Transference Focused Psychotherapy for Patients with Comorbid Narcissistic and Borderline Personality Disorder

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experience with and research data on patients with comorbid narcissistic personality disorder/borderline personality disorder (NPD/BPD). We briefly review object relations formulations of severe narcissistic pathology, as well as recent research in attachment and the allied concept of mentalization, which have provided a new lens through which to view narcissistic disorders. The research findings from two randomized clinical trials demonstrating the efficacy and effectiveness of TFP are presented. The data from the two Randomized Clinical Trials (RCT) allowed for the study of the characteristics of the subgroup of borderline personality disorder patients who have comorbid NPD/BPD. Findings on comorbidity, attachment status, capacity for mentalization, and level of personality organization of borderline patients with comorbid NPD/BPD, compared with borderline patients without comorbid narcissistic pathology (BPD), are presented. Clinical implications of the observed group differences are discussed, with a focus on refinements in the technique of TFP. Clinical case material is presented to illustrate the specific challenges posed by narcissistic patients to carrying out TFP in each phase of treatment.     

The Importance of Exercise and Dimension Factors in Assessment Centers: Simultaneous Examinations of Construct-Related and Criterion-Related Validity

This study presents a simultaneous examination of multiple evidential bases of the validity of assessment center (AC) ratings. In particular, we combine both construct-related and criterion-related validation strategies in the same sample to determine the relative importance of exercises and dimensions. We examine the underlying structure of ACs in terms of exercise and dimension factors while directly linking these factors to a work-related criterion (salary). Results from an AC (N = 753) showed that exercise factors not only explained more variance in AC ratings than dimension factors but also were more important in predicting salary. Dimension factors explained a smaller albeit significant portion of the variance in AC ratings and had lower validity for predicting salary. The implications of these findings for AC theory, practice, and research are discussed.     

Mental rotation of letters,pictures, and three-dimensional objects in German dyslexic children

This study examines mental rotation ability in children with developmental dyslexia. Prior investigations have yielded equivocal results that might be due to differences in stimulus material and testing formats employed. Whereas some investigators found dyslexic readers to be impaired in mental rotation, others did not report any performance differences or even superior spatial performance for dyslexia. Here, we report a comparison of mental rotation for letters, three-dimensional figures sensu Shepard and Metzler, and colored pictures of animals or humans in second-grade German dyslexic readers. Findings indicate that dyslexic readers are impaired in mental rotation for all three kinds of stimuli. Effects of general intelligence were controlled. Furthermore, dyslexic children were deficient in other spatial abilities like identifying letters or forms among distracters. These results are discussed with respect to the hypotheses of a developmental dysfunction of the parietal cortex or a subtle anomaly in cerebellar function in dyslexic readers.     

Bottled memories: On how alcohol affects eyewitness recall

This study investigated how different doses of alcohol affected eyewitness recall. Participants (N = 126) were randomly assigned to three groups with different blood alcohol concentration (BAC), either a control group (mean BAC 0.00%, N = 42), a lower alcohol dose group (mean BAC 0.04%, N = 40), or a higher alcohol dose group (mean BAC 0.06%, N = 44). After consumption, participants witnessed a movie of a mock crime and were interviewed one week later. The main results showed that witnesses with the higher intoxication level recalled fewer details compared to witnesses with the lower intoxication level. The amount of alcohol consumed did not have an impact on the accuracy rate. No sex differences were found. The results are discussed in the light of past research. We conclude that more studies are needed before recommendations can be made to an applied setting.     

Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors

This observational study investigates whether persons with elevated coronary risk factors (CRFs >3 and/or diabetes) and depression [i.e., ≥16 on the Center for Epidemiological Scale – Depression (CES-D)] can make changes in health behaviours over 3 months and improve depressive symptoms and other CRFs. Analyses were based on data from 310 men and 687 women enrolled in the high-risk arm of the Multisite Cardiac Lifestyle Intervention Program, targeting diet (10% fat), exercise (3 h per week) and stress management (7 h per week). As expected, at study entry, depressed persons had a more adverse medical status, consumed more dietary fat and practiced less stress management than non-depressed persons. To examine 3-month changes, participants were grouped into (1) depressed persons who became non-depressed (CES-D ≤ 16, n = 248; 73%), (2) persons who remained or became depressed (CES-D >16, n = 76) and (3) non-depressed persons who remained non-depressed (n = 597). All persons, regardless of group, met program goals. The greatest improvements (i.e., diet, exercise, perceived stress, hostility and mental health) were observed in Group 1 relative to Groups 2 and 3, which did not differ from each other. Comprehensive lifestyle changes appear to be feasible and beneficial for initially depressed persons with elevated CRFs.     

Reading and Spelling Disabilities in Children with and Without a History of Early Language Delay: A Neuropsychological and Linguistic Study

Language delay is a frequent antecedent of literacy problems, and both may be linked to phonological impairment. Studies on developmental dyslexia have led to contradictory results due to the heterogeneity of the pathological samples. The present study investigated whether Italian children with dyslexia showed selective phonological processing deficits or more widespread linguistic impairment and whether these deficits were associated with previous language delay. We chose 46 children with specific reading deficits and divided them into two groups based on whether they had language delay (LD) or not (NoLD). LD and NoLD children showed similar, severe deficits in reading and spelling decoding, but only LD children showed a moderate impairment in reading comprehension. LD children were more impaired in phonological working memory and phonological fluency, as well as in semantic fluency, grammatical comprehension, and verbal IQ. These findings indicate the presence of a moderate but widespread linguistic deficit (not limited to phonological processing) in a subset of dyslexic children with previous language delay that does not generalize to all children with reading difficulties.     

Multiple stimulus presentation yields larger deficits in children with developmental dyslexia: A study with reading and RAN-type tasks

In this study, we examined the effect of multiple versus single stimulus presentation in typically developing readers and children with developmental dyslexia. The tasks involved either reading single words or arrays of words or naming single or multiple colors and digits (rapid automatized naming or RAN). To be able to compare these sets of conditions, we recorded total response times (i.e., the time between stimulus onset and the end of the participant’s vocal response) in all cases. The study included 43 typically developing readers and 25 children with dyslexia.

Results indicate that typically developing readers have a clear advantage with multiple over single items on both RAN and reading tasks. The children with dyslexia showed a moderate advantage for multiple stimuli in naming colors and digits but presented the opposite pattern in reading.

With regard to reading, the disproportionate impairment of the children with dyslexia in dealing with multiple arrays suggests difficulty in integrating the multiple subcomponents of the reading task over and above the basic nuclear deficit in decoding words. Regarding the RAN tasks, results confirm that the requirement of integrating multiple subcomponents may be critical in mediating the predictive value of these measures on reading.     

Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study

Objective

There has been uncertainty about whether refugees and asylum seekers with PTSD can be treated effectively in standard psychiatric settings in industrialized countries. In this study, Narrative Exposure Therapy (NET) was compared to Treatment As Usual (TAU) in 11 general psychiatric health care units in Norway. The focus was on changes in symptom severity and in the diagnostic status for PTSD and depression.

Method

Refugees and asylum seekers fulfilling the DSM-IV criteria for PTSD (N = 81) were randomized with an a-priori probability of 2:1 to either NET (N = 51) or TAU (N = 30). The patients were assessed with Clinician Administered PTSD Scale, Hamilton rating scale for depression and the MINI Neuropsychiatric Interview before treatment, and again at one and six months after the completion.

Results

Both NET and TAU gave clinically relevant symptom reduction both in PTSD and in depression. NET gave significantly more symptom reduction compared to TAU as well as significantly more reduction in participants with PTSD diagnoses. No difference in treatment efficacy was found between refugees and asylum seekers.

Conclusions

The study indicated that refugees and asylum seekers can be treated successfully for PTSD and depression in the general psychiatric health care system; NET appeared to be a promising treatment for both groups.

ClinicalTrials.gov registry number

NCT00218959.