Prevalence of personality disorders among bulimics,nonbulimic binge eaters,and normal controls

We examined the comorbidity of bulimia and personality pathology among college women. Subjects included women (n=23) meeting DSM-III-R criteria for bulimia nervosa (bulimics), women (n=23) who reported binge eating but did not fulfill the criteria for bulimia nervosa (binge eaters), and women (n=23) who did not binge eat (normals). The subjects completed an assessment battery consisting of the Personality Disorders Examination and the SCID as well as the Beck Depression Inventory, the Rosenberg Self-Esteem Index, and measures of impulsivity and self-defeating tendencies. Fourteen of 23 bulimics (61%) met criterion for a personality disorder using DSM-III-R Axis II criteria. In comparison, 3 of 23 (13%) binge eaters and 1 of 23 (4%) normal subjects received an Axis II diagnosis. Borderline and self-defeating diagnoses were the predominant personality disorders in 96% of the bulimics exhibiting clinically significant personality pathology. Bulimics also exhibited significantly more depression, impulsivity, and self-defeating behavior and lower self-esteem than binge eaters and normals. The findings are discussed within a conceptual framework that posits an interaction between personality pathology and restrained eating.     

The concurrent validity of three self-report measures of borderline personality

The recent accumulation of self-report measures of borderline personality disorder (BPD) affords the opportunity to evaluate both the construct validity of the concept and the quality of these measures. This study examines the relationship among three recently developed self-report instruments for assessing BPD from the Personality Assessment Inventory (PAI; Morey, 1991), the MMPI Personality Disorders Scales (MPD; Morey, Waugh, & Blashfield, 1985), and the Bell Object Relations Inventory (BORI: Bell, Billington, & Becker, 1986). Data on the three measures were provided by 119 undergraduate subjects from a southeastern university. A correlational analysis addresses the convergence of these measures of BPD, their divergence from measures of different but related traits, and their independence from variance due to method. Application of the Campbell-Fiske (1959) criteria indicates adequate convergence for all the BPD measures but a lack of discriminant validity for the BORI scales. The fit of the data to a structural model of construct validity is tested using confirmatory factor analysis, and these results are consistent with the hypothesis of a latent borderline trait factor independent of measurement method factors. In sum, the construct validity of the borderline personality concept using self-report methodologies receives support, and a strong association between borderline personality and paranoid phenomena is also suggested.     

Structural models of psychotherapy groups and their effect on inpatients with borderline personality disorders: Patients' perceptions

This research compares the way in which various group structural models affect self-understanding, interpersonal relationships and catharsis in hospitalized patients with borderline personality disorders. Each of the models is characterized by a different combination of group focus and leadership style. Three psychotherapy groups were chosen as paradigms: the dynamic psychotherapy group; the therapeutic games group, and psychodrama group. Sixty three inpatients with borderline personality disorders participated in the study. The one-way ANOVA yielded significant differences between the group models. Results of the post-hoc t-test showed that the dynamic and the games groups were perceived by the patients as more beneficial than psychodrama.     

辩证行为疗法：理论背景、治疗效果及作用机制

辨证行为疗法（Dialectical Behavior Therapy, DBT）于20世纪90年代初由美国治疗师Linehan创立。作为第三代行为治疗之一,该疗法以行为主义理论、辩证哲学、生物社会理论及禅宗为哲学基础,通过增加患者的技能使用,提高其情绪调节能力,以达到治疗目的。临床研究已证明其在边缘人格障碍,自杀及自伤行为中具有良好的治疗效果,除此之外也广泛适用于其他心理障碍及群体。DBT的临床效果、改变机制及拓展应用都需进一步研究。     

Remembrances of parental rejection are associated with loneliness as mediated by psychological maladjustment in young Bangladeshi men but not women

Loneliness is a significant public health issue that affects young adults. This investigation drew from interpersonal acceptance-rejection theory to understand how remembrances of parental rejection contributed to psychological maladjustment and loneliness in Bangladeshi college students (N = 300; 50% female). Students reported their remembrances of mothers' and fathers' acceptance-rejection, their current psychological maladjustment, and loneliness. Remembrances of rejection by parents in childhood were associated with psychological maladjustment (hostility/aggression, negative self-esteem, negative self-adequacy, emotional unresponsiveness, emotional instability, and negative worldview) for young adult men and women. Psychological maladjustment, in turn, was associated with feelings of loneliness in young adulthood for young men, but not women. Remembrances of parental rejection were also associated with greater hostility and aggression over and above general psychological functioning among both men and women. Findings are discussed in the context of different social and structural features of young adulthood for women and men in Bangladesh.     

Back to sleep: Teaching adults to arrange safe infant sleep environments

There are over 3,000 sleep related infant deaths each year in the United States. Attempts to teach medical personnel and parents safe infant sleep practices in the infant sleep training literature have demonstrated mixed results. Thus, strategies to teach arrangements of safe infant sleep environments warrant further investigation. Behavioral skills training (BST) is an evidence-based teaching strategy shown to successfully teach various safety skills to children and adults. The current study evaluated the effectiveness of behavioral skills training to teach safe infant sleep practices to typically developing adults. Specifically, differential responding was assessed across multiple environmental arrangements typical of contexts parents may be exposed to when putting an infant to sleep. BST significantly improved appropriate arrangement of a safe sleep environment for infants for all 8 participants.     

Borderline personality disorder,complex trauma,and problems with self and identity: A social-communicative approach

Borderline personality disorder (BPD) is a relatively highly prevalent psychiatric disorder that is associated with very high personal and socioeconomic costs. This paper provides a state-of-the-art review of the relationship between complex trauma and key features of BPD, with a focus on problems with self-coherence and self-continuity. We first review evidence for the high prevalence of complex trauma in BPD patients. This is followed by a discussion of emerging knowledge concerning the biobehavioral mechanisms involved in problems related to self and identity in BPD. We emphasize three biobehavioral systems that are affected by complex trauma and are centrally implicated in identify diffusion in BPD: the attachment system, mentalizing or social cognition, and the capacity for epistemic trust—that is, an openness to the reception of social communication that is personally relevant and of generalizable significance. We formulate a new approach to personality and severe personality disorders, and to problems with self and identity in these disorders, rooted in a social-communicative understanding of the foundations of selfhood. We also discuss how extant evidence-based treatments address the above-mentioned biobehavioral systems involved in identity diffusion in BPD and related disorders, and the supporting evidence. We close the paper with recommendations for future research.     

Treatment of covert food stealing in an individual with Prader-Willi syndrome

Covert food stealing is common among individuals with Prader-Willi syndrome. We found that verbal reprimands, delivered contingent upon eating prohibited foods, were sufficient to decrease the food stealing of a girl with Prader-Willi syndrome. Warning stimuli were then used to help her discriminate between permitted and prohibited foods during sessions in which food stealing was not directly observed. This procedure resulted in decreases in food stealing from containers labeled with the warning stimuli.     

A case study of borderline anxiety andthe process of analytic transformation

Borderline patients present particular treatment problems and require close, devoted understanding of their often chaotic and shifting intrapsychic conflicts. Many of these patients act out, making it difficult to maintain an analytic process. In fact, many terminate early on. When they do stay for longer periods, they exhibit particular constellations of defense, anxiety, and conflict. One extensive case report is used to examine the overlapping cycles of treatment with this population. Frequently, self-destructive acting-out is present in the transference and extratransference. This acting-out is often followed by the self-destructive, antichange attitude of the death instinct. These ways of relating to the self and the object are mobilized within the vehicle of projective identification and are best understood as primitive defenses against core fantasies of loss and persecution. These issues of loss and fear are the final and vital phase of treatment with borderline patients, who are often able to make major fundamental changes in their internal sphere, but only if patient and analyst can tolerate and understand these three levels of intrapsychic experience.     

Chronic Fatigue Syndrome: The Need for Subtypes

Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians, and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed, and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic, and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS characteristically confusing heterogeneous symptom profiles. Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity, and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains.