Is hospitalization useful for suicidal patients with borderline personality disorder?

This article examines the value of hospitalization for chronically suicidal patients with borderline personality disorder (BPD). One in 10 of these patients will eventually complete suicide. However, this outcome is not readily predictable. Hospitalization is of unproven value for suicide prevention and can often produce negative effects. Day treatment is an evidence-based alternative to full admission. Chronic suicidality can best be managed in an outpatient setting.     

Middlemarch Revisited: Changing Responses to George Eliot

The American Journal of Psychoanalysis -     

Common Sense and Maximum Entropy

This paper concerns the question of how to draw inferences common sensically from uncertain knowledge. Since the early work of Shore and Johnson (1980), Paris and Vencovská (1990), and Csiszár (1989), it has been known that the Maximum Entropy Inference Process is the only inference process which obeys certain common sense principles of uncertain reasoning. In this paper we consider the present status of this result and argue that within the rather narrow context in which we work this complete and consistent mode of uncertain reasoning is actually characterised by the observance of just a single common sense principle (or slogan). This revised version was published online in June 2006 with corrections to the Cover Date.     

Pain tolerance selectively increased by a sweet-smelling odor

The mechanism underlying reported analgesic effects of odors in humans is unclear, although odor hedonics has been implicated. We tested whether odors that are sweet smelling through prior association with tasted sweetness might influence pain by activating the same analgesic mechanisms as sweet tastes. Inhalation of a sweet-smelling odor during a cold-pressor test increased tolerance for pain compared with inhalation of pleasant and unpleasant low-sweetness odors and no odor. There were no significant differences in pain ratings among the odor conditions. These results suggest that smelled sweetness can produce a naturally occurring conditioned increase in pain tolerance.     

Understanding heterogeneity in borderline personality disorder: Differences in affective reactivity explained by the traits of dependency and self-criticism

This study examined whether the personality traits of self-criticism and dependency respectively moderated the effects of perceived inferiority and emotional insecurity on negative affect during interpersonal interactions in individuals with borderline personality disorder (BPD). A sample of 38 patients with BPD and matched community comparison participants completed event-contingent record forms after each significant interaction for a 20-day period. Multilevel models showed that, controlling for baseline levels of depressive symptoms and neuroticism, as well as lagged negative affect, event-level elevations in perceived inferiority and emotional insecurity were related to more negative affect in both groups. Event-level perceived inferiority was more strongly associated with negative affect in patients with BPD who reported higher levels of self-criticism, while event-level perceived emotional insecurity was more strongly associated with negative affect in patients with BPD who reported higher levels of dependency. No significant interactions emerged for the comparison group. These findings further our understanding of differences among patients with BPD and support the application of personality-vulnerability or diathesis-stress models in predicting negative affect in BPD. Results have implications for the design of therapies for patients with BPD. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.     

Dewey Between the Lines: George Kelly and the Pragmatist Tradition

In his own somewhat sly and sardonic way, George Kelly always insisted that personal construct theory could not be assimilated into any other kind of psychology. We believe this was not an example of Kelly being difficult or protecting his turf, but that he resisted such efforts at categorization because he formulated personal construct psychology from an entirely different set of assumptions than those which have traditionally guided the construction of psychological theories. We begin by looking at the unusual life path Kelly took in order to enter the field of psychology and what it reveals about the independent turn of mind he brought to creating his own theory of personality. We then examine what we believe is the single most important influence on Kelly's thinking—the tradition of American pragmatism, in general, and the philosophy and psychology of John Dewey, in particular. We argue that Kelly embraced the pragmatic epistemological assumptions that guided Dewey's work, and that he used these assumptions to develop the only pragmatic theory of personality and psychotherapy. It is, in fact, the influence of Dewey and the pragmatists that makes personal construct psychology so different from and, at times, more difficult to understand than other, more traditional, “realist” theories, but it is also this pragmatic orientation that makes Kelly's theory such an important contribution.