Diagnosis Of Personality Disorder Research Articles

Weapon use during the index offense: a study among forensic psychiatry patients in Ontario, Canada

BackgroundUnderstanding the nature and circumstances around the use of weapons to perpetrate an offense among individuals with mental illness is crucial for evidence-informed policies and actions. However, little is known about the prevalence and factors associated with weapon use during index offenses among patients in the forensic system. Therefore, the present study was designed to address this gap and determine the prevalence and the patient and victim characteristics associated with weapon use during the index offense in a Canadian province.MethodsThis retrospective exploratory study utilized data extracted from the Ontario Review Board reports of 2014/15. Data was analyzed using Stata, and logistic regression was employed to determine the factors associated with weapon use.ResultsApproximately half (48.11%) of the individuals included in this analysis (n = 819) used weapons during their index offense as an instrument of violence. Both patient-related and victim-related factors had a statistically significant association with weapon use during index offenses. Specifically, two patient-related factors (including a history of hospitalization prior to the index offense and diagnosis of personality disorder) were associated with lower odds of weapon use during the index offense. However, only prior hospitalization remained statistically significant after adjusting for victims’ factors. Victim-related factors were associated with both lower and higher odds of weapon use during the index offense. The highest odds of weapon use were found if the victim was an extended family member of the patient, followed by sibling, lover/partner/spouse, parent, and then adult acquaintance. The odds of weapon use during the index offense were lower if victims were healthcare workers, law enforcement professionals, and females when compared to adult strangers.ConclusionThe study highlights the significant role of both patients’ and victims’ characteristics as important factors associated with weapon use during index offenses among forensic patients. Notably, prior hospitalization emerged as a crucial factor with a reduced likelihood of weapon use. Implicitly, this underscores the importance of risk mitigation strategies.

Borderline personality disorder in Trichotillomania and skin picking disorder: a survey study

BackgroundComorbidity studies in trichotillomania and skin picking disorder (known as Body-Focused Repetitive Behaviors, BFRBs) have traditionally not examined rates of borderline personality disorder. When it co-occurs, borderline personality disorder may necessitate different treatment approaches and if untreated may interfere with the response to the treatment for trichotillomania or skin picking disorder. The objectives of this study were to (1) examine the rate of co-occurring borderline personality disorder in BFRBs; and (2) explore associations between co-occurring borderline personality disorder and relevant clinical characteristics (such as demographic features, BFRB symptom severity, lifetime history of suicide attempt[s], levels of dissociation, and other comorbidities including impulsive conditions that are often unmeasured in studies).MethodsAdults with skin picking disorder, trichotillomania, or both completed an online survey. The survey was comprised of demographic and clinical questions, plus instruments to measure for probable borderline personality disorder, as well as BFRB severity, dissociation, impulse control conditions (including BFRBs), and alcohol use disorder. Each participant also completed questions about previous formal mental health diagnoses.ResultsOf the 281 adults with BFRBs (n = 105 with skin picking disorder; 93 with trichotillomania, and 82 with both disorders), 105 (37.4%) screened positive for a probable diagnosis of borderline personality disorder. Participants screening positive for probable borderline personality disorder reported significantly worse pulling and picking symptoms (p < .001), higher rates of dissociation (p < .001), and were significantly more likely to report lifetime suicide attempts (p < .001) and to endorse co-occurring alcohol problems (p < .001), compulsive buying disorder (p < .001), gambling disorder (p < .001), compulsive sexual behavior (p < 001), and kleptomania (p = .005).ConclusionsThese data suggest relatively high rates of borderline personality disorder in people with BFRBs, in turn linked to more severe psychopathology and elevated lifetime suicide attempt risk. Perhaps the comorbidity with borderline personality disorder reflects a possible subtype of these behaviors that is more impulsive and may necessitate different treatment approaches.

Advancing understanding of the relation between criterion a of the alternative model for personality disorders and hierarchical taxonomy of psychopathology: Insights from an external validity analysis.

Increasing interest surrounds the relation between Level of Personality Functioning (LPF), as defined by Criterion A of the Alternative Model for Personality Disorders, and the Hierarchical Taxonomy of Psychopathology (HiTOP) model. However, the integration of LPF within HiTOP remains unclear. Using bivariate correlation and linear regression analyses, this study assessed the associations between LPF and HiTOP spectra (externalizing antisocial, externalizing drug use, internalizing, antagonism, detachment, and psychoticism). A sample of 1,183 participants (46.2% female, Mage = 31.3 ± 14.8 years) from the Italian community completed various self-report measures to capture impairments in personality functioning, and several psychopathology symptoms. Bivariate correlations and regression analyses showed that the LPF facets were consistently associated with all HiTOP domains, even though the LPF measures used in this study appeared more reflective of internalizing symptoms than externalizing ones. The identity facet of LPF was uniquely associated with all outcome criteria, whereas no unique associations were evident for self-direction. Empathy facet had the highest association with antagonism while intimacy presented the highest relation with detachment. Overall, the evidence presented in this study partially supports the construct validity of Criterion A, highlighting its relevance across a wide range of psychopathological symptoms and its potential utility in clinical assessment beyond formal personality disorder diagnoses. Thus, this study may contribute to the understanding of LPF's role in the dimensional model of psychopathology and underscores the importance of considering personality functioning in the assessment and treatment of mental disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Access to psychological therapies amongst patients with a mental health diagnosis in primary care: a data linkage study.

Significant numbers of people in England have fallen into a gap between primary care psychological therapies and specialist mental health services. We aim to examine pathways to care by looking at demographic variation in detection and referral to primary and secondary psychological services in south London. Longitudinal descriptive study using a record linkage between a primary care database (Lambeth DataNet) and a secondary care mental health database (CRIS). We extracted data on mental health diagnosis, prescriptions and episodes of care in mental health services for all patients of working age registered from 1 January 2008 to 1 March 2018 (pre-covid era). Of those with a mental disorder detected in primary care (n = 110,419; 26.8%); 33.7% (n = 37,253) received no treatment; 21.3% (n = 23,548) exclusively accessed psychological treatment within NHS Talking Therapies and 7.6% accessed secondary care psychological therapies. People from minoritised groups were more likely to be prescribed psychotropic medication as the only treatment offered compared to the White British group. Men, Black African and Asian groups were less likely to access NHS Talking Therapies. People with a personality disorder diagnosis had the highest prevalence and number of NHS Talking Therapies treatment episodes (48.0%, n = 960), a similar percentage (44.1%, n = 881) received secondary care psychology treatment. Our study highlights marked inequalities in access to psychological therapies for men and people from some minoritised ethnic groups across primary and secondary care and how individuals with personality disorders are offered multiple short-term courses in NHS Talking Therapies even where this is not recommended treatment.

Prediction of borderline personality disorder based on childhood trauma with the mediating role of experiential avoidance.

Traits of borderline personality disorder are important for the determination of the prognosis of mental illnesses and in evaluating risks of negativity as well as impulsivity. But, there is a lack of information about the distribution characteristics of borderline personality disorder traits and symptoms within clinical groups. The goal of the current study was to predict borderline personality disorder based on childhood trauma, using experiential avoidance as a mediator. All male patients hospitalized in local psychiatric health centers with a diagnosis of borderline personality disorder comprised the statistical population of the current study. The number of 60 patients were selected by the purposeful sampling method. The questionnaire included the Childhood Trauma Questionnaire (CTQ), the Experiential Avoidance Questionnaire (AAQ-II), and the Borderline Personality Disorder Symptoms (BSL-23). The results demonstrated that there is a considerable and positive relationship between childhood trauma and experiential avoidance (r = 0.711, p< 0.01). In the mediating model, childhood trauma had significant direct predictive effects on borderline personality disorder (β = 0.546, p< 0.01). Also, between childhood trauma and BPD, experienced avoidance acts as a moderating factor. (β = 0.304, p< 0.01).

Exploring the Relationship Between Prolonged Grief and Borderline Personality Symptoms.

Prolonged grief disorder (PGD) is a new diagnosis that is often mistaken for other psychopathologies. We report a case of PGD in a patient who screened positive for personality disorder. Both PGD and personality disorder symptoms were much improved after a course of prolonged grief disorder therapy. A bereaved woman in her mid-20s sought treatment for depression 9 months after the death of her father. Her depressive symptoms responded well to antidepressant medication and a brief course of interpersonal psychotherapy. However, prolonged grief symptoms persisted at a clinically significant level. Elements of her history, as well as her score of 9 out of 10 on the McLean Screening Instrument for Borderline Personality Disorder, indicated a possible diagnosis of borderline personality disorder. Yet, after completing a course of prolonged grief disorder therapy, both her grief and borderline symptoms were much reduced. This case raises the possibility of an association between prolonged grief and borderline symptoms. Disruption of attachment relationships provides a possible way of understanding this association. The case we present raises the possibility that prolonged grief disorder may better explain symptoms in some patients presenting with borderline personality disorder symptoms.

'I'm ruined': Young people's and their mothers' experiences of living with, and receiving a diagnosis of, borderline personality disorder: An interpretative phenomenological analysis.

The adolescent borderline personality disorder (BPD) diagnosis has been widely debated for many years. Strikingly, young people's experiences of both receiving a diagnosis of BPD, and of living with BPD, are largely under-explored. The current study seeks to address these gaps in the literature in a multi-perspectival design utilising young people-parent dyads. Young people (aged 16-18 years) with a diagnosis of BPD (n = 5) and their mothers (n = 5) were recruited from two NHS Community Mental Health Services in the West Midlands and participated in semi-structured interviews. Data were analysed using interpretative phenomenological analysis [IPA]. Analysis identified two superordinate themes with five subthemes: (1) The "ugly" reality of living with BPD (providing a stark insight into what it is like to live with the unpredictable nature of experiences labelled as BPD), and (2) The diagnosis that dare not speak its name (highlighting the complexities of how the diagnosis itself is experienced by participants as a symbol of personal and permanent defectiveness and danger). Findings highlight a clear commonality of experience centred around the intensity of the young people's emotional distress and the accompanying pressure on parents to keep young people safe, both of which services must strive to do more to contain. Ultimately, the costs of receiving a BPD diagnosis appear to outweigh the benefits, and this paper adds support to calls for change in respect to how we conceptualise difficulties labelled as BPD and how we communicate about these difficulties, in order to avoid causing harm.

Substance use by homeless clinic attenders in Sydney.

Describe patterns of substance use and comorbid conditions among clinic attenders in homeless shelters in Sydney. Retrospective cohort study of 2498 people who attended a psychiatric clinic at one of three homeless hostels between February 2008 and May 2020. Multivariable logistic regression was used to identify factors associated with self-reported substance use, psychiatric diagnosis and measures of social function. A total of 2041 of the 2498 (81.7%) reported the harmful use of at least one substance, with alcohol (61.8%), cannabis (50.9%) and stimulant drugs (34.9%) the three most common. Those reporting the regular use of two or more substances (1466, 58.7%) were more likely to have a history of early life and adult trauma, a diagnosis of personality disorder, a criminal conviction, receive the Disability Support Pension, be chronically homeless and sleep in the open. The study found a high rate of polysubstance use among homeless clinic attenders in Sydney, and an increase in the prevalence of substance use compared to previous studies. Substance use is both a cause and a consequence of homelessness, and services to address substance use have to be part of any program to reduce homelessness and sleeping in the open.

Re-authoring identity conclusions in borderline personality disorder

This paper describes the use of narrative therapy with people who had been given a diagnosis of borderline personality disorder. In a context of significant stigma against persons with this diagnosis, perpetuated both within and beyond mental health systems, this paper shows how concepts of identity developed in narrative therapy were used to resist totalising identity conclusions and uncover possibilities for hope.

Cluster B personality disorders and psychotropic medications: a focused analysis of trends and patterns across sex and age groups.

This study investigated sex and age differences in patterns of psychotropic medication use before and after the initial diagnosis of Cluster B personality disorders (PDs) and analyzed trends over time. Analyzing data from the Quebec Integrated Chronic Disease Surveillance System for individuals newly diagnosed with Cluster B PD (≥ 14 years) between 2002 and 2018 and under the provincial public drug plan, we calculated yearly and monthly proportions of individuals exposed to psychotropic medications during the year before and after their diagnosis by sex and age. Robust Poisson regression models assessed the association between sex and exposure to psychotropic medications after the diagnosis of Cluster B PD. Among 87,778 individuals with a first Cluster B PD diagnosis (mean age: 44.5 years; 57.5% women), the proportion of users increased post-diagnosis. Notably, after diagnosis, females were more likely to receive psychiatric medications (between 78.9% and 83.7% during the study period vs. 72.8% and 76.8%). Males were less likely than females to receive antidepressants (adjusted prevalence ratio (aPR): 0.83; 99% confidence interval (CI): 0.82-0.85) and anxiolytics (aPR: 0.86; 99%CI: 0.84-0.88), whereas they had higher exposure to antipsychotics (aPR: 1.04; 99%CI: 1.02-1.06) and ADHD medications (aPR: 1.14; 99%CI: 1.07-1.2). Age-specific trends showed increased ADHD medication use among younger patients (14-24 years), and anxiolytic use predominated in those aged ≥ 65 years. Psychotropic medication use was high among Cluster B PD patients, with differences in medication classes according to age and sex. The marked sex and age differences in psychotropic medication use among Cluster B PD patients underscore the need for a sex-sensitive and age-specific approach in psychiatric care.

Bias in the Diagnosis of Borderline Personality Disorder Among Sexual- and Gender-Minority Persons: Results From a Vignette-Based Experiment

Sexual- and gender-minority (SGM) individuals are diagnosed with borderline personality disorder (BPD) more than cisgender heterosexuals. Using a large sample of mental-health practitioners in the United States and Canada ( N = 426), we examined bias in the diagnosis of BPD. Mental-health practitioners were randomly assigned to receive one of three clinical vignettes (cisgender heterosexual man, cisgender gay man, or transgender woman) and asked to provide psychiatric diagnoses based on the vignette. Mental-health practitioners demonstrated a predilection to diagnose BPD when presented with the transgender vignette (odds ratio [ OR] = 1.99, p = .01) but not the cisgender-gay vignette ( OR = 1.34, p = .29) compared with practitioners presented the cisgender-heterosexual vignette. Psychiatrists, mental-health counselors, and clinical social workers were significantly more inclined to diagnose BPD than psychologists, although reasons for underdiagnosis differed across groups. These findings bear important implications for future training given the nature of the mental-health workforce in the United States.

Court-ordered forensic psychiatry treatment in prison: determinants of outcome and risk mitigation.

Court-ordered forensic psychiatry treatments (COT) are specifically designed to reduce the risk of violence in mentally disordered offenders. Given their high costs and ethical issues, mental health professionals need admission criteria to be able to select those candidates with optimal benefit. This study analyses offender-related and treatment-related determinants of COT outcome and risk mitigation. This two-year longitudinal study assessed the evolution of 117 adult offenders admitted to a specialized medium-security forensic psychiatry clinic. Treatment outcome included court-ordered discharge locations and the Historical Clinical Risk Management (HCR) score evolution. Treatment progress was assessed every six months across five time-points including measures of protective factors, work rehabilitation and security. Outcome determinants included psychiatric diagnosis and type of offence. Discharge locations are predicted by pre-treatment risk level. Lower HCR scores are associated with discharge into low-security psychiatry wards independently of the psychiatric diagnosis. Risk reduction follows diagnosis-specific and offense-related patterns and reveals that mentally disordered offenders with Cluster B personality disorders or those sentenced for drug crimes are significantly less prone to benefit from COT. Our findings indicate that criminological characteristics at baseline as well as diagnosis of personality disorders are the main determinants of treatment outcome in our care setting. Inmates with concomitant higher violence risk at baseline and presence of Cluster B personality disorders might benefit the least from court-ordered forensic inpatient psychiatric care in prison.

Exploring real-world prescribing patterns for maintenance treatment in bipolar disorders: a focus on antidepressants and benzodiazepines

Objective Bipolar disorders (BD) are characterized by highly recurrent nature, necessitating adequate maintenance treatment for long-term disorder control. This study aimed to investigate real-world prescribing patterns among outpatients with BD, focusing on the utilisation of antidepressants (AD) and benzodiazepines (BDZ). Methods We analysed prescription patterns of the five main groups of psychotropic medications (antipsychotics, mood stabilizers, AD, BDZ, and anticholinergic medications) and their relationships with basic socio-demographic and clinical data in a sample of 107 clinically stable BD outpatients (75.7% female, age 44.8 ± 11.7). Results Maintenance therapy predominantly involved polypharmacy (92.5%), with mood stabilizers (87.9%) and antipsychotics (80.4%, predominantly second-generation) being the most commonly prescribed. Our findings highlight a high percentage of patients prescribed AD (50.5%) and BDZ (54.2%). BDZ patients, compared to the non-BDZ group in maintenance treatment, were significantly older with longer psychiatric history and a decreased likelihood of comorbid personality disorder diagnoses. Conclusions This study offers insights into prescribing practices within a university psychiatric clinic in the Western Balkans. The prevalent use of polypharmacy in real-world clinical settings, along with high percentage of patients prescribed AD and BDZ, suggests a gap between guideline recommendations and clinical practice, indicating a lack of consensus or standardized approaches in clinical practice.

Positive psychological functioning, resilience and styles of coping as buffers against suicidal behaviours. A case-control study

BackgroundStudies in the literature mainly focus on understanding the risk factors for suicide, giving little relevance to protective variables. This study aimed at exploring the specific contribution of protective variables (resilience, coping and psychological well-being) in hospitalized suicide attempt (SA) makers. MethodsWe recruited 50 inpatients who made a SA before admission and 50 inpatients with no history of SA matched for DSM-5 diagnosis, gender and age. Protective variables were evaluated with: Brief COPE questionnaire, Dispositional Resilience Scale (DRS-15), Psychological Well-Being Scale (PWB-18). Psychopathological features and symptom severity were assessed with: Global Assessment of Functioning Scale (GAF), Rapid Dimensional Assessment Scale (SVARAD), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions (CGI), Hamilton Depression Rating Scale (HDRS17). ResultsThe DRS-15 total score was significantly lower in SA makers. SA makers displayed significantly lower scores on the Engagement and Cognitive Restructuring subscales of the Brief COPE. On the PWB-18, the Self-Acceptance subscale score was lower in SA makers. LimitationsThe small sample size suggests the need for caution in interpreting the results. Matching was carried out by excluding diagnoses of personality disorders. ConclusionsPatients hospitalized following a SA are more often diagnosed with personality disorders, have deficit areas concerning resilience and coping, and lower psychological well-being compared to patients without a SA. When approaching a patient who has committed a SA, it may be useful to evaluate protective variables as well as risk factors, and encourage the development of adaptive coping mechanisms and positive self-evaluation through more dynamic therapeutic paths.

Reliability and validity of the Chinese version of the Structured Interview of Personality Organization-Revised (STIPO-R).

With the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a set of dimensional criteria was added as an emerging alternative model to the diagnosis of personality disorder (PD; American Psychiatric Association, 2013). Parallel to this, within the object relations conceptualization of personality pathology, a structured interview, the Structured Interview of Personality Organization (STIPO), was developed to assess pathological personality and then revised (STIPO-R). In this study, the reliability and validity of the Chinese version of the STIPO-R were tested on a sample of 236 Chinese participants, including both psychiatric patients and healthy individuals. Overall, the STIPO-R showed good internal consistency, interrater and test-retest reliability, and generally satisfactory results in structure and convergent validity. The STIPO-R also demonstrated discriminant validity (healthy individuals vs. psychiatric patients with PD vs. psychiatric patients without PD). Results are also discussed in light of cultural differences between Chinese and Western cultures. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The emotional labour of peer work: encountering stigma in mental healthcare spaces

ABSTRACT This article focuses on the workplace experiences of peer workers with a diagnosis of borderline personality disorder (BPD) in mental healthcare settings in Australia. Our article is located at the intersection of political, social, cultural, and legislative forces that have fostered the development of peer work as a paid profession. We draw on the concept of stigma to analyse findings from qualitative interviews with peer workers conducted in [state], Australia. By examining peer work in the broader context of lifeworlds of BPD, we address the interplay of work and professional identity, and the experience of a profoundly stigmatised diagnosis at this intersection. Our findings demonstrate the physical and emotional effects of stigma and how it produces boundaries and inequalities between peer workers and other health practitioners. These boundaries are reinforced by invisible markers that delineate what is expected, ‘normal’ and deemed professional in the workplace. Moreover, these same medico-socio-political relations help shape peer workers’ identities and experiences. The development of peer workforces in mental healthcare service delivery is a prominent area of reform in Australia and internationally. Our research highlights the urgency of efforts to transform current socio-cultural-political relations that inhibit peer workers in their roles and impact workplace experiences.

The Impact of Patients and Student Mental Health Nurses Sharing Time Together in Forensic Units.

Student mental health nurses have greater patient contact than registered nurses, and this is appreciated by patients. This phenomenological study explored the impact of patients and student mental health nurses' time shared on forensic units for men carrying a personality disorder diagnosis. Phenomenology was the underpinning philosophy of this research. Patients and student mental health nurses in forensic hospitals participated in unstructured hermeneutic interviews. The time students and patients shared together was considered a gift, enabling them to feel that they were "just people" and valued, strongly impacting on their sense of person. The impact the students have on patients' quality of life is meaningful. When the students and patients connected, it had powerful implications for their sense of humanness and value, highlighting the reciprocal impact they each have on another and the importance of having student nurse clinical placements in forensic wards and facilities.Implications for Clinical Forensic Nursing Practice: This article offers a unique contribution to forensic practice by exploring the experiences of the time patients and students share together in forensic units. Students, who often have the greatest contact with patients, represent the present and future of nursing, and their time is appreciated by patients. Previous research focuses on attitudes and therapeutic relationships, rather than the impact of shared contact. In addition to this, patients in forensic services with personality disorder diagnoses can be the most stigmatized group in mental health care, and exploration of their experiences is lacking. These experiences must be shared.

Do risk measure scores and diagnoses predict evaluator opinions in sexually violent predator cases? It depends on the evaluator.

Field research increasingly reveals that forensic evaluators are not interchangeable. Instead, they tend to differ in their patterns of forensic opinions, in ways that likely reflect something about themselves, not just the persons evaluated. This study used data from sexually violent predator (SVP) evaluations to examine whether evaluator differences in making intermediate decisions (e.g., instrument scoring, assigning diagnoses) might explain their different patterns of final opinions. Although this study was generally exploratory and not strongly hypothesis driven, we expected that there might be evidence for a simple form of bias in which some evaluators would be more likely than others to consistently "find" indications of SVP status (i.e., consistently assigning higher risk scores and more SVP-relevant diagnoses) and, therefore, be more likely to find behavioral abnormality, the legal construct qualifying someone for commitment as an SVP. The study used data from 745 SVP evaluations conducted by 10 different evaluators who were assigned cases from the same referral stream. Potential evaluator difference variables included behavioral abnormality opinions, paraphilia and antisocial personality disorder diagnoses, and Psychopathy Checklist-Revised and Static-99 scores. Evaluator differences explained a statistically significant (p < .001) amount of variance in behavioral abnormality opinions (17%), paraphilia diagnoses (7%), and Psychopathy Checklist-Revised scores (16%). Contrary to our expectation of a simple tendency for some evaluators to find all indicators of SVP status more often than others, evaluators differed in the ways that underlying diagnoses and scores corresponded with their conclusions. The overall pattern was one in which different evaluators appeared to base their final opinions on different factors. Findings reveal further evidence of substantial forensic evaluator differences in patterns of assigning instrument scores and reaching forensic conclusions. But these findings are the first to also reveal wide variability in their patterns of reaching forensic conclusions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring the correlates of head-banging behaviour in a female forensic mental health unit: a mixed-methods study

ABSTRACT Despite the documented high prevalence of head-banging being used as a form of self-harm in forensic settings, little research has investigated its correlation with demographic and clinical factors. This mixed-methods study explores head-banging episodes (n = 145) within a female forensic mental health unit in England between 2019 and 2021. Using between-groups analyses, the study identifies clinical and demographic risk factors associated with head-banging behaviour in the sample. Results showed that White ethnicity, younger age, and a diagnosis of personality disorder were associated with an increased likelihood of head-banging. A subsequent regression analysis underscored the statistical significance of White ethnicity and younger age as predictors of head-banging behaviour in the sample. A thematic analysis of descriptive incident reports provided insights into the underlying psychological factors driving head-banging behaviour, which often emerged as a response to interpersonal factors or psychotic symptomatology. It is hypothesised that head-banging may vary in function across diagnoses. Further research should focus on using in-depth qualitative methods to better understand the functions of head-banging, developing effective management strategies for head-banging, as well as assessing its impact on healthcare staff.

Borderline personality disorder and parenting capacity: Understanding child protection population characteristics

Objective This paper describes an audit of borderline symptoms, risk factors for maltreatment and types of abuse among parents who completed a parenting capacity assessment at a South Australian health-based child protection service. Method A retrospective case note audit within a 28-month period was conducted and included parents ( n = 107) who had completed a Mclean’s screening instrument for borderline personality disorder and/or had a psychiatric review with a formal diagnosis. Parents who had a borderline personality disorder diagnosis or endorsed five or more symptoms were categorised into the ‘high’ borderline symptom group. Rates of parental risk factors for maltreatment and type of abuse were compared between parents with low or high borderline symptoms. Results Forty percent of parents endorsed at least five borderline symptoms on the screening tool. On average, parents high in borderline symptoms had a greater number of parental risk factors. Conclusions These findings highlight the importance of screening for personality pathology among parents presenting to child protection services. Foundational training for staff and making evidence-based interventions available should be considered in such settings.