Gender,Mental Disorder and Law at the Borderline: Complex Entanglements of Victimization and Risk

Legal, psychological, criminological, narrative and ideological representations of borderline personality disorder (BPD) are examined through 20 years of germane Canadian case law situated within the context of multidisciplinary scholarly and clinical literature on the themes of gender, mental disorder and culpability. These cases document the claim that the BPD diagnosis pathologizes women whose conduct represents adaptive responses to trauma, conflicts of selfhood and safety. A troubling sub-theme is identified in a cluster of cases where expert medical professionals are found culpable of predatory exploitation and re-victimization of patients seeking their therapeutic assistance. A third theme is the overrepresentation of BPD diagnoses in female forensic populations and the fusion of risk/need in correctional policies. It is argued that the legal deference shown to medical expertise validates BPD as a forensic category. Ultimately, the imposition of punitive corrective measures criminalizes, punishes and marginalizes this population in ways unlikely to rehabilitate and restore them to the normative order.     

首发未用药抑郁症患者大五人格特征对照研究

目的探讨首发未服药抑郁症患者的大五人格特征。方法采用大五人格量表简化版(neuroticism extraversion openness five-factor inventory,NEO-FFI),对112例首发未服药抑郁症患者及99名性别、年龄、文化背景相匹配的正常对照进行大五人格特征评估,汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评定患者的抑郁症状。结果患者组神经质维度得分高于对照组,而外向性、开放性、宜人性及责任感维度得分均低于对照组(P0.05)。Logistic回归分析示,抑郁症与高水平神经质(OR=1.106,95%CI:1.029~1.189)、低水平外向性(OR=0.809,95%CI:0.733~0.893)和宜人性(OR=0.870,95%CI:0.794~0.953)相关联(均P0.01)。线性回归分析示,HAMD评分仅与高水平神经质相关(B=0.121,P=0.003),发病年龄则与责任感维度得分相关(B=0.015,P=0.001)。结论本研究确认了抑郁症患者人格维度与正常对照有差异,高水平神经质维度是首发抑郁症患者的重要人格因素特征,低水平责任感则可能与抑郁症发病年龄早有关。     

某职业院校大学生应对方式在人格特征与幸福感关联中的中介作用

目的 探讨应对方式在人格特征与幸福感关联中的中介作用。 方法 采用整群抽样的方法,选择安徽省六安市某职业院校在校大一、大二学生进行统一匿名问卷调查,评价人格特征、应对方式和主观幸福感情况,并通过自举(Bootstrap)程序和PROCESS软件检验应对方式在人格特征与幸福感关联中的中介作用。 结果 3 183名在校大学生中,神经质(t=6.896,P<0.001)和宜人性(t=5.854,P<0.001)人格特征评分女性高于男性,宜人性(t=4.834,P<0.001)、开放性(t=5.128,P<0.001)和外向性(t=2.992,P=0.003)人格特征评分大一学生高于大二学生,差异均具有统计学意义。幸福感评分中,大一学生高于大二学生(t=2.624,P=0.009),自评家庭经济条件较好者高于自评家庭经济条件较差者(t=6.421,P≤0.001),自评学习成绩较好者高于自评学习较差者(t=5.512,P≤0.001),差异均具有统计学意义。中介效应分析显示,积极应对方式在神经质、严谨性、宜人性、开放性、外向性人格和幸福感关联中介效应比例分别为15.60%、39.01%、28.31%、61.46%和33.77%;消极应对方式在神经质、宜人性、开放性和外向性人格特征与幸福感关联中的中介效应比例分别为34.50%、4.78%、8.63%和5.28%。 结论 大学生人格特征是影响主观幸福感的重要因素,应对方式在人格特征与主观幸福感关联中起部分中介作用。     

Exploring therapeutic engagement with individuals with a diagnosis of personality disorder in acute psychiatric inpatient settings: A nursing team perspective

Individuals with a diagnosis of personality disorder (PD) face negative attitudes and are often deemed harder to care for than individuals with other diagnoses. To improve care and engagement with services, it is essential to understand the ways general psychiatric nursing staff approach this client group. This research aims to examine the ways inpatient psychiatric nursing staff therapeutically engage with individuals with a diagnosis of PD. Focus groups were conducted with Registered Mental Health Nurses (n = 7) and Health Care Assistants (formally known as nursing assistants; n = 12) who care for individuals with a diagnosis of PD in a general psychiatric inpatient setting. A thematic analysis indicated six themes: the right frame of mind, knowing the service user, knowing when to engage, service user input, a unified approach, and structured admissions. The findings highlight what non‐PD specialist inpatient nursing staff do in order to engage therapeutically with this group of service users and areas that require improvement. Supporting good practice could improve staff confidence when caring for this client group, lower stigma around the diagnosis, and promote a more positive experience of care for individuals with a diagnosis of PD who are using general inpatient mental health services.     

Introversion and Medical Student Education: Challenges for Both Students and Educators

Issue: Introversion is one of the personality factors that has been shown to be associated with performance in medical school. Prior cross-sectional studies highlight performance evaluation differences between introverted and extraverted medical students, though the mechanisms and implications of these differences remain relatively unexplained and understudied. This gap in the literature has become more salient as medical schools are employing more interactive learning strategies into their curricula which may disproportionately challenge introverted learners. Evidence: In this article, we provide an overview and working definition of introversion as a valid construct occurring on a continuum. We apply a goodness of fit model to explore how various medical training contexts may be more or less challenging for introverted students and the potential consequences of a poor fit. As preliminary support for these hypothesized challenges, we share observations from students self-identified as introverts. Examples include introverted students feeling at times like misfits, questioning a need to change their identity to succeed in medical school, and being judged as underperformers. We offer pragmatic suggestions for improving the fit between introverted students and their training contexts, such as teachers and students pausing between a question being asked and the initial response being offered and teachers differentiating between anxious and introverted behaviors. We conclude with suggested areas for future qualitative and quantitative research to examine how medical school curricula and the teaching environment may be differentially impacting the learning and health of introverted and extraverted students. Implications: Extraverted behaviors will continue to be an important part of medical training and practice, but the merits of introverted behaviors warrant further consideration as both medical training and practice evolve. Educators who make manageable adjustments to current teaching practices can improve the learning for both introverted and extraverted styles of academic engagement.     

Relations between Eastern Four Pillars Theory and Western Measures of Personality Traits

Purpose

The present study investigated the validity of personality classification using four pillars theory, a tradition in China and northeastern Asia.

Materials and Methods

Four pillars analyses were performed for 148 adults on the basis of their birth year, month, day, and hour. Participants completed two personality tests, the Korean version of Temperament and Character Inventory-Revised-Short Version (TCI) and the Korean Inventory of Interpersonal Problems; scores were correlated with four pillars classification elements. Mean difference tests (e.g., t-test, ANOVA) were compared with groups classified by four pillars index.

Results

There were no significant correlations between personality scale scores and total yin/yang number (i.e., the 8 heavenly or earthly stems), and no significant between-groups results for classifications by yin/yang day stem and the five elements. There were significant but weak (r=0.18-0.29) correlations between the five elements and personality scale scores. For the six gods and personality scales, there were significant but weak (r=0.18-0.25) correlations. Features predicted by four pillars theory were most consistent when participants were grouped according to the yin/yang of the day stem and dominance of yin/yang numbers in the eight heavenly or earthly stems.

Conclusion

Although the major criteria of four pillars theory were not independently correlated with personality scale scores, correlations emerged when participants were grouped according to the composite yin/yang variable. Our results suggest the utility of four pillars theory (beyond fortune telling or astrology) for classifying personality traits and making behavioral predictions.     

A Review of the Agreement Between Clinicians’ Personality Disorder Diagnoses and Those From Other Methods and Sources

This review synthesizes a wide literature on the agreement of treating clinicians’ PD diagnoses with each other and their convergence with common research methods. Median interrater reliability between clinicians was moderate when calculated dimensionally (r = .46) or categorically (κ = .40). The agreement between clinicians’ diagnoses and those from research methods (e.g., self‐report questionnaire) was more modest. Median dimensional agreement across 27 studies ranged from .05 to .36, with an overall median of .23. This overall value was moderated by several factors. First, clinicians’ diagnoses agreed more with semi‐structured interviews than self‐report questionnaires. Second, convergence increased slightly when clinicians utilized more systematic diagnostic methods. Results suggest relatively little overlap between PD diagnoses assigned in research versus naturalistic settings.     

Hallucinations and inhibitory functioning in healthy young adults with high and low levels of hypomanic personality traits

Introduction. Hallucinations in schizophrenia and hallucination proneness in healthy young adults are associated with a common cognitive mechanism, namely impaired inhibitory control. Hallucinatory-like experiences also seem related to hypomanic symptoms in non-clinical participants; however, the mechanisms involved are unknown. We sought to examine self-reported hallucinatory/anomalous perceptual experiences in students selected for high versus low levels of hypomanic personality traits, and whether hypomania is characterised by deficient inhibitory control.

Method. Undergraduate students with either high (n = 26) or low (n = 28) scores on the Hypomanic Personality Scale-Revised (HPS-20) were compared on: (1) the Launay Slade Hallucination Scale-Revised (LSHS-R), a measure of hallucination proneness, (2) the Cardiff Anomalous Perceptions Scale (CAPS) and (3) the Inhibition of Currently Irrelevant Memories (ICIM) task, an index of intentional inhibition.

Results. The high HPS group had higher total scores, as well as higher frequency (on CAPS only), intrusiveness and distress (CAPS) scores compared to the low HPS group. They also produced significantly more false alarms on the second run of the ICIM task than the low hypomania traits group.

Conclusions. Frequent, intrusive and distressing perceptual anomalies and proneness to hallucinations tend to occur in healthy individuals with hypomanic personality traits and may be associated with transient difficulties with inhibitory control. Inhibitory control may be a cognitive marker of vulnerability to hallucinations across diagnostic boundaries.