- p.3 / Epidemiology of BPD --- p.4 / Co-occurrence and Comorbidity of BPD --- p.4 / Construct Validity and Dimensionality of BPD --- p.6 / Prototypic Validity and Subtypes of BPD --- p.8 / Taxometric analysis --- p.8 / Latent class analysis --- p.9 / Diagnostic efficiency of individual BPD criteria --- p.11 / Comparable Constructs ofBPD in the ICD-10 and the CCMD-III --- p.13 / Emotionally unstable personality disorder (EUPD) --- p.13 / Impulsive personality disorder (IPD) --- p.14 / "Comparison of Diagnostic Features in DSM-BPD, ICD-EUPD and CCMD-IPD" --- p.15 / Purposes of This Study --- p.19 / Chapter Chapter 2: --- Method / Participants --- p.21 / Procedures --- p.21 / Instruments and Measures --- p.22 / Cross-cultural Personality Assessment Inventory-2 (CPAI-2) --- p.22 / Chinese Personality Disorder Inventory (CPDI) --- p.22 / Multi-axial Clinical Assessment Inventory (MCAI) --- p.23 / "Simulated diagnostic assessment for BPD, IPD and EUPD" --- p.23 / Statistical Analyses --- p.26 / "Validation of the constructs of BPD, IPD, and EUPD" --- p.26 / "Relationships among diagnostic features in BPD, IPD and EUPD" --- p.29 / "Rate and co-occurrence of the diagnosis of BPD, IPD and EUPD" --- p.29 / "Sociodemographic, Personality and Clinical Characteristics of Chinese BPD, IPD and EUPD patients" --- p.29 / Subtypes of DSM-IV-TR BPD patients --- p.30 / Diagnostic information of DSM-IV-TR BPD criteria --- p.32 / Chapter Chapter 3: --- Results / "Validation of the Constructs of BPD, IPD, and EUPD" --- p.34 / Construct validity of BPD among Chinese psychiatric patients --- p.34 / Construct validity of IPD among Chinese psychiatric patients --- p.36 / Construct Validity of EUPD among Chinese Psychiatric Patients --- p.38 / "Relationships among diagnostic features in BPD, IPD and EUPD" --- p.45 / "Rate and Co-occurrence of the Diagnosis of BPD, IPD and EUPD" --- p.46 / "Sociodemographic,Personality and Clinical Characteristics of Chinese BPD, IPD and EUPD Patients" --- p.49 / Sociodemographic profile --- p.49 / Personality profile --- p.51 / Psychosocial functioning --- p.52 / Clinical profile --- p.53 / Latent class analysis of DSM-IV-TR BPD Patients --- p.60 / Item Response Theory Analysis of DSM-IV-TR BPD criteria --- p.66 / Chapter Chapter 4: --- Discussion / "Is BPD, IPD, and EUPD a Valid Construct?" --- p.71 / Internal consistency --- p.71 / Factorial validity --- p.72 / "How Frequent is the Diagnosis of BPD, IPD and EUPD in Clinical Setting of China? Can BPD Capture Patients Diagnosed with IPD or EUPD Otherwise?" --- p.74 / "What are the Socio-demographic, Personality and Clinical Characteristics of BPD, IPD and EUPD Patients?" --- p.75 / "Similar characteristics between Chinese BPD, IPD and EUPD patients" --- p.75 / "Distinguishing characteristics between Chinese BPD, IPD and EUPD patients" --- p.79 / "Are BPD, IPD and EUPD Distinct Clinical Construct?" --- p.80 / Do Subtypes of BPD Exist? --- p.81 / What are the Core Features of the BPD Diagnosis? --- p.83 / "Suggestions for Future Revision of the ""Borderline"" Diagnosis" --- p.84 / "Development of sub-division of ""borderline"" patients" --- p.85 / Towards a classical classification model --- p.86 / Towards an etiological based model --- p.86 / Strengths and Limitations of the Study --- p.91 / FOOTNOTES --- p.95 / REFERENCES --- p.96 / APPENDIX --- p.122

Recent conceptualizations of psychopathy are moving toward more inclusive, purely trait-based models. However, researchers continue to heavily rely on assessments of psychopathy that include categorical behavioral elements. The newly developed Comprehensive Assessment of Psychopathic Personality – Institutional Rating Scale appears to be a promising interview-based measure of psychopathy, but research on its reliability and validity is in its infancy. As a second issue, the vast majority of research on psychopathy, particularly in offender populations, is conducted with male participants. Nonetheless, the growing body of literature involving incarcerated females suggests gender differences in the prevalence and manifestation of psychopathic traits. Reasons for these differences are unclear, but some have proposed socialized gender roles as a contributing factor. With a sample of 52 female 49 male offenders recruited from a large, metropolitan jail, this dissertation evaluated the construct validity of the CAPP-IRS and examined the effect of gender role conformity on the manifestation of psychopathic traits. Results indicated that a three-factor model of psychopathy represented by antagonistic interpersonal relations, restricted emotions, and disinhibited behavior best fit the data. Findings further suggested convergent and discriminant validity for the CAPP-IRS. Additionally, masculine and feminine gender role conformity differentially related to psychopathy, but generally accounted for a small proportion of the variance in psychopathic traits. Recommendations for future research on the CAPP model and its assessment as well as implications for the clinical assessment of psychopathy in women are discussed.

Introdução: A prática de atos infracionais e comportamento antissocial entre jovens podem estar associados a traços psicopáticos constitucionais (primários) ou ambientais (secundários) presentes no desenvolvimento desses indivíduos. O comportamento antissocial também está associado com a resposta autonômica diminuída diante de estímulos com saliência emocional. O objetivo deste trabalho foi analisar as diferenças de traços psicopáticos primários e secundários entre jovens infratores e jovens da comunidade com nível socioeconômico semelhante. Foi também objetivo a comparação dos padrões de resposta autonômica frente a estímulos visuais agradáveis, neutros e desagradáveis entre os grupos. Métodos: A escala Psychopathy Checklist-Revised (PCL-R) foi utilizada para identificar se jovens infratores do sexo masculino, que cumpriam medida socioeducativa de internação nas unidades da Fundação Centro de Atendimento Socioeducativo ao Adolescente (CASA) em São Paulo, apresentavam diferenças na sua pontuação total, e especificamente no fator 1 ou fator 2 da escala, quando comparados com outros jovens da comunidade, em condições socioeconômicas semelhantes. Para isso foram excluídos da amostra os jovens que apresentavam critérios para Transtornos mentais ou Retardo mental de acordo com a Mini-International Neuropsychiatric Interview (MINI) e escala Wechsler de inteligência para adultos (WAIS- III), respectivamente. Foram também excluídos da comparação aqueles que apresentaram pontuação condizente com o critério de psicopatia no Brasil (igual ou maior que 23 pontos na escala PCL-R). A resposta autonômica foi avaliada por meio das medidas de latência, amplitude e labilidade da atividade elétrica da pele (AEP) diante de imagens agradáveis, neutras e desagradáveis do International Affective Picture System (IAPS). Resultados: 39 infratores e 31 jovens do grupo controle foram comparados em relação aos traços psicopáticos. Os grupos apresentaram diferenças estatisticamente significativas (p < 0,01) na pontuação média do PCL-R, sendo 13.4 a pontuação média entre infratores e 2.1 entre não-infratores. Foram encontradas também diferenças estatisticamente significativas entre os grupos quando analisadas separadamente as médias de pontuação no fator 1 (p < 0,01) e fator 2 (p < 0,01) da PCL-R. Apesar dos grupos terem apresentado diferença estatisticamente significativa (p < 0,01) nos níveis educacionais, a ANCOVA realizada para comparar os resultados da média de pontuação na PCL-R entre os grupos, controlando para nível educacional, mostrou que a diferença nos resultados da PCL-R permaneceu estatisticamente significativa (p < 0,01). Na comparação da resposta autonômica foi possível a inclusão de 33 infratores com os mesmos 31 do grupo controle. Foram também encontradas diferenças estatisticamente significativas (p < 0,01) na amplitude da AEP, sendo que o grupo de infratores apresentou maior ativação autonômica para estímulos agradáveis, porém menor ativação autonômica para estímulos desagradáveis. Conclusões: nesta amostra, tanto a presença de traços psicopáticos primários - associados a características constitucionais - quanto de traços psicopáticos secundários - associados a características ambientais, foram maiores entre infratores. No entanto a proporção de cada um destes fatores foi a mesma entre os grupos, com predominância dos traços secundários em ambos os grupos. Portanto não se pode atribuir a delinquência juvenil nesta amostra a nenhum fator especificamente - constitucional ou ambiental-, ainda que os fatores ambientais tenham contribuído de forma mais significativa para os traços psicopáticos na amostra como um todo. Os padrões de ativação autonômica entre infratores indicam que as respostas emocionais destes jovens diante dos estímulos agradáveis e desagradáveis do ambiente são diferentes dos outros jovens da comunidade, apontando características singulares da reação emocional de jovens infratores. Os resultados sugerem a necessidade de intervenções amplas, não restritas a aspectos socioeconômicos, na abordagem da delinquência juvenil / Introduction: The perpetration of infractional acts and display of antisocial behavior among young people may be associated with constitutional (primary) or environmental psychopathic traits (secondary) present in their development. Antisocial behavior is also associated with impaired autonomic response to emotionally charged stimuli. The aim of this study was to analyze the differences in primary and secondary psychopathic traits among young offenders and youngsters with similar socioeconomic status in a community. Another objective was to compare the patterns of autonomic response to pleasant, unpleasant and neutral visual stimuli between groups. Method: The Psychopathy Checklist Revised (PCL-R) scale was used to identify whether male young offenders, who were detained at the units of Fundação Centro de Atendimento Socioeducativo ao Adolescente (CASA) at São Paulo, exhibited total score differences, and specifically for factor 1 or factor 2 of this scale, when compared with other young people in similar socioeconomic conditions from the community. To this end, young people who met the criteria for mental disorders or mental retardation were excluded, ased on the Mini-International Neuropsychiatric Interview (MINI) and Wechsler adult intelligence scale (WAIS- III), respectively. The comparison also excluded those who presented scores consistent with the criteria for psychopathy in Brazil (equal to or greater than 23 points on the PCL-R). The autonomic response was evaluated by means of latency, amplitude and lability of electrodermal activity (EDA) when presented with pleasant, unpleasant and neutral images from the International Affective Picture System (IAPS). Results: 39 offenders and 31 nonoffenders were compared in relation to psychopathic traits. The groups presented statistically significant differences (p < 0.01) in PCL-R score averages, being 13.4 the average score in the group of offenders and 2.1 in the non-offender group. Significant differences between the groups were also detected when factor 1 (p < 0.01) and factor 2 (p < 0.01) PCL-R score averages were analyzed separately. Although the groups presented statistically significant difference in educational level, the ANCOVA used to compare the PCL-R scores averages between the groups, controlling for educational level, showed that the difference in PCL-R scores remained statistically significant (p < 0,01). In the comparison of autonomic response, it was possible to include 33 offenders with the same 31 from the control group. Statistically significant differences (p < 0.01) in EDA amplitudes were also found, and the group of offenders showed greater autonomic activation to pleasant stimuli, but less autonomic activation to unpleasant stimuli. Conclusions: in this sample, both the presence of primary psychopathic traits (due to inherited characteristics) and secondary psychopathic traits (due to environmental factors) was greater among young offenders. However, the proportion of each of these factors was the same between groups, with predominance of secondary traits in both groups. Therefore, one cannot specifically attribute juvenile delinquency in this sample to any factor - constitutional or environmental - although the environmental factors contributed more significantly to psychopathic traits in the sample as a whole. Patterns of autonomic activation among offenders indicate that the emotional responses of these young people when presented with pleasant and unpleasant stimuli in the environment are different from the other youngsters of the community, indicating particular features in the emotional response of young offenders. These results suggest that addressing juvenile delinquency requires far-reaching interventions, not solely restricted to socieconomic factors

Introdução: A prática de atos infracionais e comportamento antissocial entre jovens podem estar associados a traços psicopáticos constitucionais (primários) ou ambientais (secundários) presentes no desenvolvimento desses indivíduos. O comportamento antissocial também está associado com a resposta autonômica diminuída diante de estímulos com saliência emocional. O objetivo deste trabalho foi analisar as diferenças de traços psicopáticos primários e secundários entre jovens infratores e jovens da comunidade com nível socioeconômico semelhante. Foi também objetivo a comparação dos padrões de resposta autonômica frente a estímulos visuais agradáveis, neutros e desagradáveis entre os grupos. Métodos: A escala Psychopathy Checklist-Revised (PCL-R) foi utilizada para identificar se jovens infratores do sexo masculino, que cumpriam medida socioeducativa de internação nas unidades da Fundação Centro de Atendimento Socioeducativo ao Adolescente (CASA) em São Paulo, apresentavam diferenças na sua pontuação total, e especificamente no fator 1 ou fator 2 da escala, quando comparados com outros jovens da comunidade, em condições socioeconômicas semelhantes. Para isso foram excluídos da amostra os jovens que apresentavam critérios para Transtornos mentais ou Retardo mental de acordo com a Mini-International Neuropsychiatric Interview (MINI) e escala Wechsler de inteligência para adultos (WAIS- III), respectivamente. Foram também excluídos da comparação aqueles que apresentaram pontuação condizente com o critério de psicopatia no Brasil (igual ou maior que 23 pontos na escala PCL-R). A resposta autonômica foi avaliada por meio das medidas de latência, amplitude e labilidade da atividade elétrica da pele (AEP) diante de imagens agradáveis, neutras e desagradáveis do International Affective Picture System (IAPS). Resultados: 39 infratores e 31 jovens do grupo controle foram comparados em relação aos traços psicopáticos. Os grupos apresentaram diferenças estatisticamente significativas (p < 0,01) na pontuação média do PCL-R, sendo 13.4 a pontuação média entre infratores e 2.1 entre não-infratores. Foram encontradas também diferenças estatisticamente significativas entre os grupos quando analisadas separadamente as médias de pontuação no fator 1 (p < 0,01) e fator 2 (p < 0,01) da PCL-R. Apesar dos grupos terem apresentado diferença estatisticamente significativa (p < 0,01) nos níveis educacionais, a ANCOVA realizada para comparar os resultados da média de pontuação na PCL-R entre os grupos, controlando para nível educacional, mostrou que a diferença nos resultados da PCL-R permaneceu estatisticamente significativa (p < 0,01). Na comparação da resposta autonômica foi possível a inclusão de 33 infratores com os mesmos 31 do grupo controle. Foram também encontradas diferenças estatisticamente significativas (p < 0,01) na amplitude da AEP, sendo que o grupo de infratores apresentou maior ativação autonômica para estímulos agradáveis, porém menor ativação autonômica para estímulos desagradáveis. Conclusões: nesta amostra, tanto a presença de traços psicopáticos primários - associados a características constitucionais - quanto de traços psicopáticos secundários - associados a características ambientais, foram maiores entre infratores. No entanto a proporção de cada um destes fatores foi a mesma entre os grupos, com predominância dos traços secundários em ambos os grupos. Portanto não se pode atribuir a delinquência juvenil nesta amostra a nenhum fator especificamente - constitucional ou ambiental-, ainda que os fatores ambientais tenham contribuído de forma mais significativa para os traços psicopáticos na amostra como um todo. Os padrões de ativação autonômica entre infratores indicam que as respostas emocionais destes jovens diante dos estímulos agradáveis e desagradáveis do ambiente são diferentes dos outros jovens da comunidade, apontando características singulares da reação emocional de jovens infratores. Os resultados sugerem a necessidade de intervenções amplas, não restritas a aspectos socioeconômicos, na abordagem da delinquência juvenil / Introduction: The perpetration of infractional acts and display of antisocial behavior among young people may be associated with constitutional (primary) or environmental psychopathic traits (secondary) present in their development. Antisocial behavior is also associated with impaired autonomic response to emotionally charged stimuli. The aim of this study was to analyze the differences in primary and secondary psychopathic traits among young offenders and youngsters with similar socioeconomic status in a community. Another objective was to compare the patterns of autonomic response to pleasant, unpleasant and neutral visual stimuli between groups. Method: The Psychopathy Checklist Revised (PCL-R) scale was used to identify whether male young offenders, who were detained at the units of Fundação Centro de Atendimento Socioeducativo ao Adolescente (CASA) at São Paulo, exhibited total score differences, and specifically for factor 1 or factor 2 of this scale, when compared with other young people in similar socioeconomic conditions from the community. To this end, young people who met the criteria for mental disorders or mental retardation were excluded, ased on the Mini-International Neuropsychiatric Interview (MINI) and Wechsler adult intelligence scale (WAIS- III), respectively. The comparison also excluded those who presented scores consistent with the criteria for psychopathy in Brazil (equal to or greater than 23 points on the PCL-R). The autonomic response was evaluated by means of latency, amplitude and lability of electrodermal activity (EDA) when presented with pleasant, unpleasant and neutral images from the International Affective Picture System (IAPS). Results: 39 offenders and 31 nonoffenders were compared in relation to psychopathic traits. The groups presented statistically significant differences (p < 0.01) in PCL-R score averages, being 13.4 the average score in the group of offenders and 2.1 in the non-offender group. Significant differences between the groups were also detected when factor 1 (p < 0.01) and factor 2 (p < 0.01) PCL-R score averages were analyzed separately. Although the groups presented statistically significant difference in educational level, the ANCOVA used to compare the PCL-R scores averages between the groups, controlling for educational level, showed that the difference in PCL-R scores remained statistically significant (p < 0,01). In the comparison of autonomic response, it was possible to include 33 offenders with the same 31 from the control group. Statistically significant differences (p < 0.01) in EDA amplitudes were also found, and the group of offenders showed greater autonomic activation to pleasant stimuli, but less autonomic activation to unpleasant stimuli. Conclusions: in this sample, both the presence of primary psychopathic traits (due to inherited characteristics) and secondary psychopathic traits (due to environmental factors) was greater among young offenders. However, the proportion of each of these factors was the same between groups, with predominance of secondary traits in both groups. Therefore, one cannot specifically attribute juvenile delinquency in this sample to any factor - constitutional or environmental - although the environmental factors contributed more significantly to psychopathic traits in the sample as a whole. Patterns of autonomic activation among offenders indicate that the emotional responses of these young people when presented with pleasant and unpleasant stimuli in the environment are different from the other youngsters of the community, indicating particular features in the emotional response of young offenders. These results suggest that addressing juvenile delinquency requires far-reaching interventions, not solely restricted to socieconomic factors

Psychological assessment relies on accurate and forthright reporting to determine valid clinical presentations. However, it has long been recognized that examinees may be motivated to present a "better picture" through Positive Impression Management (PIM). Within the PIM domain, two distinct motivations (i.e., defensiveness and social desirability) emerge that have not been clearly differentiated in empirical literature. This thesis addressed the research gap for detecting PIM distortion of personality pathology, utilizing the Personality Inventory for DSM-5 (PID-5). In this investigation, 106 psychiatric inpatients were recruited from the adult Co-Occurring Disorders and Trauma Programs at University Behavioral Health. Using a mixed within- and between-subjects design, participants engaged in simulation via scenarios to be considered for a highly valued rehabilitation program (defensiveness) or employment (social desirability). As expected, inpatients showed elevated levels of problematic personality traits when reporting genuinely, but suppressed them under PIM conditions. These findings highlight that the PID-5, like all multiscale inventories, is highly vulnerable to intentional PIM distortion. Interestingly, respondents in the social desirability condition generally engaged in more total denial than those in the defensiveness condition. Empirically- and theoretically-based validity scales were developed to identify simulators and differentiate between conditions. Besides PIM, higher levels of experienced stigma were associated with more personality pathology, particularly the domain of Detachment. In addition, ancillary analyses showed strong convergence of the PID-5 with its hierarchical trait model to the DSM-IV categorical model. Continued research to detect PIM distortion, and more importantly to differentiate between PIM motivations, is essential for accurate clinical assessment of personality disorder traits and effective treatment planning.

The study sought to explore the influence of gastrointestinal symptoms in female respondents with emetophobia disorder, panic disorder with agoraphobia and obsessive compulsive disorder. The research assessed a sample of sixty respondents which formed part of three groups which were recruited from clinical and online support groups. The age ranged from twenty to forty-five years. Non-probability quota sampling was employed. A non-experimental research design was implemented in order to make comparisons between these groups’ association of gastrointestinal symptoms and the occurrence of possible vomiting. The differential research strategy determined whether a statistically significant difference existed. The groups were assessed on the Gastrointestinal Symptom Score (2005) and the Patient Assessment of Upper Gastrointestinal Symptom Severity Index (2004). The research aimed to determine whether empirical support exists for the Cognitive Behavioural Model of Emetophobia by Boschen (2007). / Psychology / M.A. (Psychology)

In many cultures and religions of the world the belief in transcendental realities, like God, the Devil and other benevolent and malevolent spirits are widespread. These realities are constructed in different ways, depending upon context. In light of the development Western industrial societies have undergone, it follows that the belief in transcendental realities may have given way to beliefs that are steeped more, in empiricism. However, understanding the belief in transcendental realities seems to be gaining renewed interest in various social science disciplines in light of the fact that claims of experiences of spirit possession are escalating. The implication this understanding has on the treatment a patient receives is likely to depend upon the training of the practitioner consulted. It follows that the experiences of patients who believe they are possessed by a spirit is as equally important to practitioners of psychology as it is to theologians. Psychologists would likely ascribe a spirit possession to a psychological experience; while theologians will attest to the presence of a spiritual illness. This project focussed on Free Church pastors in Germany and their perceptions of spirit possession and mental illness. To explore Free Church pastors understanding of spirit possession and mental illness is critical in light of the overlap of symptoms. Misdiagnosis may result in a client receiving treatment which may not be appropriate. Interviews with Free Church pastors were conducted. The results were analysed and 4 themes were identified. Based on these interviews conclusions could be drawn which ultimately made it clear that the German free church pastors’ theological training needs to be supplemented in the area of psychology and that the pastors are unable to cope in the area of ‘spirit possession or mental illness’ / Psychology / D.Litt. et Phil. (Psychology)

The study sought to explore the influence of gastrointestinal symptoms in female respondents with emetophobia disorder, panic disorder with agoraphobia and obsessive compulsive disorder. The research assessed a sample of sixty respondents which formed part of three groups which were recruited from clinical and online support groups. The age ranged from twenty to forty-five years. Non-probability quota sampling was employed. A non-experimental research design was implemented in order to make comparisons between these groups’ association of gastrointestinal symptoms and the occurrence of possible vomiting. The differential research strategy determined whether a statistically significant difference existed. The groups were assessed on the Gastrointestinal Symptom Score (2005) and the Patient Assessment of Upper Gastrointestinal Symptom Severity Index (2004). The research aimed to determine whether empirical support exists for the Cognitive Behavioural Model of Emetophobia by Boschen (2007). / Psychology / M.A. (Psychology)