Cognitive coping and defense styles in patients with personality disorders

This study investigates the associations between cognitive coping (as measured with the Cognitive Emotion Regulation Questionnaire; CERQ), defense mechanisms (as measured with the Defense Style Questionnaire-60; DSQ-60) and personality disorders (PDs; as measured with the SIDP-IV interview) in a large sample of patients with PDs (n = 1,435). Explorative factor analyses indicated that the nine CERQ subscales can be clustered into three higher-order factors (adaptive coping, non-adaptive coping and external attribution style). When compared to a general population sample, the PD sample particularly scored higher on nonadaptive coping styles. A higher number of PDs was related to a particularly higher level of nonadaptive coping and less mature defensive functioning, but also to lower levels of adaptive coping and external attribution. This study is the first to suggest that three higher-order coping styles can be identified among PD patients, and that these coping styles are related to the presence and number of PDs.     

A functional role for the motor system in language understanding: evidence from theta-burst transcranial magnetic stimulation

Does language comprehension depend, in part, on neural systems for action? In previous studies, motor areas of the brain were activated when people read or listened to action verbs, but it remains unclear whether such activation is functionally relevant for comprehension. In the experiments reported here, we used off-line theta-burst transcranial magnetic stimulation to investigate whether a causal relationship exists between activity in premotor cortex and action-language understanding. Right-handed participants completed a lexical decision task, in which they read verbs describing manual actions typically performed with the dominant hand (e.g., "to throw," "to write") and verbs describing nonmanual actions (e.g., "to earn," "to wander"). Responses to manual-action verbs (but not to nonmanual-action verbs) were faster after stimulation of the hand area in left premotor cortex than after stimulation of the hand area in right premotor cortex. These results suggest that premotor cortex has a functional role in action-language understanding.     

Personality and personal network type

The association between personality and personal relationships is mostly studied within dyadic relationships. We examined these variables within the context of personal network types. We used Latent Class Analysis to identify groups of students with similar role relationships with three focal figures. We performed Latent Class Logistic Regression to explore the relationships of the latent classes with the Big Five personality factors. Personality was assessed with the Five Factor Personality Inventory. We found three personal network types: a primarily family oriented network, a primarily peer oriented network, and a mixed family/peer oriented network. We found significant associations between personality and personal network type. Extraverted students were more likely to have a primarily peer oriented network relative to a primarily family oriented network. Autonomous students were more likely to have a primarily family oriented network relative to a primarily peer oriented network. Autonomous students were also more likely to have a mixed family/peer oriented network relative to a primarily peer oriented network. Conscientious students were more likely to have a primarily family oriented network relative to a mixed family/peer oriented network.     

Development of E-Info Geneca: A Website Providing Computer-Tailored Information and Question Prompt Prior to Breast Cancer Genetic Counseling

This article describes the stepwise development of the website ‘E-info gene^ca’. The website provides counselees in breast cancer genetic counseling with computer-tailored information and a question prompt prior to their first consultation. Counselees generally do not know what to expect from genetic counseling and they tend to have a passive role, receiving large amounts of relatively standard information. Using the “intervention mapping approach,” we developed E-info gene^ca aiming to enhance counselees’ realistic expectations and participation during genetic counseling. The information on this website is tailored to counselees’ individual situation (e.g., the counselee’s age and cancer history). The website covers the topics of the genetic counseling process, breast cancer risk, meaning of being a carrier of a cancer gene mutation, emotional consequences and hereditary breast cancer. Finally, a question prompt encourages counselees to prepare questions for their genetic counseling visit.     

Personality disorder research agenda for the DSM-V

The American Psychiatric Association is sponsoring a series of international conferences to set a research agenda for the development of the next edition of the diagnostic manual. The first conference in this series, "Dimensional Models of Personality Disorder: Etiology, Pathology, Phenomenology, and Treatment," was devoted to reviewing the existing research and setting a future research agenda that would be most effective in leading the field toward a dimensional classification of personality disorder. The purpose of this article, authored by the Steering Committee of this conference, was to provide a summary of the conference papers and their recommendations for research. Covered herein are the reviews and recommendations concerning alternative dimensional models of personality disorder, behavioral genetics and gene mapping, neurobiological mechanisms, childhood antecedents, cross-cultural issues, Axes I and II continuity, coverage and cutoff points for diagnosis, and clinical utility.     

The burden of disease among adolescents with personality pathology: quality of life and costs

In adults, personality disorders are associated with a low quality of life and high societal costs. To explore whether these findings also apply to adolescents, 131 adolescent patients were recruited from a mental health care institute in The Netherlands. Axis I and Axis II disorders were diagnosed using semi-structured interviews. The EuroQol EQ-5D was used to measure quality of life and costs were measured by the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness. The mean EQ-5D index value was 0.55. The mean direct medical cost in the year prior to treatment was €14,032 per patient. The co-occurrence of Axis I and Axis II disorders was a significant predictor of a low quality of life. Direct medical costs were higher for the depressive personality disorder. This study shows that the burden of disease among adolescents with personality pathology is high. This high burden provides evidence to suggest that further research and development of (cost-)effective treatment strategies for this population may be worthwhile.     

Specific Personality Traits and General Personality Dysfunction as Predictors of the Presence and Severity of Personality Disorders in a Clinical Sample

This study examined the associations of specific personality traits and general personality dysfunction in relation to the presence and severity of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994) personality disorders in a Dutch clinical sample. Two widely used measures of specific personality traits were selected, the Revised NEO Personality Inventory as a measure of normal personality traits, and the Dimensional Assessment of Personality Pathology-Basic Questionnaire as a measure of pathological traits. In addition, 2 promising measures of personality dysfunction were selected, the General Assessment of Personality Disorder and the Severity Indices of Personality Problems. Theoretically predicted associations were found between the measures, and all measures predicted the presence and severity of DSM–IV personality disorders. The combination of general personality dysfunction models and personality traits models provided incremental information about the presence and severity of personality disorders, suggesting that an integrative approach of multiple perspectives might serve comprehensive assessment of personality disorders.     

Relationship between patient characteristics and treatment allocation for patients with personality disorders

Within a large multi-center study in patients with personality disorders, we investigated the relationship between patient characteristics and treatment allocation. Personality pathology, symptom distress, treatment history, motivational factors, and sociodemographics were measured at intake in 923 patients, who subsequently enrolled in short-term or long-term outpatient, day hospital, or inpatient psychotherapy for personality pathology. Logistic regressions were used to examine the predictors of allocation decisions. We found a moderate relationship (R(2) = 0.36) between patient characteristics and treatment setting, and a weak relationship (R(2) = 0.18) between patient characteristics and treatment duration. The most prominent predictors for setting were: symptom distress, cluster C personality pathology, level of identity integration, treatment history, motivation, and parental responsibility. For duration the most prominent predictor was age. We conclude from this study that, in addition to pathology and motivation factors, sociodemographics and treatment history are related to treatment allocation in clinical practice.     

The fruits of irony: gaining insight into how we make meaning of the world

Many philosophers of education emphasise the impossibility to really ‘solve’ philosophical—and with that, educational—problems these days. Philosophers have been trying to give philosophy a new, constructive turn in the face of this insolvability. This paper focuses on irony-based approaches that try to exploit the very uncertainty of philosophical issues to further philosophical understanding. We will first briefly discuss a few highlights of historical uses of irony as a philosophical tool. Then we concentrate on two different interpretations of irony, formulated by Bransen and Rorty, that aim at gaining insight into how we make meaning of the world, while at the same time recognising that such an understanding would be impossible. After discussing some problematic aspects of these interpretations a third interpretation of irony is developed, based on a third view of the nature of meaning-making. Following these three interpretations, we will discuss their philosophical merits and the different kinds of insight they can produce for philosophy of education.