A screening measure for BPD: the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD)

Borderline personality disorder (BPD) is a common psychiatric disorder that is often overlooked in treatment settings. This report describes the validation of a new self-report screening measure for DSM-IV BPD--the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Two hundred subjects with treatment histories whose ages ranged from 18 to 59 filled out the MSI-BPD. Each subject was then interviewed, blind to MSI-BPD results, with the BPD module of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV; Zanarini, Frankenburg, Sickel, & Yong, 1996). Of these 200 subjects, 139 (69.5%) met DSM-IV criteria for BPD as assessed by the BPD module of the DIPD-IV and the remaining 61 subjects (30.5%) did not. Using logistic regression analyses, an MSI-BPD cutoff of 7 or more of the measure's 10 items was judged to be the best cutoff. This was so because it yielded both good sensitivity (.81; percentage of correctly identified cases) and specificity (.85; percentage of correctly identified noncases) for the diagnosis of DSM-IV BPD. For younger subjects, diagnostic efficiency was even greater. For example, sensitivity was .90 and specificity was .93 at a cutoff of 7 for the 63 subjects who were 25 years old or younger. The results of this study suggest that the MSI-BPD may be a useful screening instrument for the presence of DSM-IV borderline personality disorder.     

Australian Consequentialism: An Australian Critique

Theoretical Medicine and Bioethics -     

The heterogeneity of picture-supported narratives in Alzheimer's disease

This study describes discourse patterns produced by 46 Alzheimer disease (AD) patients and 53 normal elderly subjects in two picture-supported narratives. Nine measures derived from a cognitive model of discourse processing were obtained and submitted to cluster analysis. Results indicate that discourse patterns elicited from both stimuli were heterogeneous. Further, they fail to clearly differentiate between normal aging and AD in half of the AD patients. Discourse patterns are examined in light of various sources of heterogeneity including severity of cognitive impairment, subject characteristics, and task demands. The usefulness of discourse as a diagnostic and therapeutic tool is discussed.     

Guest Reviewers for 2001–2002

Dedication

Guest Reviewers for 2001–2002     

Witnesses to Reality: Working Psychodynamically With Survivors of Terror 1

As generations of young men and women return from combat scarred not only physically but also psychologically by their experiences, as civil wars and genocide proliferate and refugees seek sanctuary in America from persecution in their native countries, even while others are held in violation of their international human rights by the United States government, this paper asks what role psychoanalysts can play in working with those who have survived violence and terror as adults. Offering a relational formulation of adult onset trauma, the author reviews some of the difficulties inherent in being called upon to bear witness to destructive social forces. The paper concludes with the case of a man who has been detained in Guantanamo Bay for the last 6 years.     

The Role of Racial Discrimination in the Economic Value of Education Among Urban,Low-Income Latina/o Youth: Ethnic Identity and Gender as Moderators

The present study used resilience theory to explore relationships among perceived racial discrimination, ethnic identity, gender, and economic value of education (EVE) among urban, low‐income, Latina/o youth. It was expected that racial discrimination would predict poorer perceptions of the EVE among Latina/o adolescents. Ethnic identity was hypothesized to buffer the negative effect of racial discrimination on Latina/o students’ EVE. The participants in this study were 396 urban, low‐income Latina/o high school students from a large, Midwestern city who completed surveys in both 9th‐ and 10th‐grade. Structural equation modeling was used to test the relationships among racial discrimination, ethnic identity, and EVE. Results supported a protective model of resilience. Specifically, ethnic identity served as a protective factor by buffering the negative effect of perceived racial discrimination on EVE for male participants. The present study is the first to examine ethnic identity as a buffer of racial discrimination on EVE among Latina/o high school students. Future directions and implications are discussed.     

Attachment in Adolescence and Borderline Personality Disorder

Borderline personality disorder (BPD) has been conceptualized as a constellation of symptoms related to problems in self-functioning, emotion regulation, and interpersonal relationships. Its etiology has been connected to individuals’ early childhood environment, caregiving relationships, and traumatic life events. Recent literature has noted the potential presence of BPD beginning in adolescence, or even earlier in childhood. Attachment theory offers a lens for understanding the symptoms of borderline personality disorder and identifying potential aspects of treatment that may be specifically valuable for adolescent patients. Adolescence marks a time when the attachment system has increased relevance due to the importance of identity formation, peer relationships, body representations and the development of autonomy at this time, in the face of physical changes and academic challenges. This article will summarize research on attachment, body representations, personality disorders, and features of development in adolescence, in order to enhance clinical understanding of patients who presenting with these types of difficulties.     

Dangerous Enough: Moderating Racial Bias with Contextual Threat Cues

Research shows that participants shoot armed Blacks more frequently and quickly than armed Whites, but make don't-shoot responses more frequently and quickly for unarmed Whites than unarmed Blacks. We argue that this bias reflects the perception of threat — specifically, threat associated with Black males. Other danger cues (not just race) may create a similar predisposition to shoot, and if these cues promote shooting when the target is White, they should attenuate racial bias. We embedded targets in threatening and safe backgrounds. Racial bias was evident in safe contexts but disappeared when context signaled danger, and this reduction was largely due to an increased tendency to shoot White targets.