{"title":"Trust in Therapeutic Work With Adolescents With and Without Personality Disorders: A Transference-Focused Therapy Perspective.","authors":"Karin Ensink, Lina Normandin","doi":"10.1521/pedi.2023.37.5.580","DOIUrl":"10.1521/pedi.2023.37.5.580","url":null,"abstract":"<p><p>Trust is central to successful therapeutic work with adolescents, but establishing trust can be challenging, especially with adolescents with personality disorders. We present our understanding of trust in working with adolescents with and without personality disorders. We draw on complementary and overlapping perspectives, namely the attachment model, Kernberg's object relations model, and Fonagy's mentalization model. In Kernberg's object relations conceptualization, difficulties in trust experienced by patients with borderline personality disorders result from paranoia associated with splitting and identity diffusion. In Fonagy's mentalization model, epistemic trust is rooted in early experiences of being responded to and understood. We outline how techniques used in transference-focused psychotherapy for adolescents promote the development of the adolescent's capacity to trust by facilitating identity integration, thus reducing paranoia. Finally, we use two clinical case illustrations to demonstrate how trust unfolds in working with adolescents with and without personality disorders.</p>","PeriodicalId":48175,"journal":{"name":"Journal of Personality Disorders","volume":"37 5","pages":"580-603"},"PeriodicalIF":2.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Becoming Trustworthy in Treating Patients With Borderline Personality Disorder.","authors":"Jon G Allen","doi":"10.1521/pedi.2023.37.5.604","DOIUrl":"10.1521/pedi.2023.37.5.604","url":null,"abstract":"<p><p>No one doubts the importance of trust in psychotherapy, but few therapists think about the complexities of trusting relationships, and the trustworthiness that would justify trusting remains far from view. Fortunately, inasmuch as trusting and trustworthiness are inherently ethical concepts, contemporary philosophers have given trust the consideration it warrants. Integrating science and philosophy, the author reviews the broad scope and multifaceted nature of trust and trustworthiness, the social-cognitive development of trust, and the development of distrust in the context of borderline personality disorder. Without questioning therapists' character, the author makes the case for shifting the emphasis from the patient's distrust to the therapist's challenge to become trustworthy in the course of each treatment relationship and, more broadly, over the course of a professional career.</p>","PeriodicalId":48175,"journal":{"name":"Journal of Personality Disorders","volume":"37 5","pages":"604-619"},"PeriodicalIF":2.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brinkley M Sharpe, Chelsea E Sleep, Nathan T Carter, Donald R Lynam, Joshua D Miller
{"title":"Is Personality Pathology Ego-Syntonic? Self- and Meta-Perception of Maladaptive Personality Traits.","authors":"Brinkley M Sharpe, Chelsea E Sleep, Nathan T Carter, Donald R Lynam, Joshua D Miller","doi":"10.1521/pedi.2023.37.4.383","DOIUrl":"10.1521/pedi.2023.37.4.383","url":null,"abstract":"<p><p>Research has challenged the assumption that personality pathology is \"ego-syntonic\" or perceived favorably and consistent with one's self-image. The present study employed a community sample (<i>n</i> = 401) to examine relations between self-rated maladaptive personality and liking of maladaptive traits in self and others as well as meta-perception of personality pathology (i.e., how likable participants believe others find maladaptive traits). In general, individuals with higher self-rated maladaptive traits provided higher ratings of the likability of these traits in themselves and others. However, as hypothesized, comparison of liking ratings for high scorers and the rest of the sample revealed that individuals who score high on most pathological personality traits do not \"like\" these traits (or rate others as \"liking\" them) but simply dislike them less. Results support a dimensional view of ego-syntonicity.</p>","PeriodicalId":48175,"journal":{"name":"Journal of Personality Disorders","volume":"37 4","pages":"383-405"},"PeriodicalIF":2.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mary C Zanarini, Katherine E Hein, Christina M Temes, Frances R Frankenburg, Garrett M Fitzmaurice
{"title":"Pathways to Health Reported by Patients With Borderline Personality Disorder With a Good Overall Outcome Versus a Fair-Poor Outcome Over 24 Years of Prospective Follow-Up.","authors":"Mary C Zanarini, Katherine E Hein, Christina M Temes, Frances R Frankenburg, Garrett M Fitzmaurice","doi":"10.1521/pedi.2023.37.4.456","DOIUrl":"10.1521/pedi.2023.37.4.456","url":null,"abstract":"<p><p>Our objective was to determine pathways to health reported by patients with borderline personality disorder (BPD) who had and had not attained a good overall outcome over 24 years of prospective follow-up. Overall outcome symptomatically and psychosocially and 11 pathways to health related to vocation, relationships, activities, and psychiatric treatment that patients reported were helpful to their functioning or feeling better about themselves were assessed at 12 contiguous 2-year follow-up periods using a semistructured interview. Good outcome patients reported significantly higher rates of pathways related to work performance, relationships with friends, relationship with a partner/spouse, and athletic activities. In contrast, patients with a fair-poor outcome reported significantly higher rates of psychotherapy and psychotropic medication as pathways. Taken together, the results of this study suggest that a good overall outcome is significantly associated with reported vocational, interpersonal, and activity pathways, while a fair-poor outcome is significantly associated with reported treatment-related pathways.</p>","PeriodicalId":48175,"journal":{"name":"Journal of Personality Disorders","volume":"37 4","pages":"456-468"},"PeriodicalIF":2.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Uncovering the Social-Cognitive Contributors to Social Dysfunction in Borderline Personality Disorder Through Language Analysis.","authors":"Charlotte Entwistle, Ryan L Boyd","doi":"10.1521/pedi.2023.37.4.444","DOIUrl":"10.1521/pedi.2023.37.4.444","url":null,"abstract":"<p><p>Borderline personality disorder (BPD) is characterized by severe interpersonal dysfunction, yet the underlying nature of such dysfunction remains poorly understood. The present study adopted a behavioral approach to more objectively describe the social-cognitive contributors to interpersonal dysfunction in BPD. Participants (<i>N</i> = 530) completed an online survey comprising validated measures of BPD features and other problematic interpersonal traits (e.g., narcissism), as well as a writing prompt where they were asked to share their personal thoughts about relationships. Computerized language analysis methods were used to quantify various psychosocial dimensions of participants' writing, which were incorporated into a principal component analysis. Analyses revealed four core social dimensions of thought: (1) <i>Connectedness/Intimacy;</i> (2) <i>Immediacy;</i> (3) <i>Social Rumination</i>; (4) <i>Negative Affect</i>. All four dimensions correlated with BPD features in intuitive ways, some of which were specific to BPD. This study highlights the value of natural language analysis to explore fundamental dimensions of personality disorder.</p>","PeriodicalId":48175,"journal":{"name":"Journal of Personality Disorders","volume":"37 4","pages":"444-455"},"PeriodicalIF":2.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10655919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Childhood Maltreatment History and Borderline Personality Symptoms: The Role of Mentalization Difficulties Among Vulnerable Women.","authors":"Stephanie Milan, Ana Luisa Barbosa Dau","doi":"10.1521/pedi.2023.37.4.369","DOIUrl":"10.1521/pedi.2023.37.4.369","url":null,"abstract":"<p><p>Mentalization difficulties may be one reason why individuals who experienced childhood maltreatment (CM) are at increased risk for borderline personality (BP) symptoms. The goal of this study was to identify specific aspects of mentalization associated with CM and determine their role in the short-term course of BP symptoms. A total of 253 mothers with a previous mental health diagnosis completed online surveys at three times over 9 months. A cross-lag panel model was tested to estimate reciprocal effects between mentalization measures and BP symptoms and indirect effects from CM to mentalization to BP symptoms. At baseline, women with more CM endorsed more difficulty with general mentalization, emotional clarity, and reflecting on childhood experiences. Lack of emotional clarity and disorganized responding about childhood served as indirect paths from CM to subsequent BP symptoms and showed bidirectional associations with BP symptoms over time. Thus, these may be particularly important treatment targets in this population.</p>","PeriodicalId":48175,"journal":{"name":"Journal of Personality Disorders","volume":"37 4","pages":"369-382"},"PeriodicalIF":2.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hurting the Grandiose Self: Examining Presence, Frequency, and Functions of Nonsuicidal Self-Injury in Pathological Narcissism.","authors":"Ellen F Finch, Chelsea Boccagno, Jill M Hooley","doi":"10.1521/pedi.2023.37.4.424","DOIUrl":"10.1521/pedi.2023.37.4.424","url":null,"abstract":"<p><p>The present study examines whether dimensions of pathological narcissism are associated with the presence, frequency, and function of nonsuicidal self-injury (NSSI). Adults (<i>N</i> = 252) completed questionnaires assessing narcissistic grandiosity, narcissistic vulnerability, fluctuation between these narcissistic states, and borderline personality disorder (BPD) symptoms. Those with a history of NSSI (<i>n</i> = 105) also reported the method, frequency, and function of their NSSI engagement. When controlling for co-occurring BPD symptoms, there were very few associations between vulnerability, grandiosity, and narcissistic fluctuation and NSSI presence and frequency. However, a clear pattern emerged regarding NSSI functions. Although vulnerability and narcissistic fluctuation were not associated with any functions of NSSI when co-occurring BPD symptoms were controlled for, grandiosity was positively associated with <i>all</i> interpersonal functions of NSSI (e.g., peer bonding, revenge) and negatively associated with the intrapersonal function of affect regulation. These results suggest a unique relationship between narcissistic grandiosity and NSSI that may inform clinical intervention.</p>","PeriodicalId":48175,"journal":{"name":"Journal of Personality Disorders","volume":"37 4","pages":"424-443"},"PeriodicalIF":2.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vera Békés, Dominik Szabó, Erika Evelyn Lévay, Ella Salgó, Zsolt Unoka
{"title":"Moral Injury and Shame Mediate the Relationship Between Childhood Trauma and Borderline Personality Disorder, PTSD, and Complex PTSD Symptoms in Psychiatric Inpatients.","authors":"Vera Békés, Dominik Szabó, Erika Evelyn Lévay, Ella Salgó, Zsolt Unoka","doi":"10.1521/pedi.2023.37.4.406","DOIUrl":"10.1521/pedi.2023.37.4.406","url":null,"abstract":"<p><p>Moral injury (MI) has received increased research attention in the past decades. However, despite its detrimental mental health consequences, MI has not been studied in psychiatric patients. We aimed to establish the relationship between childhood trauma, MI, and borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and disturbances in self-organization symptoms (DSO), a core diagnostic criterion of complex PTSD besides PTSD symptoms, and shame as a moral emotion in an inpatient psychiatric sample (<i>N</i> = 240). We found that the impact of childhood trauma on present BPD, PTSD, and DSO symptoms was mediated by MI and shame; the models accounted for up to 31% of variance in symptomatology. To our knowledge, this study is the first to investigate MI in a psychiatric sample, and our results highlight the importance of considering MI as a critical factor of patient experiences in relation to childhood trauma that potentially contributes to the development of psychiatric symptoms.</p>","PeriodicalId":48175,"journal":{"name":"Journal of Personality Disorders","volume":"37 4","pages":"406-423"},"PeriodicalIF":2.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Late Onset Personality Disorders in Mid-Life and Older Adults.","authors":"Jessica Dupree, Susan C South, Thomas F Oltmanns","doi":"10.1521/pedi.2023.37.3.304","DOIUrl":"https://doi.org/10.1521/pedi.2023.37.3.304","url":null,"abstract":"<p><p>There is little research on personality disorder (PD) onset in older age. Many studies have shown that normative personality traits change across the life span, even into later life. This study aimed to investigate the onset of PDs in later adulthood (>age 55), and the possible influence of major life events on predicting this late onset. The current analysis was conducted with data from the St. Louis Personality and Aging Network (SPAN). Structured diagnostic interviews were administered three times over five years. Logistic regressions were conducted predicting late onset PD from baseline to FU5 and from FU5 to FU10 as a function of each major life event. 75 PD onsets occurred from baseline to FU5, and 39 PD onsets occurred from FU5 to FU10. Personal illness predicted the onset of PDs from FU5 to FU10.</p>","PeriodicalId":48175,"journal":{"name":"Journal of Personality Disorders","volume":"37 3","pages":"304-316"},"PeriodicalIF":2.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10073803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Holly F Levin-Aspenson, Shereen Khoo, Kasey Stanton, Brittany King, Mark Zimmerman
{"title":"A Bridge Between <i>DSM-5</i> Section II Personality Disorder Criteria and <i>ICD-11</i> Personality Disorder Trait Domains.","authors":"Holly F Levin-Aspenson, Shereen Khoo, Kasey Stanton, Brittany King, Mark Zimmerman","doi":"10.1521/pedi.2023.37.3.317","DOIUrl":"https://doi.org/10.1521/pedi.2023.37.3.317","url":null,"abstract":"<p><p>The organization of personality pathology into trait domains (vs. specific disorders) in <i>ICD-11</i> represents an important shift in personality disorder (PD) nosology. However, to facilitate clinical implementation, a bridge is needed between this system and the <i>DSM-5</i> Section II system familiar to many researchers and clinicians. In this study, individual <i>DSM-5</i> PD criteria were assigned to <i>ICD-11</i> trait domains based on the published Clinical Descriptions and Diagnostic Requirements. This scoring scheme was examined empirically alongside <i>DSM-5</i> PD dimensions (using SIDP ratings from the MIDAS project; <i>N</i> = 2,147 outpatients) in terms of descriptive properties and relations with psychosocial morbidity and functioning. Most PD criteria could be matched to at least one <i>ICD-11</i> trait domain, indicating considerable cross-system continuity. However, points of incongruity are noteworthy for research and clinical applications. Results provide key information for bridging categorical and dimensional frameworks, indicating that the shift toward trait-based PD models need not be as disruptive as feared.</p>","PeriodicalId":48175,"journal":{"name":"Journal of Personality Disorders","volume":"37 3","pages":"317-336"},"PeriodicalIF":2.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10073802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}