Unstable Personality Research Articles

Risk factors for alcoholism in the Oklahoma Family Health Patterns project: Impact of early life adversity and family history on affect regulation and personality

AimThis study examined the impact of early lifetime adversity (ELA) on affect regulation and personality in persons with family history (FH+) and without (FH−) a family history of alcoholism. We examined the impact of early life adversity in healthy young adults, 18–30 years of age enrolled in a long-term study on risk for alcohol and other substance abuse. MethodsELA was assessed by a composite score of low socioeconomic status and personal experience of physical or sexual abuse and/or separation from parents before age 16, resulting in a score of 0, 1–2, or >3 adverse events. Unstable affect regulation and personality variables were obtained via self-report measures. ResultsHigher ELA scores were seen in FH+ (χ2=109.2, p<0.0001) and in women (χ2=17.82, p=0.0019). Although higher ELA predicted less emotional stability and more behavioral undercontrol, further analysis including both FH and ELA showed that FH+ persons are prone to poor affect regulation, negative moods, and have risky drinking and drug abuse tendencies independent of ELA level. ELA predicts reduced stress reactivity and poorer cognitive control over impulsive behaviors as shown elsewhere. ConclusionsThe present work shows that FH+ have poor mood regulation and antisocial characteristics. The greater prevalence of ELA in FH+ persons indicates that life experience and FH+ work in tandem to result in risky patterns of alcohol and drug experimentation to elevate risk for alcoholism. Further studies of genetic and environmental contributions to alcoholism are called for.

Self-diagnosing bipolar disorder: questions for clinicians.

It is not uncommon in psychiatry to receive referrals for patients who believe they have bipolar affective disorder. This has been explained partly by a trend of celebrities openly talking about having bipolar disorder along with an explosion of information about bipolar illness on the internet.1 We analysed the records of 46 patients who over a 3-year period requested referral to a community mental health team seeking a diagnosis of bipolar illness. The patients were predominantly young women (mean age 32 years, female:male ratio 31:15). Clinically, they presented with problems of anxiety and low mood with a history of mood swings (90%), racing thoughts (70%), impulsivity (100%) and overactivity (60%). All patients had visited a website offering self-assessment for bipolar illness and reported scores being highly suggestive of a bipolar illness – this had influenced their decision to seek referral. Around 25% of patients reported seeing a TV programme featuring a celebrity talking about their bipolar illness. Five patients, of their own accord, had joined their local Bipolar UK support group before the assessment. None of the patients were given the diagnosis of bipolar illness at initial assessment. All were given formulations about their problems in terms of mood swings, coping and lifestyle issues. The ICD-10 diagnostic categories were mixed anxiety depression/adjustment disorder/dysthymia (20 patients); emotionally unstable personality disorder (10); alcoholism/alcohol misuse (5); no psychiatric diagnosis (11). About a third of patients, after having their history taken, readily agreed at the end of the first meeting that they were not suffering from a bipolar illness. Five patients asked for a second opinion; all were experiencing relationship problems. Our experience highlights the issues that may be encountered while assessing patients who actively seek diagnosis of a bipolar illness. There is merit in taking the patient into confidence about the confusion surrounding diagnosing bipolar illness and the risks associated with medical treatment. Also, while trying to arrive at a diagnosis, it may be best to look for classical or severe bipolar illness and if the evidence is not strongly suggestive then the diagnosis should be avoided or deferred until conclusive evidence is obtained.

Impact of emotional stability of working men in their social adjustment of Mangalore, Karnataka, India

Background: Emotional stability is defined as a person's capacity to stay calm when faced with stress. An emotionally unstable person is more explosive, which confers that provoking of such persons puts them at enhanced risk of harmful behaviors. Whether the persons avoid emotions and the extent to which a person experiences anxiety in situations is determined by emotional stability. Emotional stability is associated with persons life, coping and adapting to various life situations. Moreover, it is intricately related to the individual’s occupational life, which has been focused in this study. Aims and Objective: To ascertain the subject’s social adjustment, maladjustment, and their association with emotional stability. Materials and Methods: Participants for this study were 100 working men selected from health, education, and banking sectors in and around Mangalore city, Karnataka, India. They were selected by a random sampling technique. Personal visits were made to the respective institutional heads of each of of these sectors; 35, 35, and 30 samples were selected from each of these sectors, respectively. They were randomly selected from each of these sectors. Eysenck Personality Inventory was administered to evaluate the emotional stability, and interview schedule was used to assess their social adjustment. Pearson’s X2-test was carried out. Result: The result reveals that there was a significant (r = -0.873, p < 0.001) relation between the emotional stability of these subjects with regard to their social adjustment at their workplace. Conclusion: The implication of this study is to develop insight among the employers and employees with regard to their emotionality affecting the social adjustment, which may pervade into the compatible work environment important for work productivity.

Significado da massagem com aromaterapia em saúde mental

Objetivo Compreender o significado da intervenção de massagem com aromaterapia em saúde mental para o usuário durante a internação psiquiátrica.Métodos Pesquisa qualitativa que incluiu 22 participantes com diagnóstico de Transtornos de Personalidade internados em unidade psiquiátrica de um hospital geral. Foram realizadas entrevistas semiestruturadas, com uma questão norteadora aos participantes, os quais se submeteram a intervenções de massagem com aromaterapia. O conteúdo das entrevistas foi avaliado segundo a Análise de Conteúdo.Resultados Entre os sujeitos de pesquisa, houve predominância do sexo feminino e do diagnóstico de Transtornos de Personalidade Emocionalmente Instável. Dos dados qualitativos, emergiram duas categorias: “identificando os benefícios da aromaterapia” e “possibilitando o autoconhecimento”.Conclusão O significado da intervenção de massagem com aromaterapia foi representado por melhorias no cuidado de enfermagem e no tratamento durante a internação psiquiátrica, ao auxiliar na diminuição dos sintomas ansiosos e no enfrentamento do transtorno mental.

Reduction in self‐harming behaviour after zuclopenthixol decanoate

No psychotropic drug is specifically licensed for the management of emotionally unstable borderline personality disorder. Prescribing ‘off‐label’ places additional responsibilities on the prescriber and may increase liability if there are adverse effects. This case report describes a patient with borderline personality disorder who was started on zuclopenthixol decanoate with successful outcome in terms of reducing self‐harming behaviour and impulsivity.

A study of the use of sedative PRN medication in patients at a secure hospital

We have investigated the use of ‘as required’ (PRN), sedative psychotropic medication in 242 forensic rehabilitation patients at a UK secure psychiatric hospital. In total, 176 (73%) patients were prescribed PRN medication and 90 (37%) received a total of 542 doses in the preceding two weeks. The principle indication for use was agitation. Oral benzodiazepines, particularly Lorazepam, were most commonly prescribed and administered followed by Haloperidol. Although high-dose antipsychotics and polypharmacy due to PRN prescribing were common (11 and 20%, respectively), on only 6% of the days studied did patients actually receive PRN antipsychotic medication. Using univariate analyses, PRN administration was associated with younger age, female gender, emotionally unstable personality disorder, shorter length of stay and detention in medium security. Case note documentation of PRN administration was often absent (44%) or vague. Further research, both quantitative and qualitative, is needed into the precise circumstances under which PRN is administered.

Developing PGSD Students Character through Experience Learning Theory

PGSD student is a prospective educator for the next generation. In PGSD student's hands, children of the nation is guided and nurtured being person who is smart and and have good character as the goal of education in Indonesia. So, PGSD student have to be equipped the educator competencies such as pedagogic competence, personal competence, social competence, and professional competence. But in fact, the provision which is covered by four competencies has not possessed in the whole PGSD student self completely. From the result of tracer study in PGSD student alumni which was done by PGSD department on 2011, it shows that the pedagogic competency of PGSD alumni had been innovative and creative; but the personal, social and professional competence had not achieved the standarized yet. It seems from the alumnus behavior, such as a lack of communication skills alumnus fellow colleagues, had an unstable personality (or immature), selfish and less authoritative, less polite in clothes, smoking in any place, and others. Indeed, this requires the existence of learning strategy in PGSD department to impress the candidate of elementary school teachers, who are competent and have character. One of learning strategies to make competent teacher which have the character is the intervention techniques experience learning theory (ELT) by David Kolb model (1984). David Kolb intervention strategy consists of four stages: concrete experience (real), reflection, conceptualization, and application. With the utilization of ELT which is as one part in this study, it is expected that PGSD students can apply their knowledge in the real field, as well as get a firsthand experience of being a teacher from the beginning of the semester.

Eclectic Therapeutic Relationship with BPD Clients: Examining the Eclectic Therapeutic Relationship with Clients with Borderline Personality Disorder

Borderline Personality Disorder (BPD) or Emotionally Unstable Personality Disorder (EUPD) clients are characterised by behavioural symptoms of acts of deliberate self-harm, difficulty controlling anger, and instability in relationships, besides others. While specific therapies address specific problem behaviours, an integrated or eclectic approach enables clinicians to adopt a comprehensive therapy plan (Livesley, 2008). Since the therapeutic relationship with BPD clients is characterised by frequent ruptures and fluctuations, it is necessary to understand how the eclectic stance approaches the therapeutic relationship with BPD clients. This study explores these questions through in-depth interviews with seven self-identified eclectic therapists who have worked with BPD clients. Using Thematic Network Analysis, it was found from the interviews that eclectic therapists choose the stance because of the flexibility it offers them, and because of definite client and setting factors. This stance, they suggested, helps in mutual decision-making and leads the therapist to make constant adjustments to the client‘s level. The process of rapport-building was seen to be an on-going process, where the therapist acts as a facilitator, and often works against resisting traits of the clients. Therapists also talked about ruptures in the relationship due to certain factors and identified means through which these can be repaired. Finally, they identified their reactions to BPD clients as consisting of both positive reactions, and negative and unconscious reactions, which require monitoring. The results of this study yield an understanding about the reasons behind the decision to take an eclectic stance, and how it affects the therapeutic relationship. Keywords: Borderline personality disorder, Eclectic therapy, Therapeutic alliance.

Using psychoeducation to motivate engagement for women with personality disorder in secure settings

A group psychoeducation programme for women in medium security was piloted. The programme aimed to increase participants’ knowledge about emotionally unstable personality disorder, decrease feelings of stigma, increase hope and motivate engagement in treatment. Treatment completers showed significant improvements on selected measures while non-completers did not. The implications of the findings are discussed along with suggestions for further research.

Legal Aspects of End-of-Life Care in Severe Anorexia Nervosa

Anorexia nervosa has the highest mortality rate of any psychiatric illness. Its management can be complicated as people with the condition can resist efforts to enable them to eat and drink. Ethical, medico-legal and psychological issues need careful exploration when considering compulsory treatment. This article summarises the judgment from the High Court case of a 32-year-old woman, ‘E’, with severe anorexia nervosa, emotionally unstable personality disorder, alcohol and opiate dependence and physical complications of malnutrition. Her death was imminent and she was placed on an end-of-life care pathway. Despite two advance directives refusing life-sustaining treatment, and her parents’ skepticism about further intervention, the judge declared that it was lawful and in her best interests for her to be fed, forcibly if necessary. This unique and complex case was heavily dependent on the detailed application of the Mental Capacity Act 2005. Respect for personal independence was balanced against the right to life to make a decision about E’s best interests. Conflicts of interest: none

Vishamanava-The Myth Broken: A Case Report

A nineteen year old male presented to the casualty department of our tertiary care hospital with a history of snake venom addiction. The case coloured on a background of emotionally unstable personality disorder and poly substance abuse {as per criteria coinciding with ICD-10}. Behavioural traits were characterized typically by impulsivity, mood swings and marked interpersonal dysfunction. The hallmark of the case was however an absence of severe and evident withdrawal symptoms caused due to venom intoxication.

EPA-1306 - Prescribing for inpatients with borderline personality disorder

Aims NICE guidance (2009) advises not to use drug treatment specifically for Borderline Personality Disorder (BPD) or for the individual symptoms or behaviour associated with it. Despite this, the Prescribing Observatory in Mental Health (POMH UK, 2012) found that 82% of Personality Disorder patients with no co-morbid mental illness were prescribed at least one psychotropic medication. We aimed to assess characteristics of patients with BPD and their use of medication in an inpatient population. Method The population included 100 discharges from four acute inpatient wards in Sheffield, U.K., with a diagnosis of Emotionally Unstable Personality Disorder (F60.3 and F60.31) from April 2012 to April 2013. Results Of the 100 discharges, 69% were female, 91% unemployed, 59% single and 98% admitted under the Mental Health Act. Hospitalisation was usually after a crisis: 68% reported suicidal ideation, 37% a suicide attempt and 13% risk of harm to others. Most common co-morbid diagnoses were depression, (18%) illicit drug related disorders (7%), alcohol related disorders (5%) and schizophrenia (5%). Medications prescribed included antipsychotics (57%), antidepressants (66%), anxiolytics (38%), hypnotics (31%), and mood stabilisers (19%). Drug treatment specifically for BPD (e.g. repeated self-harm, marked emotional instability, risk-taking behaviour and transient psychotic symptoms) was prescribed to 80% of patients. Conclusions Findings highlight that despite national guideline recommendations, patients with BPD continue to be prescribed psychotropic medications in clinical practice. As most admissions are associated with crises, a comprehensive crisis plan including (only if indicated) appropriate use of medication is essential in helping during periods of distress.

Overview of the treatment for borderline personality

Borderline personality disorder (BPD) is a relatively new concept which has received much attention recently. In ICD-10, emotionally unstable personality disorder, is subcategorised as impulsive type and borderline type. According to DSM IV diagnosis of BPD requires at least five out of nine features. Antipsychotics is effective in reducing affective instability, anger and psychotic symptoms. Beneficial effects were found with mood stabilisers such as semisodium valproate, lamotrigine and topiramate, but not carbamazepine. Psychological treatment is considered as first line treatment for borderline patients but the evidence is not extensive for most of the therapies except for dialectical behavioural therapy. DOI: http://dx.doi.org/10.4038/sljpsyc.v4i2.5698

Concomitant Intramural Stomach and Portal Venous Gas: A Case Report

Purpose: An 82-year-old female originally with a PMH of Afib not on anticoagulation, colon cancer, and uterine cancer, presented to our ER with abdominal discomfort, nausea, and five episodes of bilious vomiting. She did not have any constipation or diarrhea, and her last bowel movement was a day prior to presentation. Her vitals in the ER showed tachycardia and hypotension. Physical exam revealed a tender abdomen with rebound. Labs including ACP, Chem-7, coagulation studies and CXR were all within normal limits. CBC showed leukocytosis and occult blood was positive. CT abdomen showed intrahepatic portal venous air with circumferential intramural air within the proximal-mid stomach consistent with emphysematous gastritis (EG) with no evidence of SBO. She was started on IV hydration, empiric antibiotics and kept NPO. Surgery was consulted. Her hospital course was better than predicted. Her vitals improved with hydration and broad spectrum antibiotics. On day 5, CT abdomen was repeated which showed interval resolution of EG and portal venous gas. She was started on a dysphagia diet on day 6, gradually advanced and discharged home on day 9. Discussion: Gas in the gastric wall is a rare finding associated with a high mortality rate of 50%. Different etiologies include gastric outlet obstruction, damage from instrumentation, extensive CPR, ulcers, steroids, and caustic ingestion. The presence of gastric dilatation with gastric and portal venous air on CT narrows the differential to two main diseases with very different symptoms and prognosis. EG must be differentiated from gastric emphysema early in order to avoid adverse outcomes. EG has concomitant air in the portal venous system and presents acutely in a hemodynamically unstable person as opposed to gastric emphysema which is usually asymptomatic and incidentally found on imaging with air only in the stomach. EG is a severe and rare form of gastritis due to invasion of gas producing organisms, with late complications including strictures and perforations. Early diagnosis and non-operative management with IV hydration and broad spectrum antibiotics is imperative for a preferred outcome.Figure

Leadership Characteristics Prioritized by Students in Developing Countries: Pakistani Perspective

Main salient features for leaders in developing Asian countries may include vigilant, intelligent, hardworking, goal oriented, persistent, determined, and highly motivated to establish a strong sense of teamwork with great vision, while having good and healthy relationships with their employees, being conscious of high moral values and ethical standards. This research paper will identify the strongly emphasized traits of leaders demanded by the young generation of Pakistani students. The study concluded following main findings: The most important trait that they want to see in their leaders is being intelligent having mean value as 1.3 surpassed other mean scores while the second choice was being honest and trustworthy. Students think that leaders must take care of their subordinates and as a human being must attend to their well being. They usually want their leaders to treat them with respect and dignity. On the other side, unstable person is the worst thing for a leader, being dishonest and deceitful minded are rated as second highest traits of bad leaders. Here it is important to note that not to give right instructions is a bad trait but may be excused as compared to other deadly evils. DOI: 10.5901/jesr.2013.v4n3p245

Changes in Treated Incidence of Borderline Personality Disorder in Denmark: 1970–2009

To investigate whether there are any trends in treated incidence of borderline personality disorder (BPD) in Danish psychiatric hospitals based on different diagnostic systems from 1970 to 2009. All patients diagnosed with BPD for the first time as a main or an auxiliary diagnosis treated in in- or outpatient facilities in Danish psychiatric hospitals were identified through the Danish Psychiatric Central Research Register. Age-standardized, sex-specific, and standardized rates were calculated for the International Classification of Diseases (ICD), Eighth Revision, diagnostic period from 1970 to 1993 and the ICD-10 diagnostic period from 1994 to 2009. The incidence for BPD in females as a main or an auxiliary diagnosis increased linearly from 1970 to 2009 (β = 0.69 per 100 000 per year [95% CI 0.66 to 0.73]). The rates for males also increased linearly from 1970 to 1993 (β = 0.37 [95% CI 0.30 to 0.43]) followed by a linearly decrease (β = -0.22 [95% CI -0.29 to -0.15]) in the ICD-10 period from 1994 to 2009. The increase in females with BPD after the mid-1990s is smaller when controlling for outpatients mandatorily registered from 1995. The lack of defined criteria for BPD in ICD-8 may have been interpreted broadly to mean Kernberg's overarching concept of borderline personality organization, resulting in similar rates for males and females. However, in ICD-10, clinicians using the more narrow criteria for emotionally unstable personality disorder (borderline type), tended to diagnose BPD more commonly in women. These results suggest the importance of using specific criteria in diagnosing. They also suggest the importance of stability in the diagnostic criteria for BPD and other disorders.

Is there a crisis about crisis houses?

Is there a crisis about crisis houses?

Understanding workplace violence and its prevention in New Zealand: The 2011 New Zealand workplace violence survey

AbstractThis exploratory study examined the workplace violence problem in a sample of 96 New Zealand organisations. Just over one-half of participating organisations reported cases of violence, with a total of nearly 2,500 cases reported in 2009. The incidence rate for all violence cases was high compared with internationally reported rates. Highest violence incidence rates and lost-time were reported for the health sector, where patients, customers/clients and family members were rated as sources of violence of particularly high importance. Risk factors with highest mean importance ratings were related to exposure to unstable persons, including: alcohol and drug use, harassment, and mental and physical instability/distress. Workload and time-pressure were also identified as risk factors for some organisations. Just 50% of organisations formally recognised violence as a hazard in the workplace, while interventions were largely limited to employee training and technological factors.

Human-Related Emotional Stimuli Can Cause a Hippocampal and Thalamic Over-Response in People with Unstable Personalities

Hippocampus is crucial for the formation of emotional memory. We found the relationship between hippocampal responses to emotional stimuli and the mental stabilities of people in our preliminary study. In this study, we have also evaluated how the emotional stimuli would affect amygdala and thalamus in the brain, and how the personality stabilities could relate to the responses in the brain using functional magnetic resonance imaging (fMRI). We evaluated the subjects’ personality features with the Yatabe-Guilford Personality Test (Y-G test) and psychosomatic symptoms with the Cornell Medical Index (CMI). The subjects were categorized into the mentally stable group and the mentally unstable group according to the total scores of the Y-G test and the CMI. The brain functional responses under emotional stimuli were measured using fMRI. The region of interest (ROI) analysis was performed to abstract significant changes in order to compare responses among the different emotional stimuli. We conducted the regression analysis to abstract the relationship between the mean % signal change from fMRI and the personality stability. The fMRI results showed that the hippocampus, thalamus, and right amygdala activities under the human relationship stimuli increased with ascending value of mental instability. Our findings suggest that the memory process in the hippocampus and the threat alarm system in the thalamus under the human-related stimuli crucially influence the emotional reaction of mentally unstable people. These processes in the brain would affect the event that stresses on human relationships that often cause people to suffer from mental disorders.

Внутриличностная конфликтность как диспозиция в зарубежной и отечественной психологии

The article views intrapersonal proneness to conflict as a personal disposition. We have made an attempt to interpret proneness to conflict from the point of view of traits theory. The article overviews opinions of Russian psychologists that deal with proneness to conflict from the perspective of consciousness problem. Proneness to conflict is viewed through the idea of a personality that possesses an in-born set of dispositions, which allow it to react in a steady and certain way in different situations. The article presents Gordon Willard Allport’s statement that the quality of personal maturity is opposed to inner proneness to conflict. The article examines the point of view, which states that threat is closely interconnected with experiencing anxiety, emotional strain, and personal anxiety is a thorough personal characteristic, that acts as a predictor of a neurotic conflict and psychosomatic disorders. The article presents Hans Jürgen Eysenck’s research results that prove that emotion of fear is fixed at the physiological level and can be consistent in emotionally unstable persons. We view Karl Leonhard’s personal accentuation concept, which shows that certain personal formations, notwithstanding hereditary determination can be developed under the influence of certain types of psychological traumas or difficult life situations.