Thesis (Ph. D.)--Western Conservative Baptist Seminary, 1987. / Typescript. Includes bibliographical references (leaves 102-113).

Dysfunction in interpersonal relationships is central to Borderline Personality Disorder (BPD) and provides the context in which self-harming behaviour, impulsivity and affective liability manifest (Lazarus et al., 2014). A growing evidence base exists for Mentalisation Based Treatment (MBT) in regard to symptom burden and extent of personality disturbance in BPD (Choi-Kain, Albert, & Gunderson, 2016). Less is known about patients’ experience of MBT, potential moderators or the utility of group only MBT. Method: First, a meta-analysis examining the relationship between attachment organisation and BPD diagnosis was conducted. Second, a mixed method design was employed to assess change in interpersonal problems and symptomatic distress following a group only MBT intervention. Potential moderators were examined and patient narratives were elicited and qualitatively analysed. Results: Across 20 studies including 1,948 participants, we found significant, medium to large effect sizes linking BPD to insecure attachment organisation. The largest effect sizes were found for a negative relationship between BPD diagnosis and attachment security, and a positive relationship between BPD and unresolved, anxious and avoidant attachment. The results of the empirical study revealed a significant reduction in interpersonal problems and psychological distress over the course of the intervention. Pre-treatment level of interpersonal problems did not function as a moderator. Patients found the group to be a challenging but rewarding experience. Conclusion: There is a strong relationship between BPD and insecure and disorganised attachment. Less intensive, group only MBT interventions may be effective in reducing levels of interpersonal problems and psychological distress in adults with a diagnosis of BPD.

Professionals in the mental health industry often attach a stigma to Borderline Personality Disorder (BPD). It is commonly thought of as a frustrating disorder to treat. As a result many professionals avoid dealing with BPD individuals. In an attempt to promote positive treatment outcomes, the aim of the study is to explore how the introduction of altruistic behaviours would affect the outcome of the overall treatment of individuals with BPD. Snowball sampling procedures were implemented. Data were collected through the use of semi-structured interviews with six mental health professionals and analysed through qualitative data processing and thematic analysis procedures. To the researcher’s knowledge, no research has been conducted specifically exploring the relationship between altruistic behaviour and BPD to date. The following superordinate themes emerged: treatment challenges, treatment context, treatment approach, diagnostic challenges, altruism/prosocial influences, and altruism/prosocial behaviour. It is the researcher’s hope that the findings of this study will increase awareness of this possible avenue in the treatment of BPD, so that the results of this study can then be taken to the next level of exploration in research and in clinical practice.

Thesis (Ph.D.)--Boston University / Research suggests that "eating disorder not otherwise specified" (EDNOS) is particularly prevalent among individuals with borderline personality disorder (BPD). However, longitudinal data concerning course and predictors of outcome among different subtypes of EDNOS are scarce, particularly with comorbid BPD. The purpose of this study was to examine the longitudinal course of ED NOS subtypes and baseline predictors of outcome of ED NOS over 1 0 years of prospective follow-up in borderline patients. Two hundred and ninety patients who met Revised Diagnostic Interview for Borderlines (DIB-R) and Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised (DSM-111-R) criteria for BPD were followed prospectively over 10 years. Five subtypes of Structured Clinical Interview for DSM-111-R Axis I Disorders (SCID-1) diagnosed EDNOS were identified: subthreshold anorexia nervosa (AN) above the low-weight cut-off; subthreshold AN without loss of menses, subthreshold bulimia nervosa (BN); binge eating disorder (BED); and purging disorder. At baseline, 20% of the sample met criteria for an EDNOS subtype. In the first study, generalized estimating equations were first conducted to determine the prevalence of EDNOS subtypes over time. We used Kaplan-Meier survival analyses to examine time-to-remission, recurrence, and new onsets of the EDNOS subtypes. In the second study, baseline body mass index (BMI), socioeconomic status (SES), global assessment of functioning (GAF), social security disability income (SSOI), polypharmacy, and severity of childhood neglect, sexual abuse, and "other abuse" (e.g., physical, verbal, emotional) were examined as predictors of the course of EDNOS. Findings from the first study indicate that over time, rates of EDNOS were observed to decrease, and remissions were common. Among the EDNOS subtypes, BED was observed to have a particularly slow rate of remission and moderate rates of new onsets. Subthreshold AN without low weight had high rates of recurrence and new onsets. Findings of the second study indicate that borderline patients with EDNOS who were receiving SSDI at baseline were less likely to experience a remission of EDNOS and more likely to experience a recurrence. Additionally, severity of childhood adversity predicted new onsets of EDNOS. Findings suggest that receiving SSOI and severity of childhood adversity importantly impact the course of EDNOS in BPD.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Previous studies indicate that four childhood factors - trauma, neglect, separations, and parental psychopathology, are relevant to the etiology of borderline personality disorder (BPD). The present sought to tease apart the relative strength of relationship between these childhood factors and specific features of BPD in adults. Four hypotheses were tested. The first two are: childhood neglect is the best predictor of the BPD features 1) "chronic feelings of emptiness" and 2) "general anxiety and impulsiveness". The second two are: childhood trauma is the best predictor of 3) "self-destructive behaviors" and 4) "depersonalization and brief psychotic episodes". The sample consisted of sixty-six subjects with borderline, antisocial or schizotypal personality disorder or bipolar type II affective disorder. The latter three groups were used as psychiatric control groups. Subjects were obtained from outpatient mental health settings and advertisements for symptomatic volunteers. Thirty-four subjects met full DSM-III criteria for BPD. Ascertainment of the severity of eleven features of BPD was made using a semi-structured interview (BPD Scale). Childhood and parental psychopathology variables were assessed using semi-structured interviews based on subjects' recollections of childhood experiences. statistical procedures included stepwise multiple regression analyses designed to test the hypotheses and to determine the strongest predictor (s) for each of the remaining BPD features. The results supported all four hypotheses. In addition, the results indicated that childhood trauma was the best predictor of the BPD features "regressive behavior in psychiatric treatment", "anger and hostility in relationships", "overdependence in relationships" and overall severity of borderline psychopathology. Parental psychopathology added significant additional variance to the prediction of "overdependence in relationships" and the overall severity of borderline psychopathology. The findings suggest that, in a group of adults with a range of psychiatric illnesses, specific childhood factors are uniquely associated with specific elements of BPD. Additionally, the findings showed that the four childhood factors were significantly inter-correlated, suggesting that BPD is, in part, the result of multiple developmental factors. / 2999-01-01

A clínica psicanalítica contemporânea está desafiada a responder a condições emocionais marcadas por estados de solidão, desamparo, desorganização e enfraquecimento da experiência de alteridade, que podem se expressar nos chamados pacientes fronteiriços (borderline). Nesses estados psicopatológicos, descritos na literatura psicanalítica desde a década de 1930, há um componente central que se destaca e que inspirou a presente investigação. Trata-se da angústia de perda de objeto e da busca desesperada pelo outro na esperança de aplacar estados gravemente desestruturantes. Esta tese apresenta ponderações teóricas sobre esses pacientes a partir de importantes autores da psicanálise, além de uma revisão da literatura disponível em bases de dados relevantes, abrangendo pesquisas realizadas nos dez últimos anos sobre adicção e pacientes fronteiriços. Realizada a partir desse aprofundado estudo teórico, esta pesquisa teve o duplo objetivo de refletir sobre a forma de relacionamento estabelecida pelos pacientes fronteiriços e de ampliar a compreensão do drama contido nesse sofrimento. A investigação caracteriza-se como pesquisa psicanalítica qualitativa, desenvolvida com estudo de três casos clínicos: uma mulher de 41 anos, um adolescente de 14 e um homem de 32. Todos foram atendidos em contexto de psicoterapia psicanalítica individual, assim como todas as etapas da pesquisa ocorreram sustentadas pelo método psicanalítico, desde a produção, o registro e o tratamento do material, apresentado na forma de narrativas. Evidenciou-se a predominância de relacionamentos adictivos como marca proeminente da dinâmica dos três casos estudados. Tal dinâmica se manifestou intensamente na relação terapêutica e em outros vínculos na vida dessas pessoas, como se observou pelo relato dos pacientes. Considerando a história e os desenvolvimentos próprios de cada pessoa, esta pesquisa confirmou proposições de autores clássicos da psicanálise, bem como resultados de estudos mais atuais. A pesquisa trouxe, ainda, considerações que favoreceram a compreensão da dinâmica e da estrutura de personalidade de cada uma dessas pessoas, evidenciando- se a necessidade de serem acolhidas, compreendidas e tratadas, em função do intenso sofrimento e da extrema dificuldade que vivem / The contemporary clinic is challenged to respond to emotional conditions marked by loneliness states, helplessness, disorganization and weakening of otherness experience, which can be expressed in so-called borderline patients. These psychopathological states, described in psychoanalytic literature since the 1930s, there is a central component that stands out and that inspired this research. It is the anguish of loss of the object and desperate search for another in the hope of placating seriously destabilizing states. We present theoretical placements on these patients from important authors of psychoanalysis, as well as inserting a research literature review conducted in the last ten years of addiction and borderline patients in different databases. From this in-depth theoretical study, this research was conducted in order to reflect on the type of relationship established by the border patients, aiming further broaden the understanding of the drama contained in this suffering. The research is characterized as qualitative psychoanalytic research, developed a study of three clinical cases, a woman of 41, a adolecent of 14 and a man of 32. All were treated in individual psychoanalytic psychotherapy context, as well as all stages of search occurred supported by the psychoanalytic method from the generation, recording and processing of the material presented in the form of narratives. Showed the predominance of addictive relationships as a prominent mark of the dynamics of the three cases studied, which is strongly expressed in the therapeutic relationship, and as noted by the report, other links in their lives. Considering the history and own developments of each person, this research confirmed placements of classical authors of psychoanalysis, as well as the most recent research results. The research has also considerations that favored the understanding of the dynamics and personality structure of each of these people, demonstrating the need to be accepted, understood and treated, due to the intense suffering and extreme difficulty living

A clínica psicanalítica contemporânea está desafiada a responder a condições emocionais marcadas por estados de solidão, desamparo, desorganização e enfraquecimento da experiência de alteridade, que podem se expressar nos chamados pacientes fronteiriços (borderline). Nesses estados psicopatológicos, descritos na literatura psicanalítica desde a década de 1930, há um componente central que se destaca e que inspirou a presente investigação. Trata-se da angústia de perda de objeto e da busca desesperada pelo outro na esperança de aplacar estados gravemente desestruturantes. Esta tese apresenta ponderações teóricas sobre esses pacientes a partir de importantes autores da psicanálise, além de uma revisão da literatura disponível em bases de dados relevantes, abrangendo pesquisas realizadas nos dez últimos anos sobre adicção e pacientes fronteiriços. Realizada a partir desse aprofundado estudo teórico, esta pesquisa teve o duplo objetivo de refletir sobre a forma de relacionamento estabelecida pelos pacientes fronteiriços e de ampliar a compreensão do drama contido nesse sofrimento. A investigação caracteriza-se como pesquisa psicanalítica qualitativa, desenvolvida com estudo de três casos clínicos: uma mulher de 41 anos, um adolescente de 14 e um homem de 32. Todos foram atendidos em contexto de psicoterapia psicanalítica individual, assim como todas as etapas da pesquisa ocorreram sustentadas pelo método psicanalítico, desde a produção, o registro e o tratamento do material, apresentado na forma de narrativas. Evidenciou-se a predominância de relacionamentos adictivos como marca proeminente da dinâmica dos três casos estudados. Tal dinâmica se manifestou intensamente na relação terapêutica e em outros vínculos na vida dessas pessoas, como se observou pelo relato dos pacientes. Considerando a história e os desenvolvimentos próprios de cada pessoa, esta pesquisa confirmou proposições de autores clássicos da psicanálise, bem como resultados de estudos mais atuais. A pesquisa trouxe, ainda, considerações que favoreceram a compreensão da dinâmica e da estrutura de personalidade de cada uma dessas pessoas, evidenciando- se a necessidade de serem acolhidas, compreendidas e tratadas, em função do intenso sofrimento e da extrema dificuldade que vivem / The contemporary clinic is challenged to respond to emotional conditions marked by loneliness states, helplessness, disorganization and weakening of otherness experience, which can be expressed in so-called borderline patients. These psychopathological states, described in psychoanalytic literature since the 1930s, there is a central component that stands out and that inspired this research. It is the anguish of loss of the object and desperate search for another in the hope of placating seriously destabilizing states. We present theoretical placements on these patients from important authors of psychoanalysis, as well as inserting a research literature review conducted in the last ten years of addiction and borderline patients in different databases. From this in-depth theoretical study, this research was conducted in order to reflect on the type of relationship established by the border patients, aiming further broaden the understanding of the drama contained in this suffering. The research is characterized as qualitative psychoanalytic research, developed a study of three clinical cases, a woman of 41, a adolecent of 14 and a man of 32. All were treated in individual psychoanalytic psychotherapy context, as well as all stages of search occurred supported by the psychoanalytic method from the generation, recording and processing of the material presented in the form of narratives. Showed the predominance of addictive relationships as a prominent mark of the dynamics of the three cases studied, which is strongly expressed in the therapeutic relationship, and as noted by the report, other links in their lives. Considering the history and own developments of each person, this research confirmed placements of classical authors of psychoanalysis, as well as the most recent research results. The research has also considerations that favored the understanding of the dynamics and personality structure of each of these people, demonstrating the need to be accepted, understood and treated, due to the intense suffering and extreme difficulty living

Na clínica contemporânea, percebe-se que as compulsões, as patologias do agir e a experiência de vazio estão cada vez mais presentes, contaminadas pela pressão de ideais de consumo ou constituídas sob a égide desses ideais, na promessa de completude presente nos valores atuais da cultura. Tais manifestações tornam-se ainda mais evidentes com a erupção de formas de sofrimento marcadas pela repetição de experiências dolorosas que limitam e empobrecem a vida dessas pessoas. Nesse contexto, quadros clínicos como a personalidade borderline e as adicções ganham relevância e exigem dos profissionais do campo da saúde mental produções acadêmicas para maior compreensão e cuidado desses fenômenos psicopatológicos. Frente a isto, o objetivo desta pesquisa consistiu em refletir sobre a relação entre as denominadas personalidades borderline e as adicções, a partir de uma investigação fundamentada em uma leitura psicanalítica. Pretende-se ainda enriquecer os instrumentos teórico-clínicos de que se dispõe, de forma a favorecer uma maior compreensão diagnóstica, imprescindível no manejo desses casos. Para tanto, esses conceitos foram estudados a partir da leitura hermenêutica entendida como construção dialética de conhecimento numa relação de intersubjetividade com as condições de sofrimento que podem ser agrupadas sob as nomeações aqui referidas e ilustradas através da utilização de material clínico. A noção de relação adictiva foi utilizada como conceito articulador, pois comporta elementos centrais da dinâmica psíquica própria das adicções e da personalidade borderline. A partir desse estudo, formulou-se a proposta de compreensão da organização borderline de personalidade como uma modalidade de adicção, cujo objeto é uma pessoa, mesmo que coisificada / Compulsive behavior, acting out pathologies and feelings of emptiness are increasingly frequent in contemporary psychoanalytical practice. Such symptoms are contaminated or even brought forth by the pressure of strongly rooted ideals of current culture regarding consumerism and its void promises of providing inner fulfillment. The result becomes even more evident in the outbursts of modern-day ways of suffering characterized by the repetition of painful experiences that limit and deplete the lives of these patients. Hence the understanding of clinical diagnosis and treatment of disorders such as addictions and borderline personality syndrome becomes an important academic requirement for mental health professionals. The goal of this research is therefore to reflect on the relation between borderline personality and addictions from a psychoanalytical perspective and thus, through the development of both theoretical and clinical knowledge, contribute to improve diagnosis, which is essential for the handling of such cases. In order to achieve such goals, these concepts have been studied from a hermeneutic approach understood as a dialectic construction of knowledge , with great attention to relations of intersubjectivity between them and conditions of suffering that may be brought together under the classification referred here. Additionally, those ideas have also been illustrated by clinical observations. The notion of addictive relations has proved to be a valuable starting point in the articulation of these studies, since it contains essential elements of the mental dynamics of patients suffering both from addictions and borderline personality syndrome. This study gave rise to the understanding of borderline personality as a modality of addiction in which the object is a person, although most probably objectified

Na clínica contemporânea, percebe-se que as compulsões, as patologias do agir e a experiência de vazio estão cada vez mais presentes, contaminadas pela pressão de ideais de consumo ou constituídas sob a égide desses ideais, na promessa de completude presente nos valores atuais da cultura. Tais manifestações tornam-se ainda mais evidentes com a erupção de formas de sofrimento marcadas pela repetição de experiências dolorosas que limitam e empobrecem a vida dessas pessoas. Nesse contexto, quadros clínicos como a personalidade borderline e as adicções ganham relevância e exigem dos profissionais do campo da saúde mental produções acadêmicas para maior compreensão e cuidado desses fenômenos psicopatológicos. Frente a isto, o objetivo desta pesquisa consistiu em refletir sobre a relação entre as denominadas personalidades borderline e as adicções, a partir de uma investigação fundamentada em uma leitura psicanalítica. Pretende-se ainda enriquecer os instrumentos teórico-clínicos de que se dispõe, de forma a favorecer uma maior compreensão diagnóstica, imprescindível no manejo desses casos. Para tanto, esses conceitos foram estudados a partir da leitura hermenêutica entendida como construção dialética de conhecimento numa relação de intersubjetividade com as condições de sofrimento que podem ser agrupadas sob as nomeações aqui referidas e ilustradas através da utilização de material clínico. A noção de relação adictiva foi utilizada como conceito articulador, pois comporta elementos centrais da dinâmica psíquica própria das adicções e da personalidade borderline. A partir desse estudo, formulou-se a proposta de compreensão da organização borderline de personalidade como uma modalidade de adicção, cujo objeto é uma pessoa, mesmo que coisificada / Compulsive behavior, acting out pathologies and feelings of emptiness are increasingly frequent in contemporary psychoanalytical practice. Such symptoms are contaminated or even brought forth by the pressure of strongly rooted ideals of current culture regarding consumerism and its void promises of providing inner fulfillment. The result becomes even more evident in the outbursts of modern-day ways of suffering characterized by the repetition of painful experiences that limit and deplete the lives of these patients. Hence the understanding of clinical diagnosis and treatment of disorders such as addictions and borderline personality syndrome becomes an important academic requirement for mental health professionals. The goal of this research is therefore to reflect on the relation between borderline personality and addictions from a psychoanalytical perspective and thus, through the development of both theoretical and clinical knowledge, contribute to improve diagnosis, which is essential for the handling of such cases. In order to achieve such goals, these concepts have been studied from a hermeneutic approach understood as a dialectic construction of knowledge , with great attention to relations of intersubjectivity between them and conditions of suffering that may be brought together under the classification referred here. Additionally, those ideas have also been illustrated by clinical observations. The notion of addictive relations has proved to be a valuable starting point in the articulation of these studies, since it contains essential elements of the mental dynamics of patients suffering both from addictions and borderline personality syndrome. This study gave rise to the understanding of borderline personality as a modality of addiction in which the object is a person, although most probably objectified

Made available in DSpace on 2016-04-28T20:40:05Z (GMT). No. of bitstreams: 1 Natalie de Jesus Santana Bedoya.pdf: 629363 bytes, checksum: aa66743f55a082a44f1014a3ae43535c (MD5) Previous issue date: 2009-06-01 / In post-modernity, the psychoanalytical practice has been facing the challenge of dealing with changes in subjectivity and new psychopathological disorders. In this scenario, it comes the Borderline patient, bringing up challenges and opportunities in psychoanalysis that are gaining more relevance in the clinical and scientific discussions of the country, requiring analysts dedication to reflect on how to handle this sort of patiens within the clinical practice. Given this reality and in search for a more clinically effective approach, the objective of this survey was to deepen the current insights on the Borderline Personality disorder, with the intention of undertanding specific aspects of transference and countertransference demand that are experienced in the psychoanalysis process. This work was accomplished through a qualitative approach based on the clinical method of psychoanalysis, following the theoretical framework of Donald Winnicott. Having reflected on how to manage a borderline case, this survey outlines specific issues concerning transference and countertransference. It was observed that the problem lies at the confluence of the existential suffering of the patient and the countertransferencial suffering of the analyst, that requires professional sensitivity so as to ensure an appropriate approach aligned with the patient needs, indeed considering its own limits. In sum, the analysis process should be oriented to provide the patient a more integrated self / Na pós-modernidade, a clínica psicanalítica vem se deparando com o desafio de lidar com mudanças na subjetividade e novas formações psicopatológicas. Neste cenário, está o paciente borderline, cujos desafios e possibilidades no atendimento vêm ganhando cada vez mais espaço nos meios clínicos e científicos do país e exigindo dos analistas tempo para refletir sobre como manejá-los clinicamente. Diante desta realidade e em busca de uma clínica mais efetiva, o objetivo deste trabalho foi aprofundar o estudo acerca do Transtorno de Personalidade Borderline, para compreender aspectos específicos da demanda transferencial e da contratransferência experimentados nesse atendimento. Tratou-se de um trabalho de abordagem qualitativa, baseado no método clínico da psicanálise, seguindo o referencial teórico winnicottiano. Ao refletir sobre o manejo do borderline, foram sublinhadas demandas específicas assentadas nas questões da transferência e da contratransferência. Observou-se que a problemática reside na confluência do sofrimento existencial deste paciente com o sofrimento contratransferencial do analista, exigindo do profissional sensibilidade para a realização de um manejo ajustado às necessidades de cada paciente, considerando também seus próprios limites. Desta forma, a análise funcionaria como um caminho para a construção de um self mais integrado