Treating Symptoms of Borderline Personality Disorder Through Narrative Therapy and Naltrexone

Abstract

Borderline Personality Disorder (BPD) is characterized by instability in interpersonal relationships, volatile perceptions of self-image and affects, and marked impulsivity, presenting in various contexts. Current BPD treatments are individual-centered, coping skills based, with a reduced emphasis on identifying etiology and systemic components. Narrative therapy focuses on deconstructing and reauthoring personal stories. A clinical case study shows narrative therapy to be efficacious, however, sometimes psychotherapeutic interventions alone are inadequate in managing these symptoms. Medication can serve as a useful adjunct in addressing self-injurious behaviors, suicidal ideation, and dissociation. Researchers further discuss the integration of naltrexone into treatment of BPD symptoms.     

The patient,the nurse,his life and her mother: Psychodynamic influences in nurse education and practice

Using the film The Cook, the Thief His Wife and her Lover (from which this paper's title is borrowed) as a powerful illustration, the paper examines some of the unconscious processes which form part of everyday life for nurses working in the community, particularly on the wards of our hospitals. It is an attempt to describe some of these processes and to understand the conditions that promote them. With acknowledgements to the pioneers in this sort of work, such as Main, Menzies-Lyth, Trist, Bamforth and Jaques, the paper looks at the ethology of institutions and at activity that takes place on the boundaries between self and other, between the inner world and external reality, and between various levels in the hierarchy.

The paper identifies some of the ‘routines’ which grew up in nursing (and those which have replaced them), the unconscious purpose of which is to safeguard the emotional and psychological integrity of the nurse, through creating a distance between herself and her patients. The paper argues against removing these necessary defences until more helpful alternatives are in place. To fulfil this aim, it recommends that clinical supervision and support seminars should become a regular part of all nurse-training programmes, and should continue throughout the professional life of the nurse.     

A preliminary investigation of the effect of hypomanic personality on the specificity and speed of autobiographical memory recall

There is some evidence that patients with bipolar disorder recall more overgeneral than specific autobiographical memories, a pattern widely reported in depression. However, there are also theoretical arguments (Barnard, Watkins, & Ramponi, 2006) suggesting that experiential processing should predominate during mania/hypomania, with an associated prediction of an increase in specific rather than overgeneral memories. This hypothesis was explicitly tested using the Autobiographical Memory Test (AMT). The specificity and speed of autobiographical recollection was compared for those with high or low levels of hypomanic personality as indexed by the Hypomanic Personality Scale (HPS). High HPS scorers recalled specific autobiographical memories in response to unpleasant cues more frequently and faster than low scorers. These results provide partial support for the hypothesis, but only for unpleasant cues.     

Gender differences in episodic memory and visual working memory including the effects of age

Analysing the relationship between gender and memory, and examining the effects of age on the overall memory-related functioning, are the ongoing goals of psychological research. The present study examined gender and age group differences in episodic memory with respect to the type of task. In addition, these subgroup differences were also analysed in visual working memory. A sample of 366 women and 330 men, aged between 16 and 69 years of age, participated in the current study. Results indicate that women outperformed men on auditory memory tasks, whereas male adolescents and older male adults showed higher level performances on visual episodic and visual working memory measures. However, the size of gender-linked effects varied somewhat across age groups. Furthermore, results partly support a declining performance on episodic memory and visual working memory measures with increasing age. Although age-related losses in episodic memory could not be explained by a decreasing verbal and visuospatial ability with age, women's advantage in auditory episodic memory could be explained by their advantage in verbal ability. Men's higher level visual episodic memory performance was found to result from their advantage in visuospatial ability. Finally, possible methodological, biological, and cognitive explanations for the current findings are discussed.     

Assessing the specificity of autobiographical memory in individuals at a trait-based vulnerability to bipolar disorder using a sentence completion task

Overgeneral autobiographical memory recall has been associated with the diagnosis of bipolar disorder, but the role of overgenerality in the vulnerability to bipolar disorder remains under-researched. While a previous study suggested that high-risk individuals for bipolar disorder recall emotionally negative memories in specific detail, this is in contrast to memory recall patterns noted in bipolar samples. The Autobiographical Memory Test (AMT) used in previous non-clinical studies has also been criticised for not being sensitive to overgenerality due to its repetition of specificity instructions and practice trials. The traditional AMT format may allow some individuals to override their trait-based tendencies to be overgeneral. The current study used a sentence completion task to assess memory specificity in groups of students at a low and high trait-based vulnerability for bipolar disorder. In contrast to previous research, high-risk individuals recalled fewer specific positive memories and greater numbers of overgeneral negative memories than low-risk individuals. These results support the notion that the vulnerability for bipolar disorder might be associated with similar recall biases as demonstrated in bipolar samples, and that the AMT might not be sufficiently sensitive to detect overgenerality in non-clinical groups. The implications of these findings and directions for future research are discussed.     

Treatment of Assaultiveness

Summary

Assaultiveness and abusiveness have a psychology that must be addressed in therapy; they are not merely the product of “bad attitudes” or social roles, nor can they be narrowly defined as the robotic imitation of action. Perceptions and feelings about the world of intimate relationships both sustain and are sustained by abusive actions. These provide points of intervention for cognitive behavioral therapy (CBT). Given the tendency to shame easily, abusive men must not be confronted too quickly or too strongly. On the other hand, given their well-established denial system and tendency to minimize the consequences of their abusiveness, some confrontation must occur. Hence a “Zen” line of least resistance must be found between the opposites of acceptance and confrontation. Treatment outcome studies indicate moderate success for cognitive behavioral treatment (CBT) for batterers. Treatment is less successful with men who have personality disorders, especially psychopathy.     

Male Partner Abusers' Perceptions of Family Relationship Functioning: A Comparison of Clinically Derived Abuser Types

Research has explored the differences between types of male partner abusers on various variables and yet little research has examined family experiences, such as family of origin structure and relationship patterns. The present study compared 4 male partner abuser types derived from profile interpretation of the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) and a group of nonintimately violent men on family of origin and current partner relationship functioning using two family scales from the MMPI-2, the Locke-Wallace Marital Adjustment Test, and the Family Adaptation and Cohesion Evaluation Scale III. Results indicated that male partner abusers with more severe psychopathology (i.e., borderline and antisocial) reported greater relationship distress, discord, conflict, and emotional disengagement than those men with less psychopathology (i.e., nonpathological). Clinical implications are discussed.     

Personality,Parental, and Media Influences on Aggressive Personality and Violent Crime in Young Adults

Debate remains regarding the interaction between predictor variables for aggression, including family environment, media violence, and personality. The current study examined the contributions of gender and personality, exposure to physical abuse and violence in the family, and exposure to media violence in both television and in video games on violent criminal activity. Data from young adults (n = 355) indicated that personality characteristics and direct physical abuse significantly predicted violent crime. Exposure to television and video game violence were not significant predictors of violent crime. These results elucidate the complex interplay between multiple factors related to the etiology of violent crime. These results also call into question the belief that media violence is involved in the etiology of violent crime.     

Flexible target representations underlie repetition priming in visual search

Repeating target features across consecutive visual search trials can influence response time. Three experiments are reported that show that this repetition priming is dependent on the exact stimulus configuration and feature type. In Experiment 1 the target was defined relative to distractors by its orientation and target colour was task irrelevant. The roles played by these features were reversed in Experiment 2. Repeating target colour across trials speeded responses in both Experiments 1 and 2. Repeating orientation significantly slowed responses in Experiment 1 but had no significant effect in Experiment 2. Existing feature-based and episodic memory-based explanations of priming cannot account for these data, but instead more flexible explanations are required. Experiment 3 showed that significant positive priming results from repeating distractor-defining orientation, indicating that priming of pop-out effects previously reported in the literature may result from combined target and distractor effects.     

Schizotypal personality traits and attitudes towards Hinduism among Balinese Hindus

The study explored the relationship between schizotypal personality traits and attitude of Hindus towards their faith. A total of 309 Balinese Hindus responded to the Santosh–Francis Scale of Attitude towards Hinduism, the Schizotypal Personality Questionnaire Brief, and a number of external indicators and religious practices. Attitude towards Hinduism, frequency of prayer, and temple attendance had a rather weak positive relationship with each other, while prayer behaviour exhibited negative low-to-moderate relationships with schizotypal traits. A hierarchical multiple linear regression model identified the disorganised elements of schizotypy as the primary predictor of the attitude towards Hinduism. Finally, age showed negative associations with schizotypy and positive ones with Hinduism, while women were less schizotypal and had more positive attitude towards their faith than men. These findings suggest the presence of both underlying cross-faith elements and the strong influence of faith- and culture-specific forces on the relationship between religiosity and schizotypy.