Unstable Personality Research Articles

VARIETIES OF INTERPERSONAL BEHAVIOR OF RUSSIAN SEAFARERS DURING WORK IN INTERNATIONAL CREWS

Introduction. The psycho-emotional sphere is one of the most prone to the hard conditions of maritime labor. When working in the sea on ships of foreign companies, there are often violations of working conditions. It can cause the emergence of socio-psychological conflicts that turn into psycho-emotional stress. In this regard, the study of the emotional sphere of Russian seafarers working on ships under the flags of foreign states is very relevant.Objective: to determine the characteristics of the state of the emotional sphere of Russian sailors when working in international crews and justify the need for its correction in the voyage and inter-voyage periods.Materials and methods. The psycho-emotional state of Russian seafarers who worked on ships of foreign companies was studied in real-time mode during a sea voyage using the method of «Diagnostics of interpersonal relationships» by T. Leary, adapted by L. N. Dog.Results and its discussion. A rather high level of emotional stress was found during the voyage, probably due to the difficulty of communicating with foreign sailors, the severity of work and, as a result, the occurrence of conflict situations.Conclusion. Emotional stress can result in the emergence of neurotic reactions in seafarers. For work on ships flying a foreign flag, it is recommended to conduct a careful selection of crews and not allow the conclusion of contracts with psychologically unstable persons.

Clinical characteristics and care pathways of patients with personality disorder who died by suicide.

It is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments. To describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance. National consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK. The majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients. Continuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.

Relationship between the Level of Motivation and Personality Disorder in Patients with Opioid Dependence Syndrome.

Background:The relationship between the level of motivation and personality disorder (PD) in patients with opioid dependence syndrome is understudied.Method:A cross-sectional study was conducted on consecutively selected 100 adult inpatients with opioid dependence syndrome. All participants were assessed on ICD-10-AM Symptom Checklist for Mental Disorders, University of Rhode Island Change Assessment (URICA), Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES 8D), International Personality Disorder Examination (IPDE), and Severity of Opioid Dependence Questionnaire (SODQ).Results:Most patients expressed the level of motivation at contemplation level, medium level of recognition for the need for change, and high levels of ambivalence and taking steps for change. PD was diagnosed in 40% of the patients. The most common PD identified was dissocial, followed by an emotionally unstable personality disorder-impulsive type. There was no statistically significant difference in URICA, SOCRATES 8D, or SODQ scores in opioid-dependent patients with and without PDs. Patients with severe opioid dependence reported higher readiness to change.Conclusion:Most of the patients with opioid dependence syndrome presenting for treatment are at the contemplation level of motivation. More than one-third of patients with opioid dependence syndrome have PD. A diagnosis of comorbid PD is unrelated to the level of motivation in patients with opioid dependence syndrome. Further multicentric research on personality and PD in a diverse sociocultural population with opioid use disorders is needed.

Orbitofrontal rTMS in Patients With Emotionally Unstable Personality Disorder and Depression

Orbitofrontal rTMS in Patients With Emotionally Unstable Personality Disorder and Depression

Training NHS staff to work with people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI)/borderline personality disorder

PurposeImprovement is sorely needed to the National Health Service (NHS) care for people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI), currently labelled as a variant of personality disorder [PD; borderline personalty disorder/emotionally unstable personality disorder (BPD/EUPD)]. This study aims to improve staff training.Design/methodology/approachA mixed-methods evaluation demonstrated the benefits of offering 495 staff three-day trainings with a clinician-designed, unique training package.FindingsStatistically significant improvements were reported in both staff confidence and optimism when dealing with people with a diagnosis of PD (PWDPD) and scores on the Helping Alliance questionnaire. No statistically significant changes in social attitude resulted. Qualitative data shows negative descriptions generated by staff decreased post-training with an increase in positive and neutral descriptions. The responses generated six different themes: resources, client demand, medical model, emotional, human and positive rewards. Differing proportions were found pre and post-training.Research limitations/implicationsThis was a clinical-world evaluation, not a formal research project. Different pairs/combinations of experienced clinicians (predominantly clinical psychologists) acted as trainers. Some minor variation occurred within the training package used and presentation.Practical implicationsGiven the expense of staff time and resources, this evaluation shows the resultant positive changes achieved. TIERI staff about the difficulties experienced by PWDPD and how to negotiate the relational dynamic is essential. Training helps improve staff perception of the people involved, improves staff confidence and promotes better therapeutic alliances (key to providing the relational and trauma work needed). Ongoing supervision is likely needed post-training.Originality/valuePositive changes resulted from a mixed-methods evaluation of three-day trainings by using a specially designed training package.

Effect of socio-cultural factors in therapeutic intervention

Comorbidity and presence of family dysfunction in personality disorders, namely borderline personality disorder have been found commonly with bipolar affective disorder clients. Dialectic behaviour therapy (DBT) though has shown efficacy in treatment of such conditions, at times due to the socio-cultural differences of the models adopted from the western concept, there is a felt difficulty in the formulation of the therapeutic model making it necessary to collaborate with other models for smoother formulation and improvement in the overall functioning in the clients. A 21-year-old female of bipolar affective disorder with emotionally unstable personality disorder traits was referred to a psychiatric social worker for assessment and plan of intervention inclusive of DBT and family-focused therapy (FFT). Twenty sessions, each lasting for one hour were conducted with the client and family, each on an inpatient basis to (1) Assess and grade the problems in hierarchy, (2) Understand the socio-cultural constructs in sessions, (3) Teach DBT concepts and relaxation techniques to ameliorate stress and help her to improve the relationship and dynamics with her family through FFT. At the time of discharge, the client had improved nearly 30%, and the client and family were more confident in facing social situations, emotional dysregulation, interpersonal issues, distress tolerance goals which has been explained in the context of the socio-cultural factors focusing on alliance, institutions, expectations, and cultural adaptation involved in therapy and the involvement it had in the therapeutic process.

Brief psychological intervention for distress tolerance in an adult secondary care community mental health service: an evaluation

Abstract Distress intolerance has been suggested to be a maintaining factor in several mental health conditions. Distress tolerance skills training has been found to be beneficial in emotionally unstable personality disorder (EUPD) and post-traumatic stress disorder (PTSD). Short-term targeted interventions are increasingly being implemented in response to demand. This study investigates the efficacy of a distress tolerance brief psychological intervention (DT BPI) delivered by non-psychologists within an adult secondary care mental health service. Questionnaire data (pre and post) are reported from 43 participants who completed the intervention. Results suggest that the intervention was associated with significant improvements in distress tolerance, mood, anxiety and wellbeing. This indicates that a DT BPI can be effective when delivered by non-psychologists to real-world adult secondary care clients. The findings offer promising evidence that DT BPI could be a beneficial, cost-effective intervention and warrants further large-scale investigation. Key learning aims (1) To enhance practitioners’ awareness of distress intolerance as a potential maintaining factor and therefore treatment target. (2) To outline a transdiagnostic distress tolerance brief psychological intervention. (3) To illustrate the potential of this distress tolerance brief psychological intervention to produce positive reliable change with real-world clients when delivered by non-psychologists.

Features of YouTube™ videos produced by individuals who self-identify with borderline personality disorder.

ObjectivesMany individuals use YouTube™ to seek out information and share first-hand experiences about mental illnesses, as well as to gain a sense of community. YouTube™ use may be especially appealing when offline supports are lacking or difficult to access, and when there is a fear of stigmatisation. Borderline personality disorder (BPD), also referred to as emotionally unstable personality disorder (EUPD), is a complex and often stigmatised mental-health disorder. The primary objective of this study was to describe the dominant messages that individuals who self-identify with the diagnosis of BPD present through YouTube™ videos.MethodsThe content analysis method was used to review 349 first-person YouTube™ uploads. Videos were coded for information regarding video and vlogger characteristics, video type, vlogger motivation and video content. Associations between video features including upload date and style and vlogger experience and motivation were examined.ResultsFindings indicate that more people who self-identify as being diagnosed with BPD are creating YouTube™ videos about their experiences, and these videos have shifted over time from being mostly anonymous multimedia productions to being monologues where the vlogger speaks directly to their audience. Discussions related to DSM-5 symptoms, treatment, effective coping and hope for the future are elements found in the uploads.ConclusionThe nature and content of BPD first-person YouTube™ uploads has increased and changed over time. Increased awareness of these changes may assist mental-health practitioners to support clients and direct them to explore uploads that offer hope and promote engagement in help-seeking and effective coping behaviours.

Bordering on the bipolar: a review of criteria for ICD-11 and DSM-5 persistent mood disorders

SUMMARYThe principal manuals for psychiatric diagnosis have recently been updated (ICD-11 was released in June 2018 and DSM-5 was published in 2013). A common diagnostic quandary is the classification of people with chronic low mood, especially those with repeated self-harm (‘emotionally unstable’ or ‘borderline’ personality disorder). There has been a great interest in use of type II bipolar affective disorder (‘bipolar II disorder’) as a less pejorative diagnostic alternative to ‘personality disorder’, despite the radically different treatment options for these disorders. DSM-5 (but not ICD-11) clearly distinguishes between borderline personality disorder and bipolar II disorder, indicating that intense emotional experiences (such as anger, panic or despair; irritability; anxiety) should persist for only a few hours in people with a personality disorder. Both manuals now use the term ‘borderline personality disorder’ rather than ‘emotionally unstable personality disorder’. The diagnostic criteria for cyclothymic disorder remain confusing.LEARNING OBJECTIVESAfter reading this article you will be able to: •appreciate the key differences in diagnostic classification between persistent mood disorders: bipolar II disorder, borderline personality disorder and dysthymia•be aware of the modest differences between ICD-10, ICD-11 and DSM-5 in diagnostic criteria for these disorders•appreciate that intense emotional experiences need persist for only a few hours to meet criteria for DSM-5 borderline personality disorder and that persistent emotional dysregulation (e.g. irritability, impulsiveness, disinhibition) for a few days meets criteria for DSM-5 bipolar II disorder.

Marital adjustment in patients with emotionally unstable personality disorder

ABSTRACT Back Ground: Personality disorders especially Emotionally Unstable Personality Disorder (EUPD) may lead to significant marital discord. Though the incidence of separation and divorce are on the rise the problem of underlying personality factors are not given much significance and inadequately studied. Among the personality disorders EUPD is the one that is more likely to be associated with marital discord and separation. Objective To study the marital adjustments of patients with emotionally unstable personality disorder Methodology This cross-sectional study was done in individuals between 18 to 45 years and diagnosed as having EUPD as per ICD 10 DCR criteria, currently staying with their spouse, attending psychiatry department during the study period. Details were collected, Locke Wallace marital adjustment scale was administered, and Chi-square test was used to compare the relevant variables. Results 35 % of the the Sample (n= 34) EUPD subjects reported significant marital dissatisfaction. Co morbid psychiatric disorders were obtained in 23.5% of sample. Association between type of marriage and marital adjustment was found to be significant .41.2% received some kind of psychosocial intervention. 70.6% of the spouses had history of substance use and 23.5 % had history of psychiatric illness. No significant difference in MAT severity was found between EUPD subtypes. Conclusion Study found high level of marital maladjustment among subjects with EUPD.

Effects of ketamine treatment on suicidal ideation: a qualitative study of patients’ accounts following treatment for depression in a UK ketamine clinic

ObjectiveIt is recognised that ketamine treatment can reduce suicidal ideation (SI) in people with depression, at least in the short term. However, information is lacking on patients’ perspectives on such...

Prehospital delay and its associated psychosocial factors in patients presenting with acute appendicitis in a southwestern city in China: a single-centre prospective observational study

ObjectivePrehospital delay is common among patients with acute appendicitis. The aim of this study was to measure the association of a wide range of psychosocial factors with the prehospital delay...

Descriptive examination of inpatient stays of patients with emotionally unstable personality disorder in Austria between 2001 and 2016 with special consideration of age, gender and length of stay

Emotionally unstable personality disorder (EUPD) has ahigh prevalence worldwide and especially in in-patient psychiatric settings, varying in age and gender. Due to the complex clinical picture, repeated admissions and high costs, health systems are facing great challenges. For the calculations Statistik Austria data of inpatient stays of patients with mental and behavioral disorders with special regard to EUPD as main discharge diagnosis in Austria in the period 2001-2016 were used. Included were patients with age over 14years, admission to apsychiatric clinic in acute care and maximum length of stay of 365 days. Age, gender and length of stay were analyzed with SPSS®, evaluated in descriptive form and related to each other. The prevalence of EUPD within all mental and behavioral disorders was 4.0%. Of all personality and behavioral disorders, as well as specific personality disorders, EUPD had the highest prevalence (65.3% and 79.3%). About four times more women (79.8%) than men (20.2%) received inpatient treatment. Most patients (23.1%) were admitted at the age of 20-24 years. From 40 years of age the number of admissions clearly decreased. The largest percentage of men was found to be in the age group over 45years (27.0%) and 183-365 inpatient days (27.0%), those of women aged 15-19 (83.4%) and 0 and 14-182 inpatient days (81.4% each). The average length of stay was 13days for women and 12days for men. 11.3% of patients left the clinic on the day of admission, 61.2% were treated for 1-13days, 27.2% for 14-182 days, and 0.2% for 183-365 days.

Distinction of self-produced touch and social touch at cortical and spinal cord levels.

Differentiation between self-produced tactile stimuli and touch by others is necessary for social interactions and for a coherent concept of "self." The mechanisms underlying this distinction are unknown. Here, we investigated the distinction between self- and other-produced light touch in healthy volunteers using three different approaches: fMRI, behavioral testing, and somatosensory-evoked potentials (SEPs) at spinal and cortical levels. Using fMRI, we found self-other differentiation in somatosensory and sociocognitive areas. Other-touch was related to activation in several areas, including somatosensory cortex, insula, superior temporal gyrus, supramarginal gyrus, striatum, amygdala, cerebellum, and prefrontal cortex. During self-touch, we instead found deactivation in insula, anterior cingulate cortex, superior temporal gyrus, amygdala, parahippocampal gyrus, and prefrontal areas. Deactivation extended into brain areas encoding low-level sensory representations, including thalamus and brainstem. These findings were replicated in a second cohort. During self-touch, the sensorimotor cortex was functionally connected to the insula, and the threshold for detection of an additional tactile stimulus was elevated. Differential encoding of self- vs. other-touch during fMRI correlated with the individual self-concept strength. In SEP, cortical amplitudes were reduced during self-touch, while latencies at cortical and spinal levels were faster for other-touch. We thus demonstrated a robust self-other distinction in brain areas related to somatosensory, social cognitive, and interoceptive processing. Signs of this distinction were evident at the spinal cord. Our results provide a framework for future studies in autism, schizophrenia, and emotionally unstable personality disorder, conditions where symptoms include social touch avoidance and poor self-vs.-other discrimination.

Are the Prescriptions of Psychiatric Patients Who Repeatedly Attempt Suicide Distinctive? A Study Based on a Survey of Prescription Drug Overdose Patients Admitted for Emergency Medical Care

Objectives: Examining the pharmacotherapy of patients who have attempted suicide by overdose could be useful in developing treatment and suicide prevention plans. We surveyed the drugs taken by psychiatric prescription overdose patients who received inpatient treatment and sought to determine the characteristics of patients who repeatedly attempt suicide. Methods: Subjects were 116 patients who attempted suicide by overdose with prescription psychiatric drugs and received inpatient treatment at the Intensive Care Unit of the Emergency and Critical Care Center of Teikyo University Hospital from August 2009 to July 2010. We retrospectively surveyed clinical characteristics, including prescriptions prior to hospitalization and psychiatric diagnosis, divided subjects into a first-admission (FA) and repeatadmission (RA) groups, and compared their clinical characteristics. Results: All subjects were prescribed benzodiazepine-receptor agonists (BZDRAs), whereas antidepressants and antipsychotics were prescribed to 58.6% and 49.1% of subjects, respectively. Emotionally unstable personality disorder, borderline-type (EUPD-B) was found to be significantly more common in the RA group. Comparing prescriptions in the FA and RA groups indicated that the prescribed dosage and prescription rate for antipsychotics were significantly higher for RA group patients. Conclusion: This study revealed that repeat-admission attempted suicide patients had a significantly higher rate of EUPD-B and were more frequently using antipsychotic prescription drugs. Further, in these patients, more frequent use of antipsychotics is believed to correspond to patient impulsivity. The excessive prescription of BZDRAs is a serious problem requiring urgent measures. Research on the prescriptions for overdose patients may lead to clinically significant findings and should be promoted in the future.

Are acceptance and mindfulness-based interventions 'value for money'? Evidence from a systematic literature review.

ObjectivesAcceptance and mindfulness‐based interventions (A/MBIs) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/MBIs for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions.MethodsEight electronic bibliographic databases (MEDLINE, MEDLINE In‐Process & Other Non‐Indexed Citations, EMBASE, Web of Science, NHS Economic Evaluation Database (EED), Database of s of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, and EconLit) were searched for relevant economic evaluations published from each database's inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines.ResultsTen relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness‐based cognitive therapy (MBCT), and mindfulness‐based stress reduction (MBSR). In terms of clinical presentations, the evaluation of cost‐effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/MBIs were cost‐effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made.ConclusionThis first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost‐effectiveness of A/MBIs for mental health conditions.Practitioner points The findings of the review provide information that may be relevant to mental health service commissioners and decision‐makers as all economic evidence available on acceptance and mindfulness‐based interventions for mental health conditions is summarized.Evidence relating to the cost‐effectiveness and cost‐saving potential of acceptance and mindfulness‐based interventions is focused mainly on depression and emotional unstable personality disorder to date.Heterogeneity in the specific forms of acceptance and mindfulness‐based interventions may limit generalizability of the findings.The number of health economic evaluations relating to acceptance and mindfulness‐based interventions remains relatively small. Further research in this area is required.

Dysphonia Plica Ventricularis and Emotional Dysregulation

Dysphonia plica ventricularis(DPV) is a type of functional dysphonia(FD) which can be caused by several reasons. DPV-emotional type is seen secondary to emotional crisis which is equivalent to psychogenic/dissociative dysphonia. Here we describe a case of DPV secondary to emotional dysregulation with an underlying emotionally unstable personality disorder. Crisis intervention and emphasis on regular compliance to treatment has been discussed.

General self-efficacy modifies the effect of stress on burnout in nurses with different personality types

BackgroundBurnout is a health problem in nurses. Individuals with a certain personality are more susceptible to job-related burnout. General self-efficacy (GSE) is an important predictor of job-related burnout. The relationships between general self-efficacy, job-related burnout and different personality types are still not clear. This study aims to analyze the relationships of job-related burnout, stress, general self-efficacy and personality types, as well as their interactions in job-related burnout.MethodA cross-sectional survey of 860 nurses was conducted between June and July 2015 in China. We measured their job-related burnout using the scale of the Maslach Occupational Burnout Scale, and personality, stress, and GSE. Machine learning of generalized linear model were performed.ResultsMaslach Burnout Inventory (MBI) professional efficacy was significantly associated with gender, marital status, age, job title and length of service. A machine learning algorithm showed that stress was the most important factor in job-related burnout, followed by GSE, personality type (introvert unstable), and job title. Individuals with low GSE and either introversion or unstable (high neuroticism) personality seemed to have stronger burnout when they faced stress (regardless of stress intensity) compared to others.ConclusionStress, GSE and introvert unstable personality are the top three factors of job-related burnout. GSE moderates the effect of stress on burnout in nurses with extroversion or neuroticism personality. Reducing stress, increasing GSE, and more social support may alleviate job-related burnout in nurses. Nurses with introvert unstable personality should be given more social support in reducing stress and enhancing their GSE.

Dissociative Amnesia – A Challenge to Therapy

The psychiatric disease of dissociative amnesia is described and illustrated with case reports. It is emphasized that dissociative amnesia has a stress or trauma-related etiology and that affected individuals, contrary to the still dominant clinical belief, are frequently more severely and enduringly affected. That means, most of them show severe retrograde amnesia for their biography, usually accompanied by changes in their personality and sometimes also by alterations in other cognitive and emotive domains. As many patients show the phenomenon of “la belle indifference”, their motivation for therapy or treatment of their amnesia is reduced. Patients also seem to a high degree to possess immature, unstable personality features. Nevertheless, a number of quite divergent, though largely not evidence-based, therapeutic approaches exist and are described. They are divided into (a) psychopharmacological and somatic treatments, (b) psychotherapeutic interventions, and (c) neuropsychological rehabilitation. Furthermore, detailed treatment strategies are provided.

Personality risk factors of occurrence of female breast cancer: a case-control study in China

To investigate the association of personality traits with breast cancer risk, a case-control study was conducted from May 2014 to February 2017, in which the case group consisted of 262 women with breast cancer and 262 without (control group). The Eysenck Personality Questionnaire (EPQ) (88-question Adult Edition) and another self-assessment questionnaire that contained open questions to obtain more specific character traits were used to complete this survey. The results of the E scale showed that 121 women (46.18%) in the case group and 94 women (35.88%) in the control group were extroverted. The results of the N scale showed that 150 women (57.25%) in the case group and 86 women (32.82%) in the control group had unstable personality. Adjusting for other confounding factors, extroversion and unstable personality were risk factors for breast cancer (E scale: OR = 1.70, 95% CI = 1.28–2.15; N scale: OR = 3.18, 95% CI = 1.77–4.91). Personality instability was a higher risk factor than extroversion was. People with unstable personalities were 3.18 times more likely to have breast cancer than were those who had stable personalities. The results of the self-assessment questionnaire suggested that the more frequent character traits mentioned were being concerned over everything, irritable, and perfectionistic, seeking to prevail over others, and being manipulative and oversensitive.