Objective: Deliberate foreign body ingestion (DFBI) has been reported in patients with personality disorders as part of a spectrum of self-harming behaviours, however the published literature is small (15 case reports...Objective: Deliberate foreign body ingestion (DFBI) has been reported in patients with personality disorders as part of a spectrum of self-harming behaviours, however the published literature is small (15 case reports). Method: This was a retrospective audit of medical and psychological management of a cluster of 12 DFBI incidents over 9 months in 4 young female patients with Borderline Personality Disorder (BPD). Results: All four patients knew one another from outpatient psychotherapy programmes. DFBI was associated with substance use in 5/12 incidents, and with precipitants (experiencing strong emotions, witnessing self-harm) in 4/12 incidents. Most DFBI involved sharp objects (razor blades, glass, safety pins). Medical intervention was initially active (endoscopy/surgery) but progressed to a more conservative, observational approach. Psychological management was initially restrictive, but also changed over time to focus on identifying distress, enhancing coping mechanisms and patient responsibility. Co-ordination of patient care management involvedintensive liaison (provision of interdisciplinary support and education) between medical, surgical and psychiatric teams. Conclusion: Management of DFBI in patients with BPD requires high levels of interdisciplinary collaboration. In this cluster of DFBI incidents, effective management was achieved with conservative medical/surgical methods (observation) and non-restrictive psychological approaches that enhanced patient self-efficacy.展开更多
Personality disorders are a class of mental disorders involving enduring maladaptive patterns of behaving,thinking,and feeling which profoundly affect functioning,inner experience,and relationships.This work focuses o...Personality disorders are a class of mental disorders involving enduring maladaptive patterns of behaving,thinking,and feeling which profoundly affect functioning,inner experience,and relationships.This work focuses on three Cluster B personality disorders(PDs)(Borderline,Narcissistic,and Antisocial PDs),specifically illustrating how relational dysfunction manifests in each condition.People with Borderline Personality Disorder(BPD)experience pervasive instability in mood,behavior,self-image,and interpersonal patterns.In relationships,they tend to alternate between extremes of over-idealization and devaluation.Intense fear of abandonment,fluctuating affect,inappropriate anger,and black/white thinking deeply influence how they navigate personal relationships,which are often unstable,chaotic,dramatic,and ultimately destructive.They have a fundamental incapacity to self-soothe the explosive emotional states they experience as they oscillate between fears of engulfment and abandonment.This leads to unpredictable,harmful,impulsive behavior and chronic feelings of insecurity,worthlessness,shame,and emptiness.Their relationships are explosive,marked by hostility/contempt for self and partner alternating with bottomless neediness.Manipulation,lying,blaming,raging,and“push-pull”patterns are common features.Individuals with Narcissistic Personality Disorder(NPD)exhibit a long-standing pattern of grandiosity and lack of empathy.They have an exaggerated sense of self-importance,are self-absorbed,feel entitled,and tend to seek attention.Scarcely concerned with others’feelings,they can be both charming and exploitative.Oversensitive to criticism,they are prone to overt or covert rage,gaslighting and self-referential thinking.Antisocial Personality Disorder(APD)is marked by impulsive,callous,and irresponsible behavior with no regard to be manipulative,parasitic,aggressive,cold,cruel,and self-serving.In addition to analyzing relational dysfunction in each disorder,this paper presents three relational case studies(BPD-couple,NPD-parent/child,APD-various relations)and discusses treatment implications.展开更多
The purpose of this study was to explore the process of family support provided by nurses to families with a borderline personality disorder (BPD) patient. Semi-structured interviews were conducted with 16 nurses who ...The purpose of this study was to explore the process of family support provided by nurses to families with a borderline personality disorder (BPD) patient. Semi-structured interviews were conducted with 16 nurses who had provided care to BPD patients. Data obtained from the interviews were qualitatively analyzed using a modified grounded theory approach. As an overall core category of family support processes practiced by nurses for families with BPD patients, family support practiced without awareness that the nurses were supporting families was extracted. Through this process, nurses held perceptions that were premises for family support, which were formed through their individual nursing experiences and perspectives. Nurses also had diverse perceptions concerning the image of families. Through the integration of perceptions that were premises for family support and perceptions of an image of the family, nurses underwent a process of “determination and ambivalence about the need for family support.” Then, nurses provided “family support practice” when they acknowledged the need for family support. During the “family support practice,” nurses had difficulties in providing family support. When family support was not successfully provided, nurses provided “family support practice with seeking more effective ways through trial and error.” For cases in which nurses did not acknowledge the need for intervention, they intentionally chose “not to provide family support.” Furthermore, during the “family support practice,” nurses had contradictory perspectives of family support. Such family support processes ultimately led to an awareness of the same family support required for the future. Family support was provided with “family support practice” and “family support practice with seeking more effective ways through trial and error.” In some cases, however, the process ended in “not to provide family support intentionally.” Experiences and perspectives in providing family support are important factors in carrying out future family support. Developing the positive implications of these factors and reducing psychological strain on nurses may ensure smooth implementation of family support. Thus, nurses need to recognize that they are supporting the family, which is identified as a core category.展开更多
BACKGROUND A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders(BPD)are still insufficiently understood.Evidence of differences between different typ...BACKGROUND A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders(BPD)are still insufficiently understood.Evidence of differences between different types of therapies has been questioned.AIM To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.METHODS Psychoanalysis(PSA)or psychodynamic psychotherapy(PDT)was administered to 10 patients each,the two groups were matched.Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual.Randomization to one of the groups was done after baseline assessment.During classical PSA(n=10)and PDT(n=10),semiannually,recordings(audio or video)of five consecutive therapy sessions were taken over three years for an ex-post analysis.The patients'characteristics,such as affect parameters[Affect regulation and experience Q-sort(AREQ)],quality of object relations(quality of object relations scale)and personality traits[Shedler-Westen Assessment Procedure(SWAP-200)]were analyzed retrospectively by independent raters.Therapeutic action(psychotherapy process Q-sort)and affective(re)actions of the patients(AREQ)were then analyzed in relation to changes found in the patients'characteristics.RESULTS During the first year of therapy(PSA:n=10;PDT:n=9),the therapeutic method PSA was associated with significant improvements in the variable"SWAP Borderline",while in PDT change was not significantly different to baseline(PSA:P=0.04;PDT:P=0.33).Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years;change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline(P=0.545).However,differences between PSA and PDT were significant when analyzing the“mean change”in the SWAP Borderline variable after one year of therapy(P=0.024):PSA led to slightly increased BPD symptoms,while PDT to a decrease;for the long run,variance of observed change was higher in PSA than in PDT(SDPSA±9.29 vs SDPDT±7.94).Our assumption that transference interpretations,closely followed by affective changes in the patient,could be useful modes of interaction was reproducible in our findings,especially when looking at the descriptive findings in the long-term data.The analysis of repetitive interaction structures demonstrated a very specific"time-lag"between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.CONCLUSION Exploring the change processes in the patients'characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.展开更多
This study aimed to discover the possibility of reducing the symptoms of borderline personality disorders (BPD) through the dialectical treatment of a sample group of individuals with BPD in Kuwait. To achieve this ob...This study aimed to discover the possibility of reducing the symptoms of borderline personality disorders (BPD) through the dialectical treatment of a sample group of individuals with BPD in Kuwait. To achieve this objective, a quasi-experimental approach was applied by dividing the study sample into two groups;the control group consisted of 75 individuals and the experimental group consisted of 75 individuals. In addition, a borderline personality disorder scale and program were developed based on American psychologist Marsha Linehan’s rules of dialectical behavioral therapy (DBT). Among the results, the study found statistically significant differences between members of the two groups due to the use of the counseling program based on dialectical treatment. This indicates a positive effect of using the counseling program to reduce the level of BPD among the members of the study sample, in favor of the experimental group.展开更多
Borderline Personality Disorder(BPD)is a personality disorder marked by unpredictable behaviors,emotional instability,and self-injurious conduct,which typically begins in adolescence.BPD patients are difficult to trea...Borderline Personality Disorder(BPD)is a personality disorder marked by unpredictable behaviors,emotional instability,and self-injurious conduct,which typically begins in adolescence.BPD patients are difficult to treat.The majority have had child sexual abuse,and roughly a quarter have experienced sexual abuse by a caregiver.The study is an overview of Borderline Personality Disorder,including current and past understanding of its main features,etiology,impact,treatment,and future directions since the public’s recognition of BPD is only at a beginning stage.The passage would be mainly focused on the part of the discussion,where I would illustrate the possible factors that lead to the development of Borderline Personality Disorder from both biological and social perspectives,its impact on individual’s behavior and social functioning,and the current ways of treatments.The discipline has changed dramatically over the last two decades,with a growing number of specialized psychotherapies and drugs being explored.Since BPD patients are especially hard to treat,an evaluation of multiple therapies should be necessary.Limitations and future directions would be discussed in the conclusion.Overall,the paper is aimed to provide a comprehensive summary for the general public.展开更多
Personality Disordered (herein referred to as PD) clients are challenging to statutory mental healthcare programmes. They can be difficult to diagnose: their disorders can be obscured by second-order problems such as ...Personality Disordered (herein referred to as PD) clients are challenging to statutory mental healthcare programmes. They can be difficult to diagnose: their disorders can be obscured by second-order problems such as anxiety and depression, caused by PD cognitive processes. Treatment-as-usual (the predominant model of psychiatric intervention) for PD clients in crisis tends to focus on these second-order presentations, but provide no means of identifying underlying PD. The purpose of this paper is to describe how heuristic methods of diagnosis can be used to reframe the client’s distress in the context of personality disorders (according to DSM-IV criteria), and how subsequent application of integrative therapies can break their cycle of recidivism. Method: Two case studies of treatment-refractory individuals with cyclical patterns of crisis-point service engagement for self-harm or psychotic depression where heuristic/ integrative therapies were used. Results: The use of integrative therapies in the case studies presented resulted in a marked change in recidivism and quality of life for each client, as measured by a significant reduction in presentation of symptoms and hypervigilance. Discussion: By understanding the maladaptive cognitive-behavioural processes of PD clients, they can be modified to reduce the client’s self-defeating behavioural patterns, breaking the cycle of recidivism. However, a new diagnostic strategy must first be formulated that looks at the clients past use of mental health services to detect underlying PD.展开更多
Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th) version, due to be published, two decades after i...Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th) version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder(BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses(PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.展开更多
Borderline personality disorder （BPD） is a serious personality disorder characterized by a pervasive pattern of disturbances in mood regulation, impulse control, self-image and interpersonal relationships） In the U...Borderline personality disorder （BPD） is a serious personality disorder characterized by a pervasive pattern of disturbances in mood regulation, impulse control, self-image and interpersonal relationships） In the United States, the prevalence of BPD has been estimated at 1%-2% of the general population, 10% of psychiatric outpatients, and 20% of inpatients. According to the 4th text revision of diagnostic and statistical manual of mental disorders （DSM-IV-TR）, about 75% of BPD patients are women. The BPD diagnosis has been associated with heightened risk （8.5% to 10.0% among BPD patients） for completed suicide, a rate almost 50 times higher than in the general population.展开更多
文摘Objective: Deliberate foreign body ingestion (DFBI) has been reported in patients with personality disorders as part of a spectrum of self-harming behaviours, however the published literature is small (15 case reports). Method: This was a retrospective audit of medical and psychological management of a cluster of 12 DFBI incidents over 9 months in 4 young female patients with Borderline Personality Disorder (BPD). Results: All four patients knew one another from outpatient psychotherapy programmes. DFBI was associated with substance use in 5/12 incidents, and with precipitants (experiencing strong emotions, witnessing self-harm) in 4/12 incidents. Most DFBI involved sharp objects (razor blades, glass, safety pins). Medical intervention was initially active (endoscopy/surgery) but progressed to a more conservative, observational approach. Psychological management was initially restrictive, but also changed over time to focus on identifying distress, enhancing coping mechanisms and patient responsibility. Co-ordination of patient care management involvedintensive liaison (provision of interdisciplinary support and education) between medical, surgical and psychiatric teams. Conclusion: Management of DFBI in patients with BPD requires high levels of interdisciplinary collaboration. In this cluster of DFBI incidents, effective management was achieved with conservative medical/surgical methods (observation) and non-restrictive psychological approaches that enhanced patient self-efficacy.
文摘Personality disorders are a class of mental disorders involving enduring maladaptive patterns of behaving,thinking,and feeling which profoundly affect functioning,inner experience,and relationships.This work focuses on three Cluster B personality disorders(PDs)(Borderline,Narcissistic,and Antisocial PDs),specifically illustrating how relational dysfunction manifests in each condition.People with Borderline Personality Disorder(BPD)experience pervasive instability in mood,behavior,self-image,and interpersonal patterns.In relationships,they tend to alternate between extremes of over-idealization and devaluation.Intense fear of abandonment,fluctuating affect,inappropriate anger,and black/white thinking deeply influence how they navigate personal relationships,which are often unstable,chaotic,dramatic,and ultimately destructive.They have a fundamental incapacity to self-soothe the explosive emotional states they experience as they oscillate between fears of engulfment and abandonment.This leads to unpredictable,harmful,impulsive behavior and chronic feelings of insecurity,worthlessness,shame,and emptiness.Their relationships are explosive,marked by hostility/contempt for self and partner alternating with bottomless neediness.Manipulation,lying,blaming,raging,and“push-pull”patterns are common features.Individuals with Narcissistic Personality Disorder(NPD)exhibit a long-standing pattern of grandiosity and lack of empathy.They have an exaggerated sense of self-importance,are self-absorbed,feel entitled,and tend to seek attention.Scarcely concerned with others’feelings,they can be both charming and exploitative.Oversensitive to criticism,they are prone to overt or covert rage,gaslighting and self-referential thinking.Antisocial Personality Disorder(APD)is marked by impulsive,callous,and irresponsible behavior with no regard to be manipulative,parasitic,aggressive,cold,cruel,and self-serving.In addition to analyzing relational dysfunction in each disorder,this paper presents three relational case studies(BPD-couple,NPD-parent/child,APD-various relations)and discusses treatment implications.
文摘The purpose of this study was to explore the process of family support provided by nurses to families with a borderline personality disorder (BPD) patient. Semi-structured interviews were conducted with 16 nurses who had provided care to BPD patients. Data obtained from the interviews were qualitatively analyzed using a modified grounded theory approach. As an overall core category of family support processes practiced by nurses for families with BPD patients, family support practiced without awareness that the nurses were supporting families was extracted. Through this process, nurses held perceptions that were premises for family support, which were formed through their individual nursing experiences and perspectives. Nurses also had diverse perceptions concerning the image of families. Through the integration of perceptions that were premises for family support and perceptions of an image of the family, nurses underwent a process of “determination and ambivalence about the need for family support.” Then, nurses provided “family support practice” when they acknowledged the need for family support. During the “family support practice,” nurses had difficulties in providing family support. When family support was not successfully provided, nurses provided “family support practice with seeking more effective ways through trial and error.” For cases in which nurses did not acknowledge the need for intervention, they intentionally chose “not to provide family support.” Furthermore, during the “family support practice,” nurses had contradictory perspectives of family support. Such family support processes ultimately led to an awareness of the same family support required for the future. Family support was provided with “family support practice” and “family support practice with seeking more effective ways through trial and error.” In some cases, however, the process ended in “not to provide family support intentionally.” Experiences and perspectives in providing family support are important factors in carrying out future family support. Developing the positive implications of these factors and reducing psychological strain on nurses may ensure smooth implementation of family support. Thus, nurses need to recognize that they are supporting the family, which is identified as a core category.
文摘BACKGROUND A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders(BPD)are still insufficiently understood.Evidence of differences between different types of therapies has been questioned.AIM To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.METHODS Psychoanalysis(PSA)or psychodynamic psychotherapy(PDT)was administered to 10 patients each,the two groups were matched.Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual.Randomization to one of the groups was done after baseline assessment.During classical PSA(n=10)and PDT(n=10),semiannually,recordings(audio or video)of five consecutive therapy sessions were taken over three years for an ex-post analysis.The patients'characteristics,such as affect parameters[Affect regulation and experience Q-sort(AREQ)],quality of object relations(quality of object relations scale)and personality traits[Shedler-Westen Assessment Procedure(SWAP-200)]were analyzed retrospectively by independent raters.Therapeutic action(psychotherapy process Q-sort)and affective(re)actions of the patients(AREQ)were then analyzed in relation to changes found in the patients'characteristics.RESULTS During the first year of therapy(PSA:n=10;PDT:n=9),the therapeutic method PSA was associated with significant improvements in the variable"SWAP Borderline",while in PDT change was not significantly different to baseline(PSA:P=0.04;PDT:P=0.33).Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years;change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline(P=0.545).However,differences between PSA and PDT were significant when analyzing the“mean change”in the SWAP Borderline variable after one year of therapy(P=0.024):PSA led to slightly increased BPD symptoms,while PDT to a decrease;for the long run,variance of observed change was higher in PSA than in PDT(SDPSA±9.29 vs SDPDT±7.94).Our assumption that transference interpretations,closely followed by affective changes in the patient,could be useful modes of interaction was reproducible in our findings,especially when looking at the descriptive findings in the long-term data.The analysis of repetitive interaction structures demonstrated a very specific"time-lag"between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.CONCLUSION Exploring the change processes in the patients'characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.
文摘This study aimed to discover the possibility of reducing the symptoms of borderline personality disorders (BPD) through the dialectical treatment of a sample group of individuals with BPD in Kuwait. To achieve this objective, a quasi-experimental approach was applied by dividing the study sample into two groups;the control group consisted of 75 individuals and the experimental group consisted of 75 individuals. In addition, a borderline personality disorder scale and program were developed based on American psychologist Marsha Linehan’s rules of dialectical behavioral therapy (DBT). Among the results, the study found statistically significant differences between members of the two groups due to the use of the counseling program based on dialectical treatment. This indicates a positive effect of using the counseling program to reduce the level of BPD among the members of the study sample, in favor of the experimental group.
文摘Borderline Personality Disorder(BPD)is a personality disorder marked by unpredictable behaviors,emotional instability,and self-injurious conduct,which typically begins in adolescence.BPD patients are difficult to treat.The majority have had child sexual abuse,and roughly a quarter have experienced sexual abuse by a caregiver.The study is an overview of Borderline Personality Disorder,including current and past understanding of its main features,etiology,impact,treatment,and future directions since the public’s recognition of BPD is only at a beginning stage.The passage would be mainly focused on the part of the discussion,where I would illustrate the possible factors that lead to the development of Borderline Personality Disorder from both biological and social perspectives,its impact on individual’s behavior and social functioning,and the current ways of treatments.The discipline has changed dramatically over the last two decades,with a growing number of specialized psychotherapies and drugs being explored.Since BPD patients are especially hard to treat,an evaluation of multiple therapies should be necessary.Limitations and future directions would be discussed in the conclusion.Overall,the paper is aimed to provide a comprehensive summary for the general public.
文摘Personality Disordered (herein referred to as PD) clients are challenging to statutory mental healthcare programmes. They can be difficult to diagnose: their disorders can be obscured by second-order problems such as anxiety and depression, caused by PD cognitive processes. Treatment-as-usual (the predominant model of psychiatric intervention) for PD clients in crisis tends to focus on these second-order presentations, but provide no means of identifying underlying PD. The purpose of this paper is to describe how heuristic methods of diagnosis can be used to reframe the client’s distress in the context of personality disorders (according to DSM-IV criteria), and how subsequent application of integrative therapies can break their cycle of recidivism. Method: Two case studies of treatment-refractory individuals with cyclical patterns of crisis-point service engagement for self-harm or psychotic depression where heuristic/ integrative therapies were used. Results: The use of integrative therapies in the case studies presented resulted in a marked change in recidivism and quality of life for each client, as measured by a significant reduction in presentation of symptoms and hypervigilance. Discussion: By understanding the maladaptive cognitive-behavioural processes of PD clients, they can be modified to reduce the client’s self-defeating behavioural patterns, breaking the cycle of recidivism. However, a new diagnostic strategy must first be formulated that looks at the clients past use of mental health services to detect underlying PD.
文摘Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th) version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder(BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses(PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.
基金This research was supported by the Direct Research Grant of The Chinese University of Hong Kong
文摘Borderline personality disorder （BPD） is a serious personality disorder characterized by a pervasive pattern of disturbances in mood regulation, impulse control, self-image and interpersonal relationships） In the United States, the prevalence of BPD has been estimated at 1%-2% of the general population, 10% of psychiatric outpatients, and 20% of inpatients. According to the 4th text revision of diagnostic and statistical manual of mental disorders （DSM-IV-TR）, about 75% of BPD patients are women. The BPD diagnosis has been associated with heightened risk （8.5% to 10.0% among BPD patients） for completed suicide, a rate almost 50 times higher than in the general population.
