Shame as a prospective predictor of self-inflicted injury in borderline personality disorder: A multi-modal analysis

The primary aim of this study was to examine the prospective association of shame with self-inflicted injury (SII), including suicide attempts and nonsuicidal self-injury, among women with borderline personality disorder (BPD) who were enrolled in a clinical trial (N = 77). A multi-method approach was used to assess self-reported shame, nonverbal shame behaviors, and assessor ratings of shame during an interview regarding antecedents for a recent episode of SII. Higher levels of nonverbal shame behaviors predicted a higher likelihood of subsequent SII, and shorter time to SII, after controlling for past SII as well as other emotions associated with SII. Self-reported state shame and assessor ratings of shame were associated with prospective SII, but not after controlling for other emotions. These findings underscore the important role of shame in SII, particularly shame in the presence of contextual prompts for events that surround episodes of SII.     

Group aversion by imaginal, vicarious and shared recipient-observer shocks

Sixty college students completed waiting control or alternative group aversion conditions, matched for severity and chronicity of nail-biting. Treatments spanned four sessions. Imaginai aversion (covert sensitization) clients visualized shocks to themselves. Vicarious aversion clients observed shocks to a trained model. A ‘hotseat’ format randomized a few actual shocks to each client with observing peers shocked on remaining trials. The predominant pattern of outcome and subjective impact results was as follows: Hotseat consistently best; vicarious typically second; imaginal usually third; controls worst. Clinical and conceptual issues are raised.     

Suicide Attempt Self-Injury Interview (SASII): development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury

The authors describe the development of the Suicide Attempt Self-Injury Interview (SASII), an instrument designed to assess the factors involved in nonfatal suicide attempts and intentional self-injury. Using 4 cohorts of participants, authors generated SASII items and evaluated them with factor and content analyses and internal consistency statistics. The final measure was assessed for reliability and validity with collateral measures. The SASII assesses variables related to method, lethality and impulsivity of the act, likelihood of rescue, suicide intent or ambivalence and other motivations, consequences, and habitual self-injury. The SASII was found to have very good interrater reliability and adequate validity.     

Risky assessments: participant suicidality and distress associated with research assessments in a treatment study of suicidal behavior

The purpose of this study was to examine patterns of self-reported suicidality and distress during research assessments in a sample of 63 women meeting criteria for borderline personality disorder and current and chronic suicidality. The risk management protocol we used during the two-year study period (University of Washington Risk Assessment Protocol; UWRAP) is described. Results indicated that changes in suicidality following assessments were small and relatively infrequent, and were just as likely to reflect decreases in suicidality as increases (17.5% versus 16.4% of sessions, respectively). Further, longitudinal analyses indicated that changes in suicidality became increasingly rare over the course of the 2-year study. Ratings of distress were more changeable than suicidality, underscoring the need for separate measurement of these constructs when assessing risk. With the aid of the UWRAP, our assessors judged 15 participants as high-risk status in 28 assessment sessions (3.7% of all sessions). In comparison to the rest of the sample, these individuals were of significantly greater clinical severity as measured by the HRSD 17-item, GAF scores, number and severity of previous suicide attempts, and number of previous psychiatric hospitalizations. Low-intensity risk intervention strategies (e.g., validating participant's feelings) were typically sufficient to reduce risk in these participants. Overall, our findings indicate that research with highly suicidal individuals can be done safely with the use of well-trained assessors and an appropriate crisis management protocol.     

The brief Reasons for Living Inventory for adolescents (BRFL-A)

This study modified and evaluated the psychometric properties of the Reasons for Living Inventory (RFL) in samples of adolescents. Internal consistency reliability, corrected item-total scale correlation, and exploratory factor analysis procedures were used with a mixed sample of 260 adolescents to identify 14 items for the brief version of the RFL (BRFL-A). Confirmatory factor analyses provided support for the five-factor oblique structure of the BRFL-A in a psychiatric inpatient sample with a range of suicidal behaviors. Reliabilities of the BRFL-A subscales were satisfactory. Four of the five subscales differentiated between suicidal and nonsuicidal adolescents. Significant correlations were found between three BRFL-A subscales and several suicide indices. Convergent-discriminant validity was examined by correlating the BRFL-A subscales with the Minnesota Multiphasic Personality Inventory—Adolescents (MMPI-A) Content Scales. Limitations of the study are discussed.This study was supported in part by a Project Grant from the Graduate College, The University of Northern Iowa.     

COMMUNISM AND THE TRAUMA OF ITS COLLAPSE REVISITED

This paper focuses on the intertwinement of society and the psyche as a consequence of 70 years of Communist rule and the trauma of its collapse in the 90’s. The trauma had profound effects on the psyche. An empirical study that was carried out in 1996/1997, which compared the personality structure of adolescents from Russia and Austria, and a research dialogue in 1999, has been re-evaluated in the light of current political events. One aim that we had was to find out whether we could discover characteristic personality features, resulting from the Communist totalitarian society in Russia, as well as from the trauma of its collapse. This led to the development of the concepts of the “impersonal self” and the “denial mode”. The Russians seemed to be frozen in a protective shell with “flat” affects. They were anxious, conflict avoidant, and somewhat lost. Ideas about missing adolescence and the importance of privacy are discussed. Society was shown to not only have intruded into the individual psyche, but also into the members of the intercultural research team in the form of projective identification. The importance of the interaction between society and the individual as a basic psychoanalytic concept dating back to Freud is elaborated. Finally, considerations pertaining to mental health and democracy are presented.     

Does Reintegration Stress Contribute to Suicidal Ideation Among Returning Veterans Seeking PTSD Treatment?

Although posttraumatic stress disorder (PTSD) and other psychiatric symptoms are well‐established risk factors for suicidal ideation among returning veterans, less attention has been paid to whether the stress of reintegrating into civilian society contributes to suicidal ideation. Utilizing a sample of 232 returning veterans (95% male, mean age = 33.63 years) seeking PTSD treatment, this study tested whether reintegration difficulties contribute to suicidal ideation over and above the influence of PTSD symptoms, depression symptoms, and potential substance misuse. Logistic regressions indicated that reintegration stress had a unique effect on suicidal ideation over and above PTSD and depression symptoms. Reintegration stress interacted with substance misuse to predict suicidal ideation, such that the effect of reintegration stress on suicidal ideation was much larger for those with potential substance misuse. Exploratory analyses also examined which types of reintegration difficulties were associated with suicidal ideation, and found that difficulty maintaining military friendships, difficulty getting along with relatives, difficulty feeling like you belong in civilian society, and difficulty finding meaning/purpose in life were all significantly associated with suicidal ideation, beyond the effects of psychiatric symptoms and potential substance misuse. Findings highlight the importance of addressing reintegration stress for the prevention of suicide among returning veterans. Implications for treatment are discussed.     

Treating PTSD in suicidal and self-injuring women with borderline personality disorder: development and preliminary evaluation of a Dialectical Behavior Therapy Prolonged Exposure Protocol

This study focused on the development and pilot testing of a protocol based on Prolonged Exposure (PE) that can be added to Dialectical Behavior Therapy (DBT) to treat PTSD in suicidal and self-injuring individuals with borderline personality disorder (BPD). Women with BPD, PTSD, and recent and/or imminent serious intentional self-injury (n = 13) received one year of DBT with the DBT PE Protocol, plus three months of follow-up assessment. The treatment was associated with significant reductions in PTSD, with the majority of patients no longer meeting criteria for PTSD at post-treatment (71.4% of DBT PE Protocol completers, 60.0% of the intent-to-treat sample). A minority of patients (27.3%) engaged in intentional self-injury during the study. Improvements were also found for suicidal ideation, dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and social adjustment. There was no evidence that the DBT PE Protocol led to exacerbations of intentional self-injury urges or behaviors, PTSD, treatment dropout, or crisis service use. Overall, the results indicate that this integrated BPD and PTSD treatment is feasible to implement within one year of treatment, highly acceptable to patients and therapists, safe to administer, and shows promise as an effective intervention for PTSD in this complex and high-risk patient population.     

An Investigation of the Relationships among Negative Affect, Difficulties in Emotion Regulation, and Features of Borderline Personality Disorder

This study investigated the indirect effects of problematic emotion regulation on features of Borderline Personality Disorder (BPD) when accounting for negative affect in 456 participants from two distinct geographic regions. Participants completed the Affect Intensity Measure (AIM), Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), and the Borderline Symptom List (BSL). Results from this study supported a model in which there were significant indirect effects of both a lack of emotional clarity and limited access to emotion regulation strategies on features of BPD when accounting for negative affective intensity. Results also supported a second model in which there were significant indirect effects of both limited access to emotion regulation strategies and difficulties engaging in goal-directed behavior on features of BPD when accounting for negative affective reactivity. The results highlight important inter-relationships among features of BPD, difficulties regulating emotions, and negative affective intensity and reactivity.     

Managing Salience: The Importance of Intellectual Virtue in Analyses of Biased Scientific Reasoning

Feminist critiques of science show that systematic biases strongly influence what scientific communities find salient. Features of reality relevant to women, for instance, may be under‐appreciated or disregarded because of bias. Many feminist analyses of values in science identify problems with salience and suggest better epistemologies. But overlooked in such analyses are important discussions about intellectual virtues and the role they play in determining salience. Intellectual virtues influence what we should find salient. They do this in part by managing the emotions, which are cognitively involved in what we actually do find salient. One reason intellectual virtues do not factor more strongly in feminist epistemology is the mistaken assumption that they could not serve as explicit epistemic community standards for scientific inquiry. There are good reasons, however, to think in terms of community intellectual virtue and consequently, to advance explicit public standards of intellectual virtue for scientific research. To show how explicit public standards for intellectual virtue might improve reasoning in biased conditions, I analyze a striking oversight in several evolutionary immunological hypotheses concerning women's reproduction and sexuality. I conclude that feminist epistemology would benefit from greater consideration of intellectual virtues, particularly in connection with social epistemological insights.