From “It's Not Me” to “It Was Me,After All”: A Case Presentation of a Patient Diagnosed with Dissociative Identity Disorder

In cases of extreme childhood trauma associated with abuse and neglect, one's sense of self is seriously compromised. Attachment patterns, symptoms, defensive operations, and character formation will differ depending upon the level of interference and impingement. When repeated trauma occurs in early childhood, the dissociative response may become the first line of defense for the person to rely upon. In its most severe form, patients are diagnosed with Dissociative Identity Disorder (DID). This paper addresses the case of a woman diagnosed with DID. It describes the restoration of a cohesive sense of self from the eight parts of a dissociated and fragmented self in the course of therapy. The clinical case material presented is that of the child part of her, known as Lucy. Her treatment resulted in the integration of the “it's not me!” self to the patient's knowledge that “it was me, after all.”     

Gratitude and PTSD symptoms among Israeli youth exposed to missile attacks: examining the mediation of positive and negative affect and life satisfaction

Based on a sample of Israeli adolescents living in a city which was under missile attack 2½ months prior to this study, we examined the possible affective and cognitive mechanisms through which gratitude may serve as a protective factor against PTSD symptoms. Specifically, we focused on how this process might be mediated by positive affect, negative affect, and life satisfaction. These are widely understood as the emotional and cognitive components of subjective well-being and have each been significantly associated with gratitude and with pathology in the literature. Using pathway analysis, our findings revealed that life satisfaction and negative affect, but not positive affect, mediated the relationship between gratitude and PTSD symptoms. Our study suggests that gratitude may serve as a protective factor primarily through cognitive appraisal processes tied to greater appreciation of life in a way that distinguishes it from other positive emotions.     

Categorization behaviour in adults,adolescents, and attention-deficit/hyperactivity disorder adolescents: A comparative investigation

Although significant progress has been made with respect to our understanding of categorization and concept learning behaviour in adults, much less is known about how this key capacity plays out with respect to more restrictive populations. This is unfortunate because much may be revealed about the nature of concept learning by examining the limits exhibited by special populations. With this tenet in mind, in what follows, we investigated key aspects of concept learning in terms of the unexplored comparative performance of three populations—adults, adolescents, and adolescents with attention-deficit/hyperactivity disorder (ADHD). To do so, we employed a novel parainformative experimental task involving categorical stimuli with four objects defined over three dimensions. The learning difficulty ordering for these types of three-dimensional stimuli has proven robust and has been replicated by several researchers. Indeed, in our experiment, we observed the same concept learning ordering in adults and adolescents, but not in ADHD adolescents: For example, the latter group showed greatly impaired categorization performance on stimuli characterized by an “exclusive-or” rule. However, categorization performance on such type of stimuli indicated good reliability in discriminating between adolescents with and without ADHD (receiver-operating characteristic, ROC?=?.82). We accurately predicted and accounted for these results using generalized invariance structure theory (GIST; Vigo, 2013. The GIST of concepts. Cognition, 129, 138–162), which posits that organisms detect invariance patterns in stimuli that are necessary precursors to concept formation.     

The overall pattern of the evolution of information in dissipative,material systems

I have argued for the reality of a second law of infodynamics. That is, that the information carrying capacity in a system, as viewed from within, must continue to increase as long as the system supports internal observation. I will be concerned here with matters of scale, as well as with system senescence (rigidity produced by the asymptotic approach to maximum information storage within a system). My major categories derive from a view of system development, and are: immaturity, maturity and senescence. As an immature system grows in size, It deploys information over ever smaller scales as it transforms from the vagueness of immaturity toward ever more definite embodiment. This eventually results in an information overload, gradually eroding system adaptability as it increasingly inhibits the variety of system responses by limiting its ability to further qualify stored information;     

Emerging as a Personality Disorder Service

Personality Disorder Services working along psychotherapeutic lines are gaining appeal with Health Care Commissioners following the publication of the NICE guidelines for Borderline & Antisocial Personality Disorders and the emerging successful application of psychoanalytically-derived approaches.

Establishing a new Personality Disorder Service is akin to constructing a ‘home’ within which the therapeutic work with patients can develop. As clinicians, we are required to question what facets are important to the development of this new home, and to further to endure the unfamiliar state of being ‘not at home’ while the identity of the service is established.

We address how this process parallels the task facing the patient as they struggle to establish their own identity. We also highlight some important tenets in the work of securing a robust identity for both the service and the patient suffering from a personality disorder.     

A systematic review of the evidence-based psychosocial risk factors for understanding of borderline personality disorder

Borderline personality disorder (BPD) is a serious personality disorder characterized by affective instability, impulsivity and interpersonal disturbance. Currently, intensive research is being conducted concerning the aetiology of BPD, including research on neurobiological, temperamental, psychosocial and cultural risk factors. This study focuses on psychosocial risk factors while other risk factors are taken into account in the discussion of the development of BPD. To our knowledge, no systematic review of the evidence-based medicine literature concerning this theme has been made thus far. However, understanding psychosocial risk factors of BPD is important in order to develop psychotherapeutic treatment models and methods. We provide a systematic review of the literature focusing on psychosocial risk factors for BPD. Utilizing this knowledge, we discuss how these data may be used when studying the development of borderline personality disorder and the treatment of borderline personality disorder.     

The elephant tied up with string: a clinical case study showing the importance of NHS provision of intensive,time-limited psychoanalytic psychotherapy treatments

Prof. Richard Layard's influential advocacy for greater provision of ‘evidence-based’ psychological therapies, based in part on an economic rationale, has lead to greatly increased provision of cognitive behavioural therapy (CBT) and short-term therapies for depression, through the Increasing Access to Psychological Therapies (IAPT) initiative, whilst longer-term psychodynamic treatments are under threat, criticised as lacking an evidence base. This paper argues for the continuing provision of intensive thrice-weekly psychoanalytic psychotherapy treatments, time-limited to two years. It does so by describing such a treatment within an NHS psychotherapy department with a patient with a long history of severe personality pathology, including significant levels of perversity. The paper describes the patient's difficulties and his movement through the treatment, focussing on his difficulties making genuine emotional contact, his destructiveness of such contact, his acting out in the treatment, his perversity and the vital working through of the ending. The shifts the patient made are described, and follow-up information on the patient is given. The paper discusses the unique benefits of time-limited treatment and intensive psychoanalytic treatments for this ‘hard-to-help’ group of patients, and the economic rationale that can be made for such treatments.     

Mood-congruent bias and attention shifts in the different episodes of bipolar disorder

An “affective” go/no-go task was used in the different episodes of bipolar patients (euthymic, depressed, and manic) to examine (1) the presence of a mood-congruent attentional bias; and (2) the patients' ability to inhibit and invert associations between stimuli and responses through blocks. A group of healthy individuals served as controls. Results revealed a mood-congruent attentional bias: patients in the manic episode processed positive information faster, whereas those in the depressive episode processed negative information faster. In contrast, neither euthymic patients nor healthy individuals showed any mood-congruent biases. Furthermore, there was a shift cost across blocks for healthy individuals, but not for the patients. This may reflect a general impairment at selecting relevant information (e.g., in terms of disability to inhibit and invert associations between stimuli and responses) in bipolar participants, regardless of their episode. This state/trait dissociation in an episodic and chronic disorder such as bipolar disorder is important for its appropriate characterisation.     

Effectiveness of Noncontingent Attention to Decrease Attention-Maintained Disruptive Behaviors in the General Education Classroom

This study was conducted to investigate the effectiveness of noncontingent attention (NCA) on disruptive talking-out behavior in a student diagnosed with attention deficit and hyperactivity disorder in the general education classroom. Functional analysis indicated that the talking-out behavior was maintained by teacher attention. We used an ABAB design in which the teacher implemented NCA. Results indicated that the strategy decreased the participant's talking-out behavior. Furthermore, social validity data indicated that the participant was able to spend more time on-task. Results and implications for research and practice are discussed.     

Treatment of Adolescent Panic Disorder: A Nonrandomized Comparison of Intensive Versus Weekly CBT

This study compared the relative efficacy of intensive versus weekly panic control treatment (PCT) for adolescent panic disorder with agoraphobia (PDA). Twenty-six adolescents participated in weekly sessions and 25 received intensive treatment involving daily sessions. Both groups demonstrated significant and comparable reductions in panic disorder severity and general anxiety symptoms, which maintained over time. Participants receiving weekly treatment showed significant decreases in depressive symptoms, whereas those in the intensive program reported no change. Findings support the efficacy of the intensive approach for adolescent PDA, but suggest that adolescents receiving intensive treatment may benefit from a brief course of additional weekly sessions.