This dissertation examines how the nature, extent, and consequences of mass supervision shape the health outcomes of individuals living under parole and probation. It addresses gaps within the geography literature concerning systems of parole and probation, as well as offering a contribution to examinations of the health impacts associated with these pervasive forms of carceral control. Using qualitative approaches, I explore the following research questions: 1) What are the structural conditions through which mass supervision impacts individual and community health? 2) How are structural dimensions of mass supervision experienced, and how might these embodied experiences shape pathways to ill-health? 3) How might the health impacts of mass supervision relate to processes of racial formation? In answering these questions this study draws on and synthesizes literatures from carceral geographies, biosocial theory and theories of racial capitalism. Key to understanding the health impacts of supervision is an integrated analysis of both the structural and the embodied and experiential pathways. By examining the impacts of and interrelations between these pathways, this study provides important context for the development of future research into persistent health inequities and the role of carceral control in spatial, political-economic and racial processes. / Geography

Bakgrund: Självskadebeteende är ett allvarligt problem som förekommer idag. Under senare år har vårdgivare inom hälso- och sjukvården uppmärksammat en ökning av detta problem som leder till fysiska och psykiska hälsobesvär. Dessa hälsobesvär kan förekomma i form av exempelvis depression, fysiska skador och kan i värsta fall leda till självmord. En form av terapi som visat sig ge goda resultat för att komma till rätta med detta beteende är DBT, dialektisk beteendeterapi. Syfte: Att undersöka om DBT- terapeuters beskrivning av sitt arbete med dialektisk beteendeterapi stämmer överens med litteraturens beskrivning av behandlingen, och därmed uppnå en fördjupning i dialektisk beteendeterapi och självskadebeteende. Metod: En kvalitativ studie med sex stycken semistrukturerade intervjuer med DBT- terapeuter har genomförts. Analysen har utförts med hjälp av kvalitativ innehållsanalys. Resultat: Resultatet har delats upp i två huvudkategorier: arbetsmetod samt terapeuter och andra vårdgivares bemötande av patienter. I resultatet framkommer det hur en DBT- behandling stegvis ser ut samt vikten av ett gott bemötande av patienter. Ett gott bemötande omfattar bland annat ett respektfullt och icke- dömande förhållningssätt. Konklusion: Resultaten i studien bekräftar resultaten från den tidigare forskningen. Dock krävs det mer forskning om DBT som behandlingsmetod för att kunna dra tillförlitligare och säkrare slutsatser. Genom att arbeta med behandling av självskadebeteende kan individers hälsa förbättras, vilket i sin tur även kan leda till minskning av antalet självmord och psykisk ohälsa. / Background: Self- harm behavior is a serious problem that occurs today. In recent years care providers in the health-care have noticed an increase of this problem that leads to physical and mental health- problems. These health- problems can occur, for example, in the form of depression, physical harms and can lead to suicide in worst case. A form of therapy that has been shown to give good results to manage this behavior is DBT, dialectical behavior therapy. Aim: To investigate whether DBT- therapist’s description of their work with dialectical behavior therapy is consistent with the literature’s description of the treatment, and thereby achieve a deepening in dialectical behavior therapy and self- harm behavior. Method: A qualitative research with six semi-structured interviews with DBT- therapists have been implemented. The analysis has been done using a qualitative content analysis. Results: The result has been divided into two main categories: working- method and therapist’s and other care provider’s treatment of patients. It appears in the result how a DBT- treatment looks like, step- by step, and the importance of a good treatment of patients. A good treatment includes a respectful and non- judgemental attitude. Conclusion: The results in the study confirms the results from the recent research. However, more research on DBT as a treatment is necessary, in order to make stronger and more reliable conclusions. People’s health can be improved by working with treatment of self- harm behavior, which also can lead to a reduction in the number of suicide and mental illness.

Borderline Personality Disorder (BPD), as defined by the DSM-IV-TR (APA, 2000), is a multifaceted mental illness characterized by pervasive instability of interpersonal relationships, self-image, affect and behavior. Despite a growing consensus that the etiological basis of BPD stems from a combination of biological vulnerability and an early developmental history characterized by invalidation, abuse and/or neglect (e.g., Clarkin, Marziali, & Munroe-Blum, 1991; Linehan, 1993), the reasons for the diversity of troubling symptoms (e.g., self-injury, suicidality, mood reactivity, relationship difficulties) remain unclear. Psychopathology theorists differ in their conceptualization of the fundamental problems (e.g., impulsivity vs. identity disturbance vs. emotion dysregulation) underlying BPD and further research is needed to clarify which features are central to the maintenance of the difficulties associated with the disorder. In the current research, the some of the tenets of Linehan’s (1993) biosocial theory of BPD and the core constructs implicated in her conceptualization of the disorder were explored empirically in several samples of undergraduate university students. According to the biosocial theory, difficulties regulating emotions represent the core pathology in the disorder and contribute causally to the development and expression of all other BPD features. The emotional dysregulation is proposed to emerge from transactional interactions between individuals with biological vulnerabilities (i.e., a highly arousable temperament, sensitive to both positive and negative emotional stimuli) and specific environmental influences (i.e., a childhood environment that invalidates their emotional experience). The theory asserts that the dysregulation affects all aspects of emotional responding, resulting in (i) heightened emotional sensitivity, (ii) intense and more frequent responses to emotional stimuli, and (iii) slow return to emotional baseline. Furthermore, Linehan proposed that individuals with BPD lack clarity with respect to their emotions, have difficulties tolerating intense affect, and engage in maladaptive and inadequate emotion modulation strategies. As a result of their dysfunctional response patterns during emotionally challenging events , individuals with BPD fail to learn how to solve the problems contributing to these emotional reactions. In accordance with this theory, a number of hypotheses were tested. First, it was hypothesized that the interaction between temperamental sensitivity and an adverse childhood environment would predict BPD features over and above that predicted by either construct independently. Second, it was hypothesized that BPD traits would be predicted by high levels of emotional dysregulation (affect lability), problems across different aspects of emotional experience (e.g., intensity, awareness, clarity), and deficits in emotion regulation skills (e.g., poor distress tolerance, self-soothing). Based on the initial findings of the research, a series of competing hypotheses were tested that addressed the nature of the emotional, cognitive and motivational mechanisms that may underlie maladaptive behavior in BPD more directly. Prior to testing these hypotheses, it was important to select a set of measures that would best represent these constructs within an undergraduate population. The purpose of Studies 1a and 1b (N = 147 and N = 56, respectively) was to determine the reliability and validity of a series of self-report measures that assess BPD features and to select one questionnaire with high sensitivity (percentage of cases correctly identified) and high specificity (percentage of noncases correctly identified) as a screener for BPD within undergraduate students by comparing the results of the questionnaires against a “gold standard” criterion diagnosis of BPD (as assessed by two semi-structured interviews: DIB-R and IPDE-I). The second goal of these studies was to conduct a preliminary exploratory analysis of the association of scores on the BPD measures and constructs that have been hypothesized to be relevant to the development and maintenance of BPD symptoms (e.g., “Big Five” personality factors, emotional experience, impulsivity). Overall, the findings of Studies 1a and 1b indicated that screening for BPD in an undergraduate population is feasible and there are several questionnaires that may help in the identification of participants for future studies. Specifically, the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD; Zanarini et al., 2003), International Personality Disorder Examination DSM-IV Screening Questionnaire (IPDE-S; Loranger, 1999) and Borderline Personality Questionnaire (BPQ; Poreh et al., 2006) were all found to be internally consistent and valid screening measures. Furthermore, the results of correlation and regression analyses between dimensions of the “Big Five” and scores on the BPD measures were consistent with previous findings in the literature that BPD is associated with higher scores on neuroticism, lower scores on agreeableness, and to a lesser degree, lower scores on conscientiousness and extraversion. The similarity in results between the current and past studies suggested that individuals in the present samples showed characteristics consistent with that seen in both clinical and nonclinical populations with BPD traits. The results also provided support for the notion that individuals with BPD have a lower threshold (i.e., greater sensitivity) for both sensory and affective stimuli, as well as higher amplitude of emotional response (i.e., greater reactivity) to such stimuli. Furthermore, the findings suggested that those with BPD traits may lack understanding of their emotional state, may be unable to effectively regulate their emotional state, and that their impulsive behavior may be driven by negative affect. The purpose of Study 2 (N = 225) was to test some of the specific tenets of Linehan’s (1993) biosocial theory. The results suggested that BPD traits are associated with numerous dimensions of temperament [e.g., higher levels of negative affect; lower levels of positive affect; lower levels of effortful control; low sensory threshold (i.e., greater sensitivity) for both sensory and affective stimuli; ease of excitation (i.e., greater reactivity to sensory and affective stimuli)] and childhood environment (e.g., authoritarian parenting style, invalidating parenting, neglect, abuse). An examination of the interactions between dimensions of temperament and childhood environment suggested that interactions between (i) ease of excitation (greater reactivity to sensory and affective stimuli) and environment and (ii) trait negative affect and environment, predicted BPD symptoms over and above the temperament and environment variables alone. The results also suggested that a number of other factors are associated with BPD symptoms, including: increased attention to (or absorption in) emotional states, poor emotional clarity, affect lability (particularly anger), poor distress tolerance, and negative urgency (impulsive behavior in the context of negative affect). The association between BPD symptoms and difficulties identifying feelings seemed to be mediated by affect lability and negative urgency. Self-soothing and self-attacking did not predict BPD traits over and above the other variables. Wagner and Linehan (1999) also proposed that the intense emotions (and emotional dysregulation) experienced by those with BPD interferes with cognitive functioning and effective problem solving, resulting in poor decisions and the observed harmful behaviors. Other researchers have suggested that the repetitive, self-damaging behavior occurring in the context of BPD may reflect impairments in planning and failure to consider future consequences (e.g., van Reekum et al., 1994). Proponents of this view suggest that individuals with BPD show greater intensity and lability in their emotional response to their environment because they are unable to inhibit or moderate their emotional urges (i.e., impulsivity is at the core of the disorder). The purpose of Study 3 (N = 220) was to characterize decision making in an undergraduate sample of individuals with BPD traits and to ascertain the relative contribution of individual differences in the following areas to any deficits identified in decision making: emotional experience (e.g., increased affective reactivity or lability); reinforcement sensitivity (e.g., sensitivity to reward and/or punishment); impulsivity; executive functioning (measured by an analogue version of the Wisconsin Card Sorting Test); and reversal learning. Decision making was assessed using modified versions of two Iowa Gambling Tasks (IGT-ABCD and IGT-EFGH; Bechara, Damasio, Damasio, & Anderson, 1994; Bechara, Tranel, & Damasio, 2000) that included reversal learning components (i.e., Turnbull et al., 2006). The results of Study 3 showed that participants in the BPD group demonstrated deficits in decision-making as measured by the IGT-ABCD but not on the IGT-EFGH. The results [interpreted in the context of reinforcement sensitivity models, the somatic marker hypothesis (Damasio, 1994) and the “frequency of gain” model e.g., Chiu et al. 2008)] suggested that decision making under uncertainty may be guided by gain-loss frequency rather than long-term outcome for individuals with BPD traits. The results failed to show consistent associations between BPD symptoms and performance on either version of the IGT. Individual differences in emotional experience, executive functioning or reversal learning did not account for the decision-making problems of the BPD group on the IGT-ABCD.

Borderline Personality Disorder (BPD), as defined by the DSM-IV-TR (APA, 2000), is a multifaceted mental illness characterized by pervasive instability of interpersonal relationships, self-image, affect and behavior. Despite a growing consensus that the etiological basis of BPD stems from a combination of biological vulnerability and an early developmental history characterized by invalidation, abuse and/or neglect (e.g., Clarkin, Marziali, & Munroe-Blum, 1991; Linehan, 1993), the reasons for the diversity of troubling symptoms (e.g., self-injury, suicidality, mood reactivity, relationship difficulties) remain unclear. Psychopathology theorists differ in their conceptualization of the fundamental problems (e.g., impulsivity vs. identity disturbance vs. emotion dysregulation) underlying BPD and further research is needed to clarify which features are central to the maintenance of the difficulties associated with the disorder. In the current research, the some of the tenets of Linehan’s (1993) biosocial theory of BPD and the core constructs implicated in her conceptualization of the disorder were explored empirically in several samples of undergraduate university students. According to the biosocial theory, difficulties regulating emotions represent the core pathology in the disorder and contribute causally to the development and expression of all other BPD features. The emotional dysregulation is proposed to emerge from transactional interactions between individuals with biological vulnerabilities (i.e., a highly arousable temperament, sensitive to both positive and negative emotional stimuli) and specific environmental influences (i.e., a childhood environment that invalidates their emotional experience). The theory asserts that the dysregulation affects all aspects of emotional responding, resulting in (i) heightened emotional sensitivity, (ii) intense and more frequent responses to emotional stimuli, and (iii) slow return to emotional baseline. Furthermore, Linehan proposed that individuals with BPD lack clarity with respect to their emotions, have difficulties tolerating intense affect, and engage in maladaptive and inadequate emotion modulation strategies. As a result of their dysfunctional response patterns during emotionally challenging events , individuals with BPD fail to learn how to solve the problems contributing to these emotional reactions. In accordance with this theory, a number of hypotheses were tested. First, it was hypothesized that the interaction between temperamental sensitivity and an adverse childhood environment would predict BPD features over and above that predicted by either construct independently. Second, it was hypothesized that BPD traits would be predicted by high levels of emotional dysregulation (affect lability), problems across different aspects of emotional experience (e.g., intensity, awareness, clarity), and deficits in emotion regulation skills (e.g., poor distress tolerance, self-soothing). Based on the initial findings of the research, a series of competing hypotheses were tested that addressed the nature of the emotional, cognitive and motivational mechanisms that may underlie maladaptive behavior in BPD more directly. Prior to testing these hypotheses, it was important to select a set of measures that would best represent these constructs within an undergraduate population. The purpose of Studies 1a and 1b (N = 147 and N = 56, respectively) was to determine the reliability and validity of a series of self-report measures that assess BPD features and to select one questionnaire with high sensitivity (percentage of cases correctly identified) and high specificity (percentage of noncases correctly identified) as a screener for BPD within undergraduate students by comparing the results of the questionnaires against a “gold standard” criterion diagnosis of BPD (as assessed by two semi-structured interviews: DIB-R and IPDE-I). The second goal of these studies was to conduct a preliminary exploratory analysis of the association of scores on the BPD measures and constructs that have been hypothesized to be relevant to the development and maintenance of BPD symptoms (e.g., “Big Five” personality factors, emotional experience, impulsivity). Overall, the findings of Studies 1a and 1b indicated that screening for BPD in an undergraduate population is feasible and there are several questionnaires that may help in the identification of participants for future studies. Specifically, the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD; Zanarini et al., 2003), International Personality Disorder Examination DSM-IV Screening Questionnaire (IPDE-S; Loranger, 1999) and Borderline Personality Questionnaire (BPQ; Poreh et al., 2006) were all found to be internally consistent and valid screening measures. Furthermore, the results of correlation and regression analyses between dimensions of the “Big Five” and scores on the BPD measures were consistent with previous findings in the literature that BPD is associated with higher scores on neuroticism, lower scores on agreeableness, and to a lesser degree, lower scores on conscientiousness and extraversion. The similarity in results between the current and past studies suggested that individuals in the present samples showed characteristics consistent with that seen in both clinical and nonclinical populations with BPD traits. The results also provided support for the notion that individuals with BPD have a lower threshold (i.e., greater sensitivity) for both sensory and affective stimuli, as well as higher amplitude of emotional response (i.e., greater reactivity) to such stimuli. Furthermore, the findings suggested that those with BPD traits may lack understanding of their emotional state, may be unable to effectively regulate their emotional state, and that their impulsive behavior may be driven by negative affect. The purpose of Study 2 (N = 225) was to test some of the specific tenets of Linehan’s (1993) biosocial theory. The results suggested that BPD traits are associated with numerous dimensions of temperament [e.g., higher levels of negative affect; lower levels of positive affect; lower levels of effortful control; low sensory threshold (i.e., greater sensitivity) for both sensory and affective stimuli; ease of excitation (i.e., greater reactivity to sensory and affective stimuli)] and childhood environment (e.g., authoritarian parenting style, invalidating parenting, neglect, abuse). An examination of the interactions between dimensions of temperament and childhood environment suggested that interactions between (i) ease of excitation (greater reactivity to sensory and affective stimuli) and environment and (ii) trait negative affect and environment, predicted BPD symptoms over and above the temperament and environment variables alone. The results also suggested that a number of other factors are associated with BPD symptoms, including: increased attention to (or absorption in) emotional states, poor emotional clarity, affect lability (particularly anger), poor distress tolerance, and negative urgency (impulsive behavior in the context of negative affect). The association between BPD symptoms and difficulties identifying feelings seemed to be mediated by affect lability and negative urgency. Self-soothing and self-attacking did not predict BPD traits over and above the other variables. Wagner and Linehan (1999) also proposed that the intense emotions (and emotional dysregulation) experienced by those with BPD interferes with cognitive functioning and effective problem solving, resulting in poor decisions and the observed harmful behaviors. Other researchers have suggested that the repetitive, self-damaging behavior occurring in the context of BPD may reflect impairments in planning and failure to consider future consequences (e.g., van Reekum et al., 1994). Proponents of this view suggest that individuals with BPD show greater intensity and lability in their emotional response to their environment because they are unable to inhibit or moderate their emotional urges (i.e., impulsivity is at the core of the disorder). The purpose of Study 3 (N = 220) was to characterize decision making in an undergraduate sample of individuals with BPD traits and to ascertain the relative contribution of individual differences in the following areas to any deficits identified in decision making: emotional experience (e.g., increased affective reactivity or lability); reinforcement sensitivity (e.g., sensitivity to reward and/or punishment); impulsivity; executive functioning (measured by an analogue version of the Wisconsin Card Sorting Test); and reversal learning. Decision making was assessed using modified versions of two Iowa Gambling Tasks (IGT-ABCD and IGT-EFGH; Bechara, Damasio, Damasio, & Anderson, 1994; Bechara, Tranel, & Damasio, 2000) that included reversal learning components (i.e., Turnbull et al., 2006). The results of Study 3 showed that participants in the BPD group demonstrated deficits in decision-making as measured by the IGT-ABCD but not on the IGT-EFGH. The results [interpreted in the context of reinforcement sensitivity models, the somatic marker hypothesis (Damasio, 1994) and the “frequency of gain” model e.g., Chiu et al. 2008)] suggested that decision making under uncertainty may be guided by gain-loss frequency rather than long-term outcome for individuals with BPD traits. The results failed to show consistent associations between BPD symptoms and performance on either version of the IGT. Individual differences in emotional experience, executive functioning or reversal learning did not account for the decision-making problems of the BPD group on the IGT-ABCD.