Self-esteem in patients with borderline and avoidant personality disorders

This study compared self-esteem in patients with avoidant personality disorder (APD) and borderline personality disorder (BPD). Patients diagnosed with one or more personality disorders answered the questionnaire Index of Self Esteem as part of a comprehensive evaluation within the setting of a treatment trial. Our hypotheses were that (1) both patients with APD and patients with BPD would report low levels of self-esteem, (2) patients with APD would report lower self-esteem than patients with BPD. We further expected that (3) patients with higher levels of depression would report lower levels of self-esteem, but that (4) both borderline and avoidant personality pathology would contribute to explained variance in self-esteem beyond what would be accounted for by depression. All of our hypotheses were supported. The results from our study showed a significant difference in self-esteem level between the two personality disorders, patients with APD reporting lower self-esteem than patients with BPD. Subjects with both disorders were measured to have self-esteem levels within the range that presumes clinical problems. Self-esteem represents an important quality of subjective experience of the self, and the study of self-esteem in PDs can offer new and important knowledge of PDs as self-pathology.     

对边缘性人格障碍亚型的研究

边缘性人格障碍是一种最常见的人格障碍。描述性精神病学、心理测验和精神分析的研究发现,边缘性人格障碍可能是由若干个异质性的亚群体组成,不同的亚群在症状表现、病因、心理病理机制、对治疗干预的反应和预后等方面可能都存在着很大的差异,可以根据不同的维度将其进行亚型分类,而使同一个亚群中的个体差异小于不同亚群之间的个体差异。     

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.     

Is personality disorder inherited? An overview of the evidence

Genetic factors appear to be of considerable importance in determining normal variation in personality. This is suggested by family, twin, and adoption studies as well as by indirect findings based on animal and psychophysiological studies. In contrast, there is consistent evidence that the contribution of shared family environment is minimal. Despite difficulties in defining personality disorder, it appears that many types of personality disorder, in particular schizotypal personality disorder and antisocial personality disorder/criminality, are also influenced genetically. The genetic transmission of normal personality traits and disorder is most easily explained by the contribution of multiple genes of small effect rather than by single-gene inheritance. Recent advances in molecular genetics have led to the localization of genes of minor effect for some traits. This raises the possibility of detecting a molecular basis of traits and disorders such as personality and personality disorder.Anita Thapar is supported by a Research Training Fellowship from the Medical Research Council.     

The Treatment of Histrionic and Narcissistic Personality Disorder Behaviors: A Single-Subject Demonstration of Clinical Improvement Using Functional Analytic Psychotherapy

This article presents single-subject data for the treatment of histrionic and narcissistic personality disorder behaviors using a relatively brief course of an interpersonal therapy, Functional Analytic Psychotherapy (Kohlenberg & Tsai, 1991). The treatment produced significant changes in these behaviors both statistically and qualitatively. Empirical methods for analyzing the changes across sessions and for determining that the therapist engaged in the proposed mechanism of clinical change are discussed. While these data are for one subject, the results of treatment provide both a method of treating difficult and long-standing client behaviors such as these, and for assessing the progress of therapy.     

A child’s loss becomes a young man’s violence

Abstract

This paper describes the contribution of earlier traumatic loss to the later violent eruptions, with fatal consequences, of two young men, one who killed his mother and one who killed an unknown woman. Their developing personalities became disordered during their disturbed childhoods and the link between these developing personality disorders and psychoses is referred to. The need for long-term treatments is emphasised, as well as the importance of communication between therapist and clinical team.     

Prevalence of personality disorders among bulimics,nonbulimic binge eaters,and normal controls

We examined the comorbidity of bulimia and personality pathology among college women. Subjects included women (n=23) meeting DSM-III-R criteria for bulimia nervosa (bulimics), women (n=23) who reported binge eating but did not fulfill the criteria for bulimia nervosa (binge eaters), and women (n=23) who did not binge eat (normals). The subjects completed an assessment battery consisting of the Personality Disorders Examination and the SCID as well as the Beck Depression Inventory, the Rosenberg Self-Esteem Index, and measures of impulsivity and self-defeating tendencies. Fourteen of 23 bulimics (61%) met criterion for a personality disorder using DSM-III-R Axis II criteria. In comparison, 3 of 23 (13%) binge eaters and 1 of 23 (4%) normal subjects received an Axis II diagnosis. Borderline and self-defeating diagnoses were the predominant personality disorders in 96% of the bulimics exhibiting clinically significant personality pathology. Bulimics also exhibited significantly more depression, impulsivity, and self-defeating behavior and lower self-esteem than binge eaters and normals. The findings are discussed within a conceptual framework that posits an interaction between personality pathology and restrained eating.     

人格与病理性赌博研究述评

人格障碍是病理性赌博的定论之一。与病理性赌博有关的人格特质包括神经质、精神质、感觉寻求特质、专注特质等,这在跨文化的研究中都找到了证据。现有的研究结论存在疑问,未来研究需注意被试取样代表性,人格特质与赌博行为之间的关系有待于进一步研究,本土化研究需要加强     

Project ABLE

This paper describes a proposed model for the management of Army soldiers rendered ineffective due to inadequate skills in coping with life stress. The history of Army mental health programs is reviewed to establish the rationale for program development. The proposed treatment methods and staffing are discussed. The application of this peacetime treaetment model in the management of combat psychiatric casualties is presented. Emphasis is placed on the role of the Army occupational therapist as a professional skilled in the use of task-directed behavior to enhance daily living skills.     

Violence as Secular Evil: Forensic Evaluation and Treatment of Violent Offenders from the Viewpoint of Existential Depth Psychology

Violence is the preeminent evil of our day. Though the causes of destructive violence in our society are complex, the troublesome human emotions of anger and rage play a central role in the genesis of violent behavior and psychopathology in general. In this paper, the author discusses forensic evaluation and psychotherapeutic treatment via existential depth psychology—a synthesis of Freudian, Jungian, and existential theory—focusing on the overlooked links between repressed anger or rage, pathological narcissism, antisocial personality, and violent behavior.     

Memory transfer for emotionally valenced words between identities in dissociative identity disorder

The present study aimed to determine interidentity retrieval of emotionally valenced words in dissociative identity disorder (DID). Twenty-two DID patients participated together with 25 normal controls and 25 controls instructed to simulate DID. Two wordlists A and B were constructed including neutral, positive and negative material. List A was shown to one identity, while list B was shown to another identity claiming total amnesia for the words learned by the first identity. The identity claiming amnesia was tested for intrusions from list A words into the recall of words from list B and recognition of the words learned by both identities. Test results indicated no evidence of total interidentity amnesia for emotionally valenced material in DID. It is argued that dissociative amnesia in DID may more adequately be described as a disturbance in meta-memory functioning instead of an actual retrieval inability.     

克恩伯格边缘性人格组织理论述评

边缘性人格组织是人格障碍的内在结构。克恩伯格主要从非特异性自我虚弱性、现实检验、原始防御机制、病理性的内在客体关系以及身份认同紊乱五个方面阐述了边缘性人格组织理论。该理论弥补了DSM-Ⅳ中人格障碍诊断标准的无理论化倾向的缺陷,并为深入理解人格障碍的心理病理学提供了一个系统框架。     

Borderline personality disorder and laboratory-induced cold pressor pain: Evidence of stress-induced analgesia

Behavioral neuroscience findings regarding stress-induced analgesia may be an appropriate model for the paradoxical effects of self-mutilative pain of patients with borderline personality disorder (BPD). We hypothesized that BPD patients would show an exaggerated antinociceptive effect from an uncontrollable cold pressor stress, compared to persons with other personality disorders or to a nonpsychiatric control group. This hypothesis was supported. Limitations of the study and directions for future research are discussed.