Personality Disorder Questionnaire Research Articles

The Relationship Between Feelings of Emptiness and Self-Harm Among Thai Patients Exhibiting Borderline Personality Disorder Symptoms: The Mediating Role of the Inner Strengths.

Background and Objectives: Fifty percent of individuals with borderline personality disorder (BPD) experience self-harm. One of the crucial factors related to self-harm is feelings of emptiness. While inner strengths, such as the Five Precepts, meditation, and equanimity, have been identified as potential buffers against negative mental health outcomes in BPD, their role in mediating the relationship between feelings of emptiness and self-harm is not well-documented. This study aimed to explore how these inner strengths mediate the relationship between feelings of emptiness and self-harm in individuals exhibiting BPD symptoms. Materials and Methods: A total of 302 Thai participants exhibiting BPD symptoms completed several assessments: the SCID-II Personality Disorder Questionnaire for BPD to assess feelings of emptiness and self-harm, the Inner-Strength-Based Inventory (i-SBI) to evaluate the Five Precepts, meditation, and equanimity, and the Outcome Inventory Depression (OI-Depression) to assess depression. Mean and standard deviation were used for continuous variables, such as age and OI-Depression. A t-test assessed mean differences in continuous variables between the self-harm group and the non-self-harm group. Chi-square tests examined differences in categorical variables with three or more levels, such as education. Pearson's correlation and linear regression analyzed relationships between continuous variables, including i-SBI and OI-Depression scores. Mediation analysis was performed using IBM SPSS and AMOS, with self-harm as the outcome variable, feelings of emptiness as the predictor, and inner strengths as mediators. Results: The participants had a mean age of 36.56, with 65.4% being female. The analysis showed that the Five Precepts, meditation, and equanimity significantly mediated the relationship between feelings of emptiness and self-harm, with a standardized coefficient of β = 0.534 (95% CI = 0.417 to 0.647, p < 0.001). The indirect effect of feelings of emptiness through these inner strengths was significant (β = 0.034, 95% CI = 0.009 to 0.075, p = 0.005). The mediation model explained 38% of the variance in self-harm with a 3% increase, albeit small but significant. Conclusions: This study highlights that inner strengths negatively mediate the relationship between feelings of emptiness and self-harm, indicating that as these inner strengths increase, the direct impact of feelings of emptiness on self-harm decreases. These findings suggest that targeting inner strengths as protective factors could be a valuable strategy in developing interventions aimed at reducing self-harm by addressing the underlying emotional challenges associated with BPD.

Association between pathogenic beliefs and personality disorders

Background and objectivesPersonality disorders are significant entities in the field of psychiatry and serve as predisposing factors for Axis I clinical disorder. The Treatment of choice is psychotherapy, and one specific approach is Control Mastery Therapy, which emphasizes addressing Pathogenic beliefs (PB). This study aimed to investigate whether there is a relationship between PB and specific personality disorders and whether these beliefs align with the core features specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for that personality disorder. Materials and methodsThis study employed a retrospective cross-sectional design and included 319 participants, comprising individuals receiving treatment at the Psychotherapy Clinic at Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University between 2007 and 2023. All participants were assessed and completed the Structured Clinical Interview for DSM-IV Axis II - Personality Disorders Questionnaire (SCID-II-PQ), Pathogenic Beliefs Scale, and Outcome-Inventory (depression). A generalized linear model (binary logistic regression) was employed, and the predictors included personality disorders. The outcome was the pathogenic belief, and covariates encompassed age, sex, education, clinical diagnosis, and depression score. A sensitivity analysis was conducted to examine the effect on the model when outliers of depressive scores were present. ResultsAfter adjusting for depression, ten personality disorders were found to predict 16 pathogenic beliefs out of the 27 outcomes examined. Notably, histrionic and obsessive-compulsive personality disorders showed no association with specific pathogenic beliefs. Furthermore, certain pathogenic beliefs were predicted by multiple personality disorders, while conversely, some personality disorders were associated with multiple pathogenic beliefs as well. Sensitivity analysis revealed that outliers influenced the relationships between certain disorders and pathogenic beliefs, particularly those with small effect sizes. ConclusionsThe profound impact of pathogenic beliefs intertwined with personality disorders, particularly influenced by childhood trauma and evident in Cluster B and schizotypal disorders, underscores the critical need for targeted psychotherapeutic interventions. Addressing these beliefs directly is key to enhancing treatment efficacy and patient outcomes. Pathogenic belief should be elicited in clinical settings regardless of personality disorder, especially those who experienced depression. Moving forward, rigorous research is imperative to validate and refine therapeutic approaches aimed at reshaping pathogenic beliefs, ensuring they become pivotal in transforming clinical practice and advancing mental health care.

Cognitive Profile of Patients with Borderline Personality Disorder

Background: the relevance of this study stems from the difficulties in diagnosing borderline personality disorder (BPD) and the importance of studying neurocognitive functioning for expanding the understanding of mental disorders. The available data on the cognitive profile of patients with BPD vary markedly. We could not find any studies in this area in a domestic sample. The aim of the study was to investigate the cognitive profile of patients with BPD. Patients and methods: 50 patients (72% women; n = 36; 28% men; n = 14) aged 22.4 ± 4.3 years with ICD-10 diagnosis F60.31 “Emotionally unstable personality disorder, borderline type” were examined. The research methods included clinical and scale assessment: Hospital Anxiety and Depression Scale, Hamilton Depression Scale, Hamilton Anxiety Scale, SCL-90 symptom questionnaire, Borderline Personality Disorder Questionnaire, Brief Assessment of Cognition in Schizophrenia. Results: the obtained data indicate the presence of cognitive impairment in patients with BPD. The structure of neurocognitive deficit includes impairments of working and verbal memory and attention. The severity of BPD is associated with lower cognitive functioning. No correlation between affective symptomatology in BPD and the degree of cognitive impairment was found.

Qualifications, Self-esteem, and Attitude of Health Practitioners toward Personality Disorders in Saudi Arabia

Background The attitudes of society and mental health practitioners towards mental illness are subject to multiple dimensions. This may affect the quality of health services and the client’s ability to seek treatment. It was hypothesized that there is a relationship between qualification, self-esteem, and attitudes toward personality disorders among mental health practitioners in Saudi Arabia. Objective This study aimed to assess how attitudes toward clients’ personality disorders relate to work qualifications and self-esteem among health practitioners in Saudi Arabia. Methods A correlational, within-subject, cross-sectional study was conducted, including psychologists and psychiatrists (N=171) across the five regions of Saudi Arabia, using a survey research design. The online survey contained a demographic information sheet and two standardized scales of attitudes toward personality disorders and self-esteem. Results Descriptive analysis, Pearson’s correlation coefficient, and ANOVA were conducted using SPSS. Significant positive correlations were found between the total Attitude to Personality Disorder Questionnaire and self-esteem, APDQ, and qualification scores (r = .319 and .283, both p &lt; .001). There was also a significant positive correlation between self-esteem and qualification scores (r = .378, p &lt;.001). Conclusion The findings of the study may help mental health practitioners understand attitudes toward personality disorders and the role of qualification and self-esteem in prompting a positive attitude. Mental health practitioner training interventions can enhance and support service quality. On-job professional training, additional training on how to treat personality disorders, and proper supervision for clinicians are highly recommended.

The Complexity of Borderline Personality Disorder: Network Analysis of Personality Factors and Defense Styles in the Context of Borderline Personality Organization.

Borderline personality disorder (BPD) is known to share characteristics with a variety of personality disorders (PDs) and exhibits diverse patterns of defense mechanisms. To enhance our understanding of BPD, it's crucial to shift our focus from traditional categorical diagnostics to the dimensional traits shared with other PDs, as the borderline personality organization (BPO) model suggests. This approach illuminates the nuanced spectrum of BPD characteristics, offering deeper insights into its complexity. While studies have investigated the comorbidity of BPD with other PDs, research exploring the relationship between various personality factors and defense mechanisms within BPD itself has been scarce. The present study was undertaken to investigate the complex interrelationships between various personality factors and defense styles in individuals diagnosed with BPD. Using a network analysis approach, data from 227 patients diagnosed with BPD were examined using the Defense Style Questionnaire and Personality Disorder Questionnaire-4+ for assessment. Intricate connections were observed between personality factors and defense styles. Significant associations were identified between various personality factors and defense styles, with immature defense styles, such as maladaptive and image-distorting being particularly prominent in BPD in the centrality analysis. The maladaptive defense style had the highest expected influence centrality. Furthermore, the schizotypal, dependent, and narcissistic personality factors demonstrated relatively high centrality within the network. Network analysis can effectively delineate the complexity of various PDs and defense styles. These findings are expected to facilitate a deeper understanding of why BPD exhibits various levels of organization and presents with heterogeneous characteristics, consistent with the perspectives proposed by the BPO.

Personality disorders and addiction A study of 54 patients

IntroductionPersonality disorders are very often comorbid with addictions and are known to have a negative impact on the development of substance use disorder.ObjectivesEvaluate the prevalence of personality disorder in patients with problematic use of psychoactive substances followed at Ar Razi hospital Determine the relationship between different personality disorders and the clinical aspects of psychoactive substance useMethodsThis is a descriptive and analytical cross-sectional study carried out among 54 patients followed at Ar-Razi hospital Salé in Morocco for problematic use of psychoactive substances from June 1 to September 15, 2023 (Diagnosis assessed by DSM 5) Data collection was done using a questionnaire including clinical and socio-demographic characteristics and data on addiction to psychoactive and behavioral substances. The psychometric scale used to assess personality disorder: Personality Disorder Questionnaire (PDQ-4+)ResultsWe recruited 54 patients with age ranges from 18 to 45 years, with a male predominance. The average age at the start of psychoactive substance use was 15 years. Tobacco is the most used substance followed by cannabis Antisocial, histrionic and borderline personality disorders were the most common in our population. There was a statistically significant difference between specific personality disorder and the presence of severe psychoactive substance use disorderConclusionsThe frequency of personality disorders is high among subjects with problematic use of psychoactive substances. It is necessary to take care of them simultaneously (integrated care) in order to improve the prognosisDisclosure of InterestNone Declared

Cognitive functioning of patients with borderline personality disorder

IntroductionThe neurocognitive deficit model as a characteristic of patients with borderline personality disorder (BPD) has been the focus of research for the past 20 years. However, no such studies have been performed in Russia.ObjectivesThe aim of the present study was to investigate the neurocognitive profile of patients with BPD.MethodsFifty patients with BPD (according to DSM-V criteria) in stable mental state (72% women; mean age 22.44±4.32) were examined. BPD symptom severity was assessed using the Borderline Personality Disorder Questionnaire (PBQ-BPD), which was validated in the Russian population (34 points or more indicated a higher probability of BPD diagnosis). The Brief Assessment of Cognition in Schizophrenia (BACS) was used to assess cognitive function (in order to use these data for differential diagnosis with schizophrenia spectrum disorders). The study was approved by the ethical committee of Saint Petersburg State University.ResultsOn the PBQ-BPD results, 38% of patients (n=19) scored over 34 points, despite being stable. BACS subscales T-scores (presented as median [Q1; Q3]) were within normal limits (Verbal memory - 49.81 [46.56; 53,06]; Working memory - 43.73 [38.0; 47.50]; Motor function - 44.08 [41.0; 47.25]; Coding - 45.56 [42.50; 48.63]; Verbal fluency - 48.14 [46.0; 52.0]; Tower of London test - 52.33 [47.0; 57.0]). A number of patients had low scores on the BACS subscales (T-score &lt; 40), particularly working memory (33.3%), coding (20.8%), and verbal memory (18.8%). The BACS Composite T Score (46.02 [43.65; 48.39]) correlated with the PBQ-BPD score (32.00 [27.00; 36.00]; r=-0.316; p=0.028). To better characterize the cognitive functioning of patients with BPD, patients were divided into two groups: those who scored less than 34 on the PBQ-BPD (group 1) and those who scored more than 34 on the PBQ-BPD (group 2). Group 2 patients had a lower BACS Composite T-score (42.32 [38.06; 46.58]; 48.45 [45.87; 51.03]; p=0.009) and nominally lower mean scores on all BACS subscales, compared with Group 1 patients. We found significant differences in T-scores values on the Working Memory subscale (Group 1 - 45.0 [41.0; 49.0]; Group 2 - 38.0 [33.0; 43.5], p=0.003), Verbal Fluency (49.0 [47.25; 53.75]; 48.0 [44.0; 49.0]; p=0.047), Tower of London Test (57.0 [52.0; 57.0]; 48.0 [42.0; 57.0]; p=0.036).ConclusionsNeurocognitive impairment was detected in 33.3% of patients with BPD. The dominant cognitive impairments in the patients were decreased working and verbal memory and information processing speed. The severity of BPD symptoms has been confirmed to correlate with the neurocognitive functioning of these patients.Disclosure of InterestNone Declared

Teaching transference focused psychotherapy to South African mental health practitioners.

Personality disorders (PDs) are estimated to occur in 6.8% of South Africans and in 45% to 80% of clinical populations. Mental health practitioners often harbour negative attitudes and lack confidence in working with such patients. Brief training in transference focused psychotherapy (TFP) has been shown to improve attitudes and confidence in the management of clinical encounters with PD. This study aimed to describe the characteristics of attendees at a brief TFP training workshop and determine the impact of training on attitudes and clinical confidence towards patients with PD. We conducted two 3 h online workshops, spaced 1 week apart to staff at South African University training hospitals. At baseline, participants (N = 41) completed questionnaires on demographics, perceived need for training, supervision adequacy and perceived confidence. At baseline and after the second session, the Attitude to Personality Disorder Questionnaire (APDQ) and the Clinical Confidence in Personality Disorder Questionnaire (CCPDQ) were completed. Longitudinal data were analysed using linear mixed-effects regression. In the completer sample (N = 13), there were significant improvements in the APDQ enthusiasm subscale (p = 0.029) and in clinical confidence (CCPDQ) (p = 0.032). The APDQ total and other subscales also showed improvements. Participants with higher baseline confidence were more likely to drop out. Brief training in TFP can lead to significant improvements in attitude and confidence in managing patients with PD. This is the first study in the South African context demonstrating the potential value of brief teaching in TFP.

Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial.

Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial.

Prevalence of Personality Disorders among Males and Females between the Ages of 15 and 65 in Yazd in 2017

Background: Personality disorder is a type of mental disorder in which a rigid and unhealthy pattern of thinking, functioning, and behaving may be seen. A person with a personality disorder has trouble perceiving and relating to situations and people. Limited research has been done on the prevalence of personality disorders in Iran. This study aims at investigating the prevalence of personality disorders among males and females between the ages 15 and 65 in Yazd, Iran.&#x0D; Methods: The dataset for this cross-sectional study was extracted from a dataset of a national survey conducted on personality disorders of Iranians. The contents relevant to Yazd City were included here with a sample of 1827 people. Among the participants, 852 males and 975 females answered the personality disorders questionnaire (MILON).&#x0D; Results: Findings indicated that except histrionic and narcissistic patterns, the high rate of the rest of patterns was greater among females, which indicated that in most cases females significantly suffered higher clinical-related personality disorders. Moreover, personality disorders were more prevalent among females (29.8) compared to males (24.3).&#x0D; Conclusion: This area requires extensive investigation. More evidence is needed regarding the differential impact of personality disorders regarding men and women in other areas of Iran.

Negative influence of futures exposure on borderline personality disorder of futures investors

BackgroundBorderline personality disorder is a common type of personality disorder, and its patients have difficulties in emotional regulation and self-perception. As a high-risk financial activity, future investment may cause investors to produce huge financial and emotional pressure, resulting in negative emotional impact.Subjects and MethodsThe study selected 100 investors who experienced futures explosion within a year as the experimental group, and 100 investors who did not experience futures explosion as the control group. The Borderline Personality Disorder Questionnaire was used to assess the borderline personality disorder traits of the investors and again to classify them into high and low borderline personality disorder trait groups. SPSS software was used for data analysis, and an independent sample t-test was used to compare the difference of ESI scores between different groups.ResultsThe results of the study showed that the mean borderline personality disorder trait score of the experimental group was 28.5±5.7, while the mean ESI score of the control group was 24.2±4.9. Independent sample t test showed that the score of BPD trait in the experimental group was significantly higher than that in the control group (t = 5.73, P &lt; 0.001). The percentage of investors with borderline personality disorder trait scores higher than the standard scores reached 75% in the experimental group.ConclusionsThe results show that the number of future bursts will significantly deepen the trait of borderline personality disorder and depression of investors.

Childhood trauma and anger in adults with and without depressive and anxiety disorders.

Childhood trauma (CT) is associated with severe sequelae, including stress-related mental health disorders that can perpetuate long into adulthood. A key mechanism in this relationship seems to be emotion regulation. We aimed to investigate (1) whether childhood trauma is associated with anger in adulthood, and, if so, (2) to explore which types of childhood trauma predominate in the prediction of anger in a cohort that included participants with and without current affective disorders. In the Netherlands Study of Depression and Anxiety (NESDA), childhood trauma was assessed with a semi-structured Childhood Trauma Interview (CTI) at baseline, and analyzed in relation to anger as measured at a 4-year follow-up with the Spielberger Trait Anger Subscale (STAS), the Anger Attacks Questionnaire, and cluster B personality traits (i.e., borderline, antisocial) of the Personality Disorder Questionnaire 4 (PDQ-4), using analysis of covariance (ANCOVA) and multivariable logistic regression analyses. Post hoc analyses comprised cross-sectional regression analyses, using the Childhood Trauma Questionnaire-Short Form (CTQ-SF) also obtained at a 4-year follow-up. Participants (n = 2271) were on average 42.1 years (SD = 13.1), and 66.2% were female. Childhood trauma showed a dose-response association with all anger constructs. All types of childhood trauma were significantly associated with borderline personality traits, independently of depression and anxiety. Additionally, all types of childhood trauma except for sexual abuse were associated with higher levels of trait anger, and a higher prevalence of anger attacks and antisocial personality traits in adulthood. Cross-sectionally, the effect sizes were larger compared with the analyses with the childhood trauma measured 4 years prior to the anger measures. Childhood trauma is linked with anger in adulthood, which could be of particular interest in the context of psychopathology. Focus on childhood traumatic experiences and adulthood anger may help to enhance the effectiveness of treatment for patients with depressive and anxiety disorders. Trauma-focused interventions should be implemented when appropriate.

Childhood trauma and anger in adults with and without depressive and anxiety disorders

IntroductionChildhood trauma (CT) is associated with severe sequelae, including personality disorders and stress-related mental health disorders that can perpetuate long into adulthood.ObjectivesWe aimed to investigate (1) whether childhood trauma is associated with anger in adulthood, and, if so, (2) to explore which types of childhood trauma predominate in the prediction of anger, and (3) to explore whether the association is independent of psychopathology in a cohort that included participants without lifetime psychiatric disorders, with current or remitted depressive and anxiety disorders, or comorbid depressive and anxiety disorders.MethodsIn the Netherlands Study of Depression and Anxiety (NESDA), childhood trauma was assessed with a semi-structured Childhood Trauma Interview (CTI) at baseline, and analyzed in relation to anger as measured at 4-year follow-up with the Spielberger Trait Anger Subscale (STAS), the Anger Attacks Questionnaire, and cluster B personality traits (i.e., borderline, antisocial) of the Personality Disorder Questionnaire 4 (PDQ-4), using analysis of covariance (ANCOVA) and multivariable logistic regression analyses. Post-hoc analyses comprised cross-sectional regression analyses, using the Childhood Trauma Questionnaire – Short Form (CTQ-SF) obtained at 4-year follow-up.ResultsParticipants (n = 2,276) were on average 42.1 years (SD = 13.1), and 66.3% were female. Childhood trauma showed a dose-response association with all anger constructs. Zooming in, all types of childhood trauma except for sexual abuse were associated with higher levels of trait anger, and a higher prevalence of anger attacks and antisocial personality traits in adulthood, independently of depression and anxiety. Additionally, all types of childhood trauma were significantly associated with borderline personality traits. Cross-sectionally, the effect sizes were larger compared to the analyses with the childhood trauma measured four years prior to the anger measures.ConclusionsChildhood trauma is linked with anger in adulthood, most strongly for trait anger and borderline personality traits. It is of clinical importance to explore childhood traumatic experience and start trauma-focused interventions when appropriate.Disclosure of InterestNone Declared

Comparison of executive functions in individuals with high and low levels of schizotypal trait.

The dimensional approach to Schizotypal Personality Disorder (SPD) indicates that SPD includes a constellation of maladaptive personality traits on a continuum with general personality functioning. This study aimed to compare executive functions (EFs) in low and high-level schizotypal individuals. Using a convenient sampling method, we recruited 120 individuals, from which 30 individuals with high schizotypal trait levels (fourth quartile) and 30 participants with lower schizotypal trait levels (first quartile) were selected based on their scores on the schizotypal personality disorder questionnaire. Then, participants from the two groups were administered the Corsi Block-Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Continuance Performance Test (CPT). The results indicated individuals with higher schizotypy trait levels performed significantly poorer in tasks measuring working-visual-spatial memory, cognitive flexibility, sustained attention, and response inhibition. This pattern of results indicated that EF dysfunctions in individuals with higher schizotypy trait levels would cause significant disturbances in multiple areas of life. The practical implications of the findings are further discussed.

Psychometric Correlation of Personality Disorders Along With Defense Mechanisms in Mexican Individuals With Depressive and Anxious Disorders: A Cross-Sectional Study.

Background Personality disorders are a multi-theoretical construct that encompasses predictable and quantifiable behavioral, cognitive, and affective characteristics in individuals. Previous studies underscore the existence of a relationship between personality disorders and defense mechanisms, these being coping styles that arise unconsciously in the face of adversity and that have adaptive purposes. There is evidence that alludes to a connection between pathological personality, defense mechanisms, and their relationship with negative mental health outcomes, such as depressive and anxious symptoms. The objective of this study was to study, psychometrically measure, and associate personality disorders, defense mechanisms, and depressive and anxious symptoms. Methodology A cross-sectional study was conducted on 81 participants with major depressive disorder, generalized anxiety disorder, and panic disorder who received treatment at a tertiary care institution between July 2021 and February 2022. Psychometric instruments were employed to evaluate the study variables, such as the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), the Personality Diagnostic Questionnaire - Version 4 (PDQ-4) Plus, and the 40-item Defensive Styles Questionnaire (DSQ-40). Results Depressive and anxious symptoms were related to the scores obtained in the Defensive Styles Questionnaire and the Personality Disorders Questionnaire. Some defense mechanisms were positive predictors of the score between these scales. Conclusions There is a relationship between personality traits and defense mechanisms that could influence the development and severity of depressive and anxious psychopathology in this population.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Childhood trauma and anger in adults with and without depressive and anxiety disorders

IntroductionChildhood trauma is associated with an increased risk of anxiety and depressive disorders, but its association with anger, irritability, and related constructs has received less attention.ObjectivesWe aimed to investigate (1) the relationship between childhood trauma and anger constructs in adulthood, and (2) which types of childhood trauma is most predictive.MethodsIn the Netherlands Study of Depression and Anxiety (NESDA), childhood trauma at baseline was assessed with a semi-structured interview. Childhood trauma was analyzed in relation to the Spielberger Trait Anger Subscale (STAS), the Anger Attacks Questionnaire, and the cluster B personality traits part of the Personality Disorder Questionnaire 4 (PDQ-4), measured at 4-year follow-up, using analysis of covariance (ANCOVA) and multivariable logistic regression analyses, adjusting for sex, age, level of education, BMI, smoking, alcohol dependency/abuse, disorder status.ResultsParticipants were on average 42.1 years (SD = 13.1), and 66.3% (n = 1.508) were female. Childhood trauma showed a dose-response association with all anger constructs. Zooming in, emotional neglect, and psychological, and physical abuse were associated with all anger constructs, independently of depression or anxiety. Additionally, sexual abuse and childhood life events were associated with trait anger and borderline personality traits, and trait anger and antisocial personality traits retrospectively.ConclusionsChildhood trauma is linked with anger in adulthood. Childhood trauma may cause not only anxiety and depression, but also anger, and tailored interventions (at both childhood trauma and anger itself ) might help to improve unsatisfactory relationships and prevent violent behaviors.DisclosureNo significant relationships.

The Contribution of Transference Focused Psychotherapy in Improving Psychiatry Trainees’ Attitude and Technical Confidence Towards Patients With Personality Disorders

AimsTransference-focused psychotherapy (TFP) is a manualized evidence-based treatment for severe personality disorders (PDs) based on a psychodynamic approach that focuses on object relations theory. It has been used as a teaching tool in different psychiatric settings. Psychiatry trainees are often the “first-responders” in multiple services, and they have to deal with patients with PDs in various settings. Yet there is a documented gap in psychiatry trainees’ education regarding the assessment and management of patients with PD pathology. The aim of our study was to evaluate whether a series of teaching sessions on TFP theory and techniques as applied to PD could improve the attitude and technical confidence of psychiatric trainees in the clinical encounter of a patient with a PD.MethodsTwo cohorts of psychiatry trainees in Tower Hamlet's East London Foundation Trust received four teaching sessions, each of one hour duration, on TFP theory and techniques. All the sessions were delivered online, using video teleconferencing software. 14 Trainees completed 2 questionnaires, pre- and post-teaching: the Attitude to Personality Disorder Questionnaire (APDQ) and the Clinical Confidence with Personality Disorder Questionnaire (CCPDQ). The APDQ asks the responder to score from 1–6 the frequency they experience certain feelings towards patients with PD. In the absence of a suitable instrument, we developed the CCPDQ consisting of a set of 13 questions rated on a 6-point Likert scale addressing key issues identified in TFP including establishing and maintaining the treatment frame and in implementing the 4 main techniques. We also conducted a 1-hour focus group post teaching which was videorecorded, transcribed, and analysed thematically.ResultsOn quantitative analysis, the Wilcoxon signed-rank test indicated statistically significant improvements in the total APDQ score (P = 0.003, r = 0.81) and in the CCPDQ questionnaires (P = 0.001, r = 0.88).The thematic analysis showed an overall positive effect of the TFP teaching on trainees’ attitude and confidence: they felt it improved their understanding of the nature of personality disorder, their awareness and management of countertransference, awareness of object relations and relation dyads at play in the encounter.ConclusionTraining junior doctors about TFP theory and techniques as applied to PD can significantly improve their attitude towards these patients and their technical confidence in the clinical encounter. Of note, our workshop is resource light and can easily be delivered by remote teaching. Based on these findings, teaching of TFP in the core psychiatric training curriculum should be considered.

Developing a measure to assess clinicians’ ability to reflect on key staff–patient dynamics in forensic settings

PurposeRelational dynamics between patients and staff in forensic settings can be complicated and demanding for both sides. Reflective practice groups (RPGs) bring clinicians together to reflect on these dynamics. To date, evaluation of RPGs has lacked quantitative focus and a suitable quantitative tool. Therefore, a self-report tool was designed. This paper aims to pilot The Relational Aspects of CarE (TRACE) scale with clinicians in a high-secure hospital and investigate its psychometric properties.Design/methodology/approachA multi-professional sample of 80 clinicians were recruited, completing TRACE and attitudes to personality disorder questionnaire (APDQ). Exploratory factor analysis (EFA) determined factor structure and internal consistency of TRACE. A subset was selected to measure test–retest reliability. TRACE was cross-validated against the APDQ.FindingsEFA found five factors underlying the 20 TRACE items: “awareness of common responses,” “discussing and normalising feelings;” “utilising feelings,” “wish to care” and “awareness of complicated affects.” This factor structure is complex, but items clustered logically to key areas originally used to generate items. Internal consistency (α = 0.66, 95% confidence interval (CI) = 0.55–0.76) demonstrated borderline acceptability. TRACE demonstrated good test–retest reliability (intra-class correlation = 0.94, 95% CI = 0.78–0.98) and face validity. TRACE indicated a slight negative correlation with APDQ. A larger data set is needed to substantiate these preliminary findings.Practical implicationsEarly indications suggested TRACE was valid and reliable, suitable to measure the effectiveness of reflective practice.Originality/valueThe TRACE was a distinctive measure that filled a methodological gap in the literature.

Teaching trainee psychiatrists a Mentalization-Based Treatment approach to personality disorder: effect on attitudes.

To evaluate whether a brief training using a Mentalization-Based Treatment (MBT) model improves attitudes of trainee psychiatrists working with patients with personality disorder. Trainee psychiatrists (n = 49) completed the Attitudes to Personality Disorder Questionnaire before and after a training consisting of two 3 h lectures on (a) theory of personality disorder and (b) practical skills using an MBT role-play. There was a significant improvement on composite scores of attitude, with small to moderate effect size (Wilcoxon signed-rank test Z = 3.961, P < 0.001, r = 0.40). Brief MBT-informed teaching oriented to the clinical situation appears to have a positive effect on attitudes towards people with personality disorder.