Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Vagueness is ubiquitous in natural language. It seems incompatible with classical, bivalent logic, which tells us that every statement is either true or false, and none is vaguely true. Yet we do manage to reason using vague natural language. In fact, the majority of our day-to-day reasoning involves vague terms and concepts. There is a puzzle here: how do we perform this remarkable feat of reasoning? I argue that vagueness is a kind of semantic indecision. In short, that means we cannot say exactly who is bald and who is not because we have never decided the precise meaning of the word 'bald'--there are some borderline cases in the middle, which might be bald or might not. That is a popular general strategy for addressing vagueness. Those who use it, however, do not often say what they mean by 'borderline case'. It is most frequently used in a loose way to refer to in-between items: those people who are neither clearly bald nor clearly not bald. But under that loose description, the notion of borderline cases is ambiguous, and some of its possible meanings create serious problems for semantic theories of vagueness.Here, I clarify the notion of a borderline case, so that borderline cases can be used profitably as a key element in a successful theory of vagueness. After carefully developing my account of borderline cases, I demonstrate its usefulness by proposing a theory of vagueness based upon it. My theory, vagueness as permission, explains how classical logic can be used to model even vague natural language.

Background: Borderline personality disorder (BPD) is a psychiatric diagnosis characterized by emotional and behavioural instability, and impaired ability to maintain relationships. Previous research has demonstrated an association between BPD and insecure attachment style. It has been argued that BPD is a disorder of attachment, with insecure attachment being associated with inadequate capacity to represent mental states, or to “mentalize”. There is evidence that people with BPD are impaired in their capacity to mentalize in the context of attachment relationships. The term “mentalization” encompasses a broad range of processes including metacognition. There is a theoretical basis for metacognitive deficits in BPD. However, there is a lack of empirical evidence regarding the role of metacognition in BPD and its relationship to adult attachment style. Method: Participants with BPD were recruited from Community Mental Health Teams, Clinical Psychology and a Dialectal Behaviour Therapy (DBT) service within NHS Highland. A comparison group of participants without BPD were recruited from the Clinical Psychology service, having been referred for symptoms of depression. Both groups were administered the Relationship Scales Questionnaire (RSQ)(a self-report measure of attachment); and a short version of the Metacognitions Questionnaire (MCQ-30). Severity of clinical symptoms and current mood was assessed using the Clinical Outcomes in Routine Evaluation (CORE) and the Hospital Anxiety and Depression Scale (HADS). Results: Participants with BPD scored significantly higher than those without BPD on the attachment-anxiety and attachment-avoidance dimensions of the RSQ. The BPD group also endorsed MCQ-30 items more than the comparison group. There was a significant difference between the groups on the MCQ-30 total score and four of the five subscale scores. There were significant positive correlations between attachment dimension scores and metacognition subscales. The strongest associations were between attachmentanxiety and “uncontrollability and danger” and “need to control thoughts” subscales of the MCQ-30. Only metacognition was predictive of current mood and distress levels. Conclusions: The results of this study show that people with BPD report high attachment-avoidance and attachment-anxiety in their relationships, relative to a non-BPD, depressed comparison group. These findings are consistent with the existing literature regarding the profile of attachment in BPD. This study also found that people with BPD also have more maladaptive metacognitions than people with symptoms of depression. An association between self-reported adult attachment style and maladaptive metacognitiion was demonstrated in the present study. Maladaptive metacognitive strategies and beliefs potentially contribute to maintenance of depressed and anxious mood, as well as broader symptoms of distress.

Women interpersonal chronic trauma survivors are frequently misdiagnosed with borderline personality disorder (BPD) or post traumatic stress disorder (PTSD), which often results in mistreatment. Neither PTSD nor BPD adequately describes the unique character alterations observed among those exposed to prolonged early childhood trauma.  Researchers suggest survivors of interpersonal and chronic trauma should be subsumed under complex PTSD (CPTSD)(MacLean & Gallop, 2003).  The primary purpose of this study was to test the validity of complex PTSD as a construct. MANOVA, ANOVA, chi- Square, and independent samples t- Tests were utilized to test hypotheses. Results revealed that women who experienced higher frequencies of trauma met more CPTSD criteria and had higher mean base rate scores on the Major Depression, Depressive, Avoidant, Masochistic, Anxiety, PTSD, and Borderline scales of the MCMI- III than women who experienced fewer traumas. Additionally, findings suggest that the Major Depression, Depressive, Anxiety, PTSD, and Borderline scales may highlight differences among women interpersonal trauma survivors who meet five of six CPTSD criteria versus those who meet full CPTSD diagnostic criteria. Lastly, the mean Borderline scale score for women who met full CPTSD diagnostic criteria was below the cutoff for personality traits. Overall, these findings provide evidence and validation for the distinction of CPTSD from BPD and PTSD.

Cette étude évalue d’une part, les relations entre la psychopathie (PCL-R) et les troubles de la personnalité (Axe II du DSM) et d’autre part avec le risque de récidive. Un regard particulier est porté sur le trouble Borderline vu son implication en terme de prise en charge (certaines caractéristiques borderline seraient d’un meilleur pronostic). Les résultats montrent qu’il existe un lien entre la psychopathie et la présence des troubles Narcissique, Antisocial, Borderline et Paranoïaque. Contrairement à nos attentes, le trouble Borderline n’atténue pas le niveau de psychopathie (poids des comportements impulsifs). Ces troubles sont aussi associés au risque de récidive et au nombre de délits violents (mais pas au type de délits violents versus non violents). Ces résultats suggèrent qu’impulsions, caractéristiques antisociales, narcissiques et paranoïaques sont essentielles à repérer. Ils soulignent également l’importance de l’évaluation de type clinique et empirique dans la recherche mais aussi dans la pratique clinique à des fins de précision diagnostique et pronostique. / This study assesses firstly, the relations between psychopathy and personality disorders (DSM Axis II) and secondly with the risk for recidivism. A particular interest is related to the Bordeline disorder considering his implication in the treatment (some borderline characteristics would be of a better forecast). The results show a link exists between psychopathy and the presence of Narcissistic, Antisocial, Borderline and Paranoid disorders. Contrary to expected, the Borderline disorder does not reduce the level of psychopathy (importance of the impulsive behaviours). These disorders are also associated with the risk for recidivism and the number of violent offences (but not with the type of offences violent versus non violent). The results suggest that impulses, antisocial, narcissistic and paranoid characteristics are essential to find. The importance of clinical and empirical assessment in research but also in clinical practice for diagnostic and prognostic precision is underlined.

D.Phil. / Please refer to full text to view abstract

Leung, See Wai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 74-81). / Abstracts in English and Chinese. / List of Figures --- p.v / List of Tables --- p.vi / Introduction --- p.1 / Method --- p.15 / Results --- p.22 / Discussion --- p.51 / Conclusion --- p.72 / References --- p.74

Background Borderline Personality Disorder (BPD) is considered to be one of the most debilitating and difficult to treat mental disorders. Traditionally, studies investigating the aetiology and mechanisms associated with the development and exacerbation of BPD have relied on the use of clinical populations. As a consequence, the opportunities to understand vulnerabilities and fundamental processes that may contribute to the development and maintenance of the disorder have been limited. Objectives The aim of this study was to examine the potential interactions and mediating effects of metacognition and emotion regulation on the relationships among different forms of childhood abuse, attachment, and parental bonding with a composite of core BPD features designed to encompass major areas of personality functioning and pathological personality traits (per DSM-5 section III). Method: A non-clinical sample of 695 students in the city of Edinburgh, Scotland took part in an internet survey composed of a battery of self-report measures. This was geared to identify features associated with BPD, emotion regulation difficulties, characteristics of metacognition, adult insecure attachment, fundamental parental bonding styles and signs of childhood maltreatment. Structural Equation Modelling (SEM) was used to analyse the data. Results All variables of interest had a direct effect on the development of features associated with BPD. Metacognition was found to mediate the effects of all three forms of childhood abuse used in the study as well as the effects of adult insecure attachment on the development BPD related traits. Emotion regulation suppression was found to mediate the effects of sexual and physical childhood abuse (but not emotional abuse, adult insecure attachment, parental bonding indifference, or parental bonding overprotection) on the development of borderline features. In addition, the lack of emotion regulation reappraisal was found to mediate the effects of sexual abuse and adult insecure attachment (but not emotional or physical abuse, parental bonding indifference, or parental bonding overprotection) on the development of BPD related traits. Discussion These findings have important clinical and theoretical implications. The results provide support and understanding of the role of mediating mechanisms in the exacerbation and in the development of features associated with BPD. This is important because metacognition and emotion regulation may be more amenable to change than traumatic past experiences and/or deep seeded patterns of attachment. In addition, further development in this area of research has the potential to lead to better and more effective psychotherapeutic treatments for BPD.

Bakgrund: Diagnosen borderline har funnits i snart 100 år men fortfarande finns det brister i omvårdnaden av personer med borderline/emotionell instabil personlighetsstörning. Personer med borderline/emotionell instabil personlighetsstörning upplever att de inte blir tagna på allvar inom vården. När sjuksköterskor uppvisar ett genuint intresse upplevs dock omvårdnaden som stödjande av personer med borderline/emotionell instabil personlighetsstörning. Syfte: Syftet med föreliggande studie är att beskriva vilka omvårdnadsbehov personer med borderline/emotionell instabila personlighetsstörningar upplever sig ha inom psykiatrisk vård. Metod: Semistrukturerade intervjuer genomfördes via telefon med fyra deltagare. Alla var av kvinnligt kön, bosatta i Sverige och hade enligt egen utsago diagnosen borderline. Analysen genomfördes utifrån kvalitativ innehållsanalys med induktiv ansats. Resultat: I resultatet framkom övergripande temat Att ro tillsammans genom stormen. Personerna erfor upplevelser av att inte ha något värde till följd av att bli förnedrade, att inte tas på allvar och att vara i underläge. Detta resulterade i att deltagarna längtade att känna sig betydelsefulla genom att bli sedda som människor och att bli bemötta med kompetens. Slutsats: Personerna längtade efter att få mötas med en medmänsklig värdighet. Detta kan anses som trivialt men då vårdpersonal tillgodoser detta uppkommer en omvårdnad som kan innebära ett livsavgörande stöd för personer med borderline/emotionell instabil personlighetsstörning. Nyckelord: borderline, kvalitativ innehållsanalys, längtan, tidvattenmodellen, underläge, upplevelse.

Persönlichkeit wird zum einen durch genetische Einflüsse, zum anderen durch Erziehung und Umweltfaktoren geprägt. In heutigen Tagen ist es weitestgehend akzeptiert, dass das menschliche Naturell und die Persönlichkeit durch vielfältige genetische Faktoren beeinflusst werden. In der vorliegenden Arbeit wurde eine Genotypisierung an einer Patientenstichprobe, bestehend aus Patienten der Universitätsklinik Würzburg, mit der gesicherten Diagnose einer Persönlichkeitsstörung, und einem Kollektiv aus gesunden Probanden (Bevölkerungskollektiv) durchgeführt. Es wurden zwei verschiedene Gen-Polymorphismen (rs7275707 und rs722557) des Kandidatengens KCNJ6 hinsichtlich ihrer Beteiligung an Persönlichkeitsstörungen untersucht. Das von diesem Gen codierte Protein ist ein G-protein aktivierter einwärtsgleichrichtender Kaliumkanal (GIRK2). Es konnte zwar ein signifikanter Zusammenhang zwischen einem Single-Nukleotid-Polymorphismus (SNP) in dem Kandidatengen KCNJ6 und der antisozialen sowie Borderline-Persönlichkeitsstörung nachgewiesen werden, die molekulargenetischen Entstehungswege bis hin zur phänotypischen Ausprägung der Persönlichkeitsstörung sind allerdings multifaktoriell und an viele Rezeptor- und Neurotransmittersysteme gekoppelt. Der Ursprung kann auf den Austausch bzw. die Variation einer einzelnen Base im DNA-Strang zurückgeführt werden, im Ganzen betrachtet bleiben die Entstehung der Persönlichkeit und die daran gekoppelten Störungen aber ein multidimensionaler Prozess. / Personality of a human beiing is based on the one hand on genetic conditions, on the other hand on education and social environment. Nowadays it is broadly accepted, that human disposition and personality is influenced by a variety of genentic factors. In this study we compared patients with a diagnosis of a personality disorder in comparison to healthy candidates via genotyping. We focused on the role of the two gene polymorphisms (rs 7275707 and rs 722557) of the candidate gene KCNJ6. This gene encodes for an inwardly rectifying potassium channel (GIRK2). Though an association between one single nucleotide polymorphism(SNP) of our candidate gene and the antisocial personality disorder and the Borderline-Disorder was found, the molecular genetic pathways from the origin to the expression of the phenotype is multifactorial and linked to many systems of receptors and neurotransmitters. The origin of a disorder can be explained by the exchange of one base in the DNS, but in total the development of personality and the linked disorders are a multidimensional process.