Disturbed sense of identity in borderline personality disorder

Traditionally, personal identity is considered to be important for psychological health and adaptive functioning. Identity diffusion and other more severe forms of disturbance associated with personal identity are regarded as being essential parts of the borderline personality disorder. Moreover, disturbances in identity are seen as being part of the dynamic background for many of the symptoms and maladaptive behaviors found in borderline patients. It is argued, that the development of personal identity is intimately related to, and indeed dependent on, elements of modern culture, with significant cultural changes having affected the conditions under which human identity develops. Therefore, the identity diffusion seen in patients with borderline disorders must be understood in relation to not only the individual patient's personal history and inner structures but also contemporary late modern culture and social organization.     

Improving assessment of personality disorder traits through social network analysis

When assessing personality disorder traits, not all judges make equally valid judgments of all targets. The present study uses social network analysis to investigate factors associated with reliability and validity in peer assessment. Participants were groups of military recruits (N=809) who acted as both targets and judges in a round-robin design. Participants completed self- and informant versions of the Multisource Assessment of Personality Pathology. Social network matrices were constructed based on reported acquaintance, and cohesive subgroups were identified. Judges who shared a mutual subgroup were more reliable and had higher self-peer agreement than those who did not. Partitioning networks into two subgroups achieved more consistent improvements than multiple subgroups. We discuss implications for multiple informant assessments.     

Malingering dissociative identity disorder: objective and projective assessment

Verification of dissociative identity disorder presents challenges given the complex nature of the illness. This study addressed the concern that this disorder can be successfully malingered on objective and projective psychological tests. 50 undergraduate women were assigned to a Malingering or a Control condition, then completed the Rorschach Inkblot Test and the Dissociative Experiences Scale II. The Malingering group were asked to simulate dissociative identity disorder; controls received instructions to answer all materials honestly. Analysis indicated that malingerers were significantly more likely to endorse dissociative experiences on the Dissociative Experiences Scale II in the range common to patients with diagnosed dissociative identity disorder. However, on the Rorschach there were no significant differences between the two groups. Results suggest that the assessment of dissociative identity disorder requires a multifaceted approach with both objective and projective assessment tools. Research is needed to assess these issues in clinical populations.     

Politicized collective identity. A social psychological analysis

This article develops a social psychological model of politicized collective identity that revolves around 3 conceptual triads. The 1st triad consists of collective identity, the struggle between groups for power, and the wider societal context. It is proposed that people evince politicized collective identity to the extent that they engage as self-conscious group members in a power struggle on behalf of their group knowing that it is the more inclusive societal context in which this struggle has to be fought out. Next, 3 antecedent stages leading to politicized collective identity are distinguished: awareness of shared grievances, adversarial attributions, and involvement of society at large. This sequence culminates in the final triad because the intergroup power struggle is eventually triangulated by involving society at large or representatives thereof. Consequences of politicized collective identity are discussed.     

Similarities between near-death experiences and multiple personality disorder

In this paper I compare the phenomenology of near-death experiences to that of multiple personality disorder. The comparison reveals a number of similarities, including out-of-body experiences, the transcendental environment, encounter with the higher self, possible temporal lobe involvement, and antecedent child abuse. Rather than being disparate and unrelated experiences, I suggest that the near-death experience and multiple personality disorder may be variants of the same basic phenomenological pattern.     

The unbearable dispersal of being: Narrativity and personal identity in borderline personality disorder

Phenomenology and the Cognitive Sciences - Borderline personality disorder (BPD) is characterized by severe disturbances in a subject’s sense of identity. Persons with BPD suffer from...     

Borderline personality disorder in an intermediate psychological therapies service

The intermediate psychological therapies service is provided for individuals referred with common mental health problems within the primary care psychological therapies service, but whose difficulties are longstanding and/or complex. The prevalence of borderline personality disorder (BPD) in intermediate psychological therapy services has not been researched to-date. The current study aimed to measure the prevalence of BPD amongst patients attending intermediate psychological therapies (n?=?63). The prevalence of BPD was established by identifying the number of patients who met DSM-IV criteria. BPD prevalence amongst patients attending an intermediate psychological therapy service was 37%. The high proportion of patients presenting with BPD indicates the potential need for staff training and supervision in how to manage such high levels of need at this service level. This is the first study to report prevalence rates of BPD specifically in an intermediate care psychological therapy service.     

Assessment of ego functioning in multiple personality disorder

The dissociative disorder known as multiple personality disorder (MPD) presents a diagnostic challenge to psychological assessment techniques. A case example is presented in which a new self-report, multifactorial measure of ego functioning discriminated distinct profiles for four personalities within one multiple personality organization. Interpretations of characteristics of the primary and secondary personalities based on the Bell Object Relations Reality Testing Inventory (BORRTI) are presented. The relationship between these findings and other approaches to psychological testing for dissociation and MPD are discussed. It is suggested that this approach will facilitate the clinical assessment of suspected MPD subjects and contribute to affording appropriate treatment to this population.     

A comparison of three personality disorder assessment approaches

Three approaches to the assessment of DSM-III personality disorders are compared by examining the manner in which interrelationships between disorders are portrayed by the different techniques. Although a fair degree of convergence was noted among the three techniques, several differences were also observed. These comparisons, particularly the noted contrasts, have implications for future researchers using these techniques.     

Comparing personality disorder models: cross-method assessment of the FFM and DSM-IV-TR

The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) defines personality disorders as categorical entities that are distinct from each other and from normal personality traits. However, many scientists now believe that personality disorders are best conceptualized using a dimensional model of traits that span normal and abnormal personality, such as the Five-Factor Model (FFM). However, if the FFM or any dimensional model is to be considered as a credible alternative to the current model, it must first demonstrate an increment in the validity of the assessment offered within a clinical setting. Thus, the current study extended previous research by comparing the convergent and discriminant validity of the current DSM-IV-TR model to the FFM across four assessment methodologies. Eighty-eight individuals receiving ongoing psychotherapy were assessed for the FFM and the DSM-IV-TR personality disorders using self-report, informant report, structured interview, and therapist ratings. The results indicated that the FFM had an appreciable advantage over the DSM-IV-TR in terms of discriminant validity and, at the domain level, convergent validity. Implications of the findings and directions for future research are discussed.     

Computerized adaptive assessment of personality disorder: introducing the CAT-PD project

Assessment of personality disorders (PD) has been hindered by reliance on the problematic categorical model embodied in the most recent Diagnostic and Statistical Model of Mental Disorders (DSM), lack of consensus among alternative dimensional models, and inefficient measurement methods. This article describes the rationale for and early results from a multiyear study funded by the National Institute of Mental Health that was designed to develop an integrative and comprehensive model and efficient measure of PD trait dimensions. To accomplish these goals, we are in the midst of a 5-phase project to develop and validate the model and measure. The results of Phase 1 of the project--which was focused on developing the PD traits to be assessed and the initial item pool--resulted in a candidate list of 59 PD traits and an initial item pool of 2,589 items. Data collection and structural analyses in community and patient samples will inform the ultimate structure of the measure, and computerized adaptive testing will permit efficient measurement of the resultant traits. The resultant Computerized Adaptive Test of Personality Disorder (CAT-PD) will be well positioned as a measure of the proposed DSM-5 PD traits. Implications for both applied and basic personality research are discussed.     

Sadistic personality disorder in sex offenders: relationship to antisocial personality disorder and sexual sadism.

To investigate the relationship of sadistic personality disorder (SPD), as defined in the appendix of DSM-III-R, to other personality disorders and to sexual sadism, 70 sex offenders (27 child molesters, 33 rapists, and 10 murderers) were assessed by the International Personality Disorder Examination. In 19 subjects (27.2%) from the total sample, SPD was diagnosed. The highest overlap appeared with borderline personality disorder (31.6%) and antisocial personality disorder (42.1%). However, in four cases SPD was the only personality disorder diagnosed. Factor analysis of the antisocial and sadistic criteria resulted in four major factors--one factor with high loadings on the sadistic criteria and the violent criteria of antisocial personality disorder, two factors with different forms of adult and juvenile aggression, and a fourth factor with high loadings on the antisocial criteria covering exploitative behavior. The results do not support SPD as a discrete disorder. Nevertheless, SPD may be seen as an important subdimension of antisocial personality disorder, distinct from more exploitative forms of antisocial behavior with less violence. Of those patients with SPD, 42.1% also had a DSM-III-R diagnosis of sexual sadism, which may be the most dangerous configuration.     

The depressive personality disorder inventory and current depressive symptoms: implications for the assessment of depressive personality

The Depressive Personality Disorder Inventory (DPDI; Huprich, Margrett, Barthelemy, & Fine, 1996; see Appendix) was created to assess Depressive Personality Disorder in clinical and nonclinical samples. Since its creation, the DPDI has been used in multiple studies, and the psychometric properties of the measure have generally supported its reliability, convergent validity, and construct validity; however, evidence for the measure's discriminant validity has been mixed. Specifically, the DPDI tends to correlate highly with measures of current depressive symptoms, which limits its efficacy in differentiating current depressive symptoms from a depressive personality structure. A principal components analysis of 362 individuals who completed both the DPDI and Beck Depression Inventory (BDI-II; Beck, Steer, & Brown, 1996) found that 49% of the variance was accounted for in two components. Seven items from the DPDI loaded more strongly on the first component composed of many BDI-II items. These items were removed in order to create a measure believed to assess DPD without the confounding influence of current depressive symptomology. Principal components analysis of the revised measure yielded three components, accounting for 46% of the variance. The revised DPDI was used to calculate convergent, discriminant, and construct validity coefficients from measures used in former studies. Virtually no improvement in the validity coefficients was observed. It is concluded that assessing DPD via self-report is limited in its utility.     

Autobiographical memory in a case of multiple personality disorder

Previous research on multiple personality disorder (MPD) has been concerned with between-personalities amnesia, and little attention has been paid to within-personality memory function. This study examined the autobiographical memory of a multiple personality patient, I.C., with cueing procedures that have proven useful in previous studies of normal and abnormal memory. Results indicated that I.C. was able to retrieve autobiographical episodes from the recent past, although her performance differed in several respects from that of matched controls. The study also revealed a striking deficit in I.C.'s autobiographical memory for childhood: She was unable to recall a single episode from prior to the age of 10 in response to various retrieval cues, whereas control subjects had no difficulty recalling numerous childhood episodes. This phenomenon of extended childhood amnesia has not been reported previously in studies of MPD.     

Treatment outcome in personality disorder: The effect of social,psychological and behavioural variables

The study followed-up 245 patients referred to the Henderson Hospital (194 admitted for treatment and 51 not admitted) and for whom information had been collected on their social background and certain psychological variables allowing a classification and typology of personality disorder to be worked out. The study indicates that the therapeutic community treatment is effective with selected individuals showing the antisocial behaviour associated with such disorder. In particular this treatment is of benefit to the offenders with only one conviction and who are able to persevere with treatment for a period of 6 months for treatment to be maximally effective. The variation of psychological types within the broad category of personality disorder was demonstrated and this has a bearing on the outcome of treatment, the extrapunitive neurotic being of poorest prognosis with or without treatment. Yet even in this group, therapeutic community treatment can be effective.     

Memory and awareness in a patient with multiple personality disorder

We studied an individual with multiple personality disorder in whom each of several personalities claimed to have no direct awareness of the others and to be unable to consciously remember the experiences of other personalities. A broad selection of implicit and explicit memory tests was used to determine the extent to which one personality had access to knowledge acquired by another and the circumstances in which that knowledge would be expressed. The implicit assessment of memory was a necessary but not sufficient condition for demonstrating interpersonality access. The degree of compartmentalization of knowledge in this patient depended largely on whether the interpretation of presented information was likely to differ across personalities.