Competent resolution of alliance-threatening events is crucially dependent on therapists' ability to recognize them, and secondarily on their adherence to the principles in the refined model. The model is consistent with prior research and can be used in supervision and quality improvement strategies. The Haven is the service setting for the research reported in this paper. The Haven arose in a climate where pilot services for personality disorder were being proposed nationally by the Department of Health.
A recovery journey for people with personality disorder. Background: The study investigates the process of recovery for people diagnosed with personality disorder, a client group that suffers significant social exclusion known to impact on demand for health and other public services. It aims to examine efforts that attempt to reverse this social exclusion as an aspect of the recovery process. Aim: and Method: The following study aims to 1 explore what recovery means to people with personality disorder; 2 develop a conceptual model of recovery in personality disorder; and 3 evaluate the contribution of the setting The Haven to recovery practice.
Data was collected from 66 participants by focus groups and individual interviews. Findings: A map based on thematic analysis of data collected during the study is proposed of the recovery journey for people with this diagnosis, shown as a pyramid that represents a hierarchy of progress, from building trust through stages of recovery to social inclusion.
Conclusion: The findings offer contributions to knowledge in terms of the service design and propose a new model of recovery in personality disorder. This is defined as a journey of small steps highlighting recovery as a process rather than a goal, leading to the emergence of the new concept of transitional recovery. Service users often benefit from a sense of achievement and status from being involved in research and training Ramon, ; Castillo, There are many benefits: doing a socially valued role, financial income, increased confidence, and learning new skills.
The view from inside: Understanding service user involvement in health and social care education. Service users are increasingly involved in health and social care education, whilst the government is committed to increasing access to employment for people with mental health needs. The benefits of involving service users in social work education have been identified, including increasing skills, confidence, and building capacity; yet there is little research that reflects on the personal costs of involvement. An understanding of the social model of disability underpinned by the recovery approach enables us to conceptualise more equal involvement of experts by experience in health and social care education.
Unlike acute 'hospital' wards, TCs consider all aspects of community life potentially therapeutic, including encounters outside of structured therapy Spandler Whilst Castillo argues a sense of belonging within TCs is crucial for promoting positive change, it is unclear how communities foster and sustain this sense of belonging, especially during informal times. This paper draws on IRC theory to explain how seemingly mundane interactions outside of structured therapy can facilitate a sense of belong- ing and therapeutic change. The transformative role of interaction rituals within therapeutic communities.
Jenelle M. Mental health settings are fraught with emotion as clients address difficult life experiences and relational patterns. Clients spend a substantial amount of time together outside of structured therapy, but little is known about how these moments are potentially therapeutic, especially as sites of emotional change. We draw on interaction ritual chain theory to explore how negative emotions in situations outside of formal therapy can be transformed into positive emotions and facilitate personal change.
The research is based upon a narrative ethnography of two therapeutic communities for individuals with a diagnosis of personality disorder. Despite the presence of negative transient emotions in these rituals, clients experienced positive feelings of solidarity and belonging, and the majority of clients reported increased feelings of confidence and positive change. Conversely, dynamics between clients showed clients were not always supportive of one another and at times, could exclude others, resulting in isolation and alienation.
We argue interactions that generate feelings of inclusion or exclusion over time area key component in whether clients gain positive or negative emotional feeling and experience personal change. The small amount of funding from SWAP enabled me to be fully involved in the project. The degree of involvement also drew on a strong culture in our university department for involving service users in research examples of which include: Ramon, and Castillo, This tradition and culture was key to my effective involvement in the local project in that colleagues were accustomed to drawing upon the expertise of service users and carers to inform teaching, learning and research.
An exploration of concept mapping as a method of evaluating student learning in social work. Jan This paper explores the innovative use of concept mapping as a method for summative assessment of meaningful learning in social work education. This small scale study focused on the learning of working in partnership with service users, which is a core requirement for social work practice and education. This is however a complex, value-laden competency that develops over time and by integrating knowledge from diverse learning sources, and it is thus difficult to assess. The study involved a small number of year one social work students, and used a longitudinal quasi-experimental design and an adapted method of scoring the concept maps, more appropriate for analysing social work knowledge.
This paper focuses on the process of developing the scoring method and looks at the challenges of analysing the maps quantitatively and qualitatively. The findings suggest that concept mapping as assessment method has value in social work education but that the summative analysis might be limited in conveying accurately the quality of the knowledge displayed. The study also showed that students have difficulties in integrating knowledge acquired from fragmented sources of learning and suggests that concept mapping might be a useful teaching method for supporting student learning. Although early identification and treatment are likely to ameliorate a lifetime of potential suffering for the individual and society, a personality disorder diagnosis is a BULLET It is pointless to make a diagnosis where there is no treatment service stigmatising label that can follow a young person for a considerable time and paradoxically block their access to treatment and services Castillo Personality disorder in adolescence.
Mar Adv Psychiatr Treat. There is considerable debate about the diagnosis of personality disorder in adolescence. It is argued that, because personality is still developing in the teenage years, it is impossible to state with certainty that a young person's personality is disordered. Alternatively, some researchers and clinicians argue that it is possible to diagnose emerging personality disorder on the basis of trait theories of personality. We review the evidence for both sides of the debate. Research suggests this group may experience high levels of shame, suffering and self-stigma Perseius et al.
People with a borderline personality disorder diagnosis describe discriminatory experiences. S Veysey. The psychiatric diagnosis of borderline personality disorder BPD attracts considerable stigma. People given this diagnosis may be characterised as manipulative, difficult, attention-seeking or untreatable. This paper describes a New Zealand study where eight people with a BPD diagnosis who self-identified as encountering discriminatory experiences from healthcare professionals were interviewed. Themes found included that discriminatory experiences contributed to participants' negative self-image and negative messages about the BPD label were communicated.
A self-harm history appeared to be related to an increased number of discriminatory experiences. Additionally, a relationship between stigma and the complaints process was noted. This study privileges the voice of those interviewed and may stimulate thought and discussion for services and health professionals working with this group. Social Inclusion and Personality Disorder. May Great thanks are due to The Haven Research Group and to the clients, staff and board of The Haven Project who have worked so hard at forging successful ways forward in the journey to social inclusion.
Thank you to all those people who have donated to, and raised funds for, The Haven. Finally, a special thank you goes to Nick Benefield, and the National Personality Disorder Team at the Department of Health, for their years of invaluable help. Feb Jenelle Clarke. This chapter explores the role of everyday social interactions, such as the way people relate and communicate to one another during meal times and smoking breaks, within two therapeutic communities TCs for individuals with a diagnosis of personality disorder PD.
Rather than prioritise change outcomes, the research analyses the social mechanisms involved in the process of change. To understand how micro-interactions facilitate therapeutic change, narrative ethnography was carried out within two communities. There are two main contributions of this chapter. Firstly, this chapter addresses the gap in how informal and everyday social encounters are used as a mechanism of change within TCs. Secondly, as IR theory has not been applied widely to the field of mental health, this research suggests clarifying how negative emotions can generate positive feelings of inclusion, solidarity and confidence.
Because this process happens repeatedly, the patient develops multiple personalities; each has different memories and performs different functions, which may be helpful or destructive. Later, dissociation becomes a coping mechanism when individuals face stressful situations. Personality traits that may predispose patients to develop a dissociative disorder include mental absorption, suggestibility, ability to be easily hypnotized, and tendency to fantasize.
Legal and mental health professionals are divided on whether DID warrants an acquittal for insanity. The first time DID was recognized as a mental disorder that could excuse criminal responsibility occurred in State v Milligan Public outrage was extraordinary. Since this case, most DID defenses have not been successful Table 2.
Courts have rejected the admissibility of DID evidence because the scientific evidence failed to meet reliability standards. Skip to main content. Dissociative identity disorder: No excuse for criminal activity. Prior to testing, all participants were oriented to the administration protocol and the nature of the procedure. Verbal and written explanations of the study were provided to youth prior to testing, and youth were advised that study participation was voluntary. All youth were informed that they could withdraw their informed consent at any time during and after testing.
If they had difficulty understanding procedures, additional explanation was provided prior to interviews. The legal status of the participant, the number of convictions and length of incarceration were collected from file information. The protocol excluded juveniles with a schizophrenic spectrum diagnosis, who were under the acute influence of alcohol or other drugs, or who had an IQ lower than 70, determined by a standardized German clinical interview for children and juveniles according to ICD DISYPS [ 64 ] and by subtests of the Wechsler Adult Intelligence Test [ 65 ].
The presence of psychopathic traits was assessed with the PCL:YV, a multi-item rating scale that measures interpersonal and affective characteristics as well as overt behaviors. Trained observers rate the presence and severity of each disposition associated with psychopathy based on a semi- structured interview, a review of case history information, and behavioral observation cross-checked with collateral informants.
They assigned scores of 0 absent , 1 inconsistent , or 2 present for each item of the PCL:YV based on the consistency of the evidence for each specific tendency or disposition across different situations.
All the scores summed up to a total score maximum of 40 points. Although a defined cut-off does not exist for the PCL-YV, most authors consider a total score of 25 or 30 or above as pathological with respect to a psychopathic personality.
On item basis only a score of two means that the criterion is met. Regarding psychopathy factors, the maximum score for factor 1 and factor 2 is eight and the maximum score for factor 3 and 4 is Researchers suggest that two-thirds of criteria met mean a pathological tendency on factor basis. All authors recommend a dimensional trait analysis of the psychopathy checklist rather than a categorical one [ 86 ]. The interview, developed by Forth et al. The PCL:YV assessments were carried out by four specially trained professionals with at least master-level education and long-term clinical experience.
They received extensive training in administration and scoring of the PCL:YV before conducting the interviews and assessed at least 5 subjects together with one of the two trainers. Afterwards, interrater reliability was re-examined every 10—15 interviews. It was calculated in several ways.
First, we compared item scores for all 20 items and reached a kappa score between. The interrater reliability for the males was also compared with that for the females. Reliability studies demonstrated similar levels of interrater agreement e.
Traumatic experiences were measured with the CTQ, a item self-report instrument using a 5-point Likert scale never, rarely, sometimes, often, and very often true. The instrument has been validated for use with adult and adolescent patients. The German version of the CTQ was translated by the authors, using a forward—backward method. In our juvenile control sample and in the delinquent adolescent sample, respectively, internal consistencies for the five scales were as follows: Emotional Abuse. In categorical analyses comparing traumatized versus non-traumatized groups of delinquent juveniles, a CTQ score of 1 rarely true or above was used as the cut-off to differentiate the trauma from the non-trauma group, irrespective of the numeric score on the CTQ.
The items can be summed to yield scores on 18 personality disorder scales. Principal components analyses yielded four higher-order factors emotional dysregulation, dissocial behavior, inhibitedness, and compulsivity underlying the 18 basic traits. This structure was stable across clinical and non-clinical adult samples and was found to be congruent for environmental, genetic, and phenotypic factors based on twin data [ 70 ].
The following traits were consistently found to have their highest loading on this factor: anxiousness, submissiveness, cognitive distortion, identity problems, affective lability, oppositionality, social avoidance, and insecure attachment.
For the calculations the mean scores of the higher order factor emotional dysregulation has been computed into the analyses. The German version of the DAPP-BQ was developed from the original version by the Psychology Department at the University of Bielefeld, Germany, using a forward—backward method and was validated in clinical and non-clinical adult samples [ 71 , 72 ].
Krischer et al. The discrete variables sex, physical abuse and sexual abuse were entered as dichotomous variables; emotional dysregulation, as a quantitative variable. Firstly, the overall psychopathy score served as dependent variable DV. In a second step for more differentiated and detailed analyses, the four dimensions of psychopathy constituted the outcome variables. All independent variables IVs were included in all models irrespective of the strength of their contribution.
Two possible interactions were tested for significance; any significant interactions were included in the final model. Assumptions of normal distribution and variance homogeneity within each model were met. However, the positive bias created by this particular measure needs to be considered when interpreting effects [ 76 ]. PCL:YV psychopathy checklist:youth version total score; Interpersonal interpersonal facet score; Affective affective facet score; Lifestyle lifestyle facet score; Antisocial antisocial facet score; Physical abuse and sexual abuse subscales on the childhood trauma questionnaire; EmoDys emotional dysregulation on the dimensional assessment of personality pathology-basic questionnaire DAPP - BQ.
DV dependent variable; IVs independent variables. In addition, the model addressing overall levels of psychopathy showed main effects for emotional dysregulation and physical abuse as well as their interaction. Interestingly a closer look at this interaction revealed that for individuals who reported no physical abuse the association between emotional dysregulation and psychopathy score proved to be stronger than for individuals reporting physical abuse.
With respect to facets, neither scores on the Interpersonal dimension nor on the Affective dimension showed any effects other than sex. Difficulties in emotion regulation were not associated with higher or lower scores on these components of psychopathy. In contrast, the Lifestyle and Antisocial dimensions showed consistent positive associations with emotional dysregulation with effect sizes similar to that of participant sex.
Results were similar for indices of traumatic experience. There were no relationships between maltreatment and scores on the interpersonal or affective components of psychopathy. However, there were relationships between traumatic experience and one component of Factor 2. More specifically, only for the Antisocial dimension was a form of maltreatment found to be related to levels of psychopathic traits.
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The present study examined emotional dysregulation and trauma as predictors of overall psychopathy scores and scores on the dimensions underlying psychopathy. Unlike most prior studies, we included both female and male detainees to be able to address sex differences within the psychopathy syndrome. With the exception of a few studies with women, research so far has focused on male detainees.
Direct comparison between females and males that could be informative about the etiology of psychopathy are rarely examined. In our study, sex was a strong predictor of the PCL:YV total score and of scores on all four psychopathy dimensions. Consistent with the prior literature [ 26 ] incarcerated male adolescents were significantly higher than incarcerated female adolescents on the PCL:YV total score as well as on all four psychopathy dimensions. As illustrated by the beta-estimates the differences in the overall score between persons who report physical abuse versus persons who do not are quite substantial as well.
The absolute extent of the coefficient suggests that physical abuse could even have a higher impact in the overall model than sex. This interpretation is put into perspective when considering the beta-estimates within the models explaining the variance in the sub dimensions of psychopathy. In these, the estimates of sex are consistently higher than the ones of physical abuse. Nevertheless, the regression coefficients underscore the importance of the interaction terms in the models and highlight the effects of physical abuse on the one hand and emotional dysregulation on the other hand.
In their interpretation, it is important to keep in mind that each coefficient does not explain the total effect on psychopathy of its corresponding variable but that it rather represents the additional effect of adding that variable to the model, if the effects of all other variables in the model are already accounted for. The differences between boys and girls in the associations between emotional dysregulation and psychopathy contradicted our second hypothesis that relationships between predictors and outcome would be stronger for boys than for girls. More concretely, the interactions between sex and emotional dysregulation suggest that difficulties in regulating emotion may be more strongly related to the Lifestyle and Antisocial dimensions of psychopathy in girls than in boys.
In girls, other family-related variables, such as non-parental living arrangements, seemed to be more influential in developing the psychopathy syndrome than traumatization. Our overall results appear consistent with the first hypothesis that emotional dysregulation and physical traumatization are associated with some components of psychopathy in both male and female detainees.
However, a more detailed analysis of the separate regression models reveals that some of these relationships were specific to girls. Moreover, with the exception of the sex differences noted above, the interaction involving overall levels of psychopathic traits was quite distinct from the interaction involving the lifestyle and antisocial components of psychopathy. The fact that sex accounts for most of the variability on the one hand demonstrates the importance of differentiating between male and female individuals when investigating psychopathy.
On the other hand, especially when considering the extent of the beta-estimates, our results show that next to the effect of gender, there are still mechanisms that account for specific relations between other variables and psychopathy. We consider the findings involving overall levels of psychopathic traits first.
The overall model shows effects for emotional dysregulation and physical abuse as well as for their interaction. Experiences of physical abuse were associated with higher psychopathy ratings. Similarly, ratings of poorer emotion regulation were associated with higher psychopathy scores. The interaction indicated that the association between emotional dysregulation and psychopathy score held even more for detainees reporting no physical abuse than for participants describing physical abuse during childhood.
One can only speculate about the mechanism underlying this particular pattern. The unique effect of physical abuse in the overall model is especially difficult to determine, since it proves significant as a rather strong main effect as well as in the interaction term, where its effect is different at every one of the different values of emotional dysregulation.
However, both physical abuse and emotional dysregulation were associated with increased levels of psychopathic traits, but these associations may well reflect largely distinct mechanisms. At the same time, it is important to keep in mind that physical abuse was associated with emotion dysregulation in both male and female youth. Alternatively, there may be something about the impact of physical abuse that masks the impact of maladaptive emotion regulation or changes its expression. In this study, there was no evidence for any other Abuse X Emotion dysregulation interactions for any component of psychopathy for either boys or girls.
Because studies often required larger samples sizes to detect significant interactions, it is possible that the current study was underpowered for assessing the possibility of a three-way interaction involving not only emotion regulation and abuse but also participant sex. However, the samples of males and females in this study were among the largest samples yet employed in studies using clinical measures of psychopathic traits. The relationship between reports of physical abuse and antisocial facet scores is also interesting.
Although relationships between physical abuse and the antisocial or lifestyle features of psychopathy and antisocial personality disorder have been replicated in various samples in different countries and settings [ 77 , 78 ], it remains unusual to see a specific correlation with only one of four dimensions underlying psychopathy. We approach this correlation cautiously in recognition that some prior studies have reported similar correlations with environmental factors for the antisocial facet and the interpersonal facet [ 30 ]. However, it is remarkable that this association between the antisocial facet and physical abuse was consistent in both male and female adolescent offenders.
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Moreover, the antisocial facet was the only component to be related to either physical or sexual abuse in youth of either sex. Given that this component of psychopathy reflects early, persistent, and versatile involvement in antisocial activity [ 79 ], such findings contribute to a growing literature indicating that this dimension of psychopathy is not simply a measure of conduct problems or traits related to antisocial behavior but an index of an important individual differences construct with important developmental implications.
Consistent with this perspective, there are now findings linking the antisocial facet of psychopathy to the presence of other erratic dramatic personality disorders and paranoid personality disorder [ 42 , 80 ]. In line with our third hypothesis, the patterns of relationships were also quite consistent for the two core dimensions of psychopathy as well as for the two behavioral dimensions. First, with respect to the core affective and interpersonal dimensions neither emotional dysregulation nor trauma were meaningful predictors; the corrected R 2 for the Interpersonal dimension was so small that it seems that individual differences in this dimension likely reflect an entirely separate etiology rather than through effects of emotional dysregulation or traumatization.
The corrected R 2 for the Affective dimension was somewhat higher; still scores on this component of psychopathy were only predicted by the variable sex and not by any of the psychopathological variables tested in this study. Results were also similar for the Lifestyle and Antisocial dimensions. Emotional dysregulation has the same importance for explaining these dimensions as sex, and both models reveal a significant interaction of these two variables. In both cases, results indicate a stronger association between emotional dysregulation and variance in these components of psychopathy for girls than for boys.
It could well be that girls with more emotional liability show heightened aggressive behavior, stimulation seeking and impulsivity, which are measured by the behavioral factors, but on the other hand are also relatively common among other forms of personality pathology, including borderline personality pathology and antisocial personality disorder without psychopathic features [ 81 , 82 ]. Hence, these results may be indicative of a gender specific etiology of the traits captured by the behavioral factors, whereas it remains unclear which personality pathology is captured by the behavioral factors.
Hicks, vaidyanathan and patrick [ 83 ] described a secondary psychopathy subtype for both men and women which is similar to an externalizing variant of borderline personality disorder characterized by extreme negative affect and impulsivity; reactive anger, aggression, and violence; substance abuse; trauma; and suicidal behavior.sunporttermiwit.gq
Dissociative identity disorder: No excuse for criminal activity
Furthermore, some researchers have argued that secondary psychopathy is one manifestation of a process associated with an impulsive-aggressive behavioral style that is underpinned by weaknesses in neurobiological inhibitory control systems [ 84 , 85 ]. Contrary to our first hypothesis, sexual abuse was not a significant predictor of psychopathy in this sample. Although there is some evidence from prior studies that sexual abuse may be related to affective deficits of psychopathy [ 23 ], but current findings do not appear consistent with these findings.
This could be due to the fact, that as reported earlier the prevalence of sexual abuse was comparatively small in our sample. In addition, the CTQ uses a narrow definition of abuse, which only includes exposure to, but not the observation of, abusive acts. Moreover, it is well known that self-reports of experiences of sexual abuse are not always accurate.
This study has several limitations. With respect to measurement, the retrospective nature of reporting trauma experiences presents a number of challenges. Furthermore, the data on trauma experiences and personality pathology were gathered with a self-report measure and were not validated by interview or observational data. In addition, the study was cross-sectional, so all of the relationships reported here are correlational, and any inferences about etiological process are speculative.
In any correlational study, it remains possible that an outside factor could account for the relationships reported here. Replication in prospective, longitudinal studies is an important priority for future research. In addition, the novel findings regarding different mechanisms associated with dysregulation and physical abuse should be regarded as tentative pending replication in an independent sample. In addition, because samples differ not only in the baserates of psychopathic traits but in the extent to which psychopathic traits are correlated with demographic variables, it is important to examine the extent to which relationships that are potentially relevant to the etiology of psychopathic traits generalize across different kinds of samples.
A high total score on the PCL:YV checklist can be regarded as an indication for outstanding antisocial pathway; however, the total score as a pool for most different antisocial dimensions needs to be interpreted with caution. Both our results and other findings on the heterogeneity of psychopathy suggest that, in some ways, the total score does not seem to be a very useful diagnostic label, whereas the patterns of the core and behavioral facets seem more expedient. Moreover, our results indicate that the heterogeneity of the psychopathy concept is increasingly problematic in an era of developmental psychiatry as we are acquiring increasingly specific treatment methods for specific disorders.
Therefore, based on our findings one would recommend adolescent detainees with high scores on the behavioral dimensions of the PCL:YV and correspondent emotional regulation deficits to attend an anti-aggression-training in order to improve impulse control deficits and to handle traumatic experiences. In adolescents with high scores on the psychopathy dimensions, these therapeutic objectives seem to be displaced.
Instead, it should be focused on the pathological personality dimensions while new therapeutic strategies for these specific characteristics ought to be developed. Current results and as well as other recent findings pointing to distinct subtypes of individuals with psychopathic traits and distinct correlates for some of the different components of psychopathy appear consistent with recent arguments that the psychopathy total score may be less informative than the profile of scores on the core and behavioral facets.
On the other hand is the heterogeneity of the psychopathy concept increasingly problematic in an era of developmental psychiatry where we are acquiring increasingly specific treatment methods for specific disorders. KS carried out the study, participated in the examination of the adolescents and drafted the manuscript.
SF participated in the statistical design of the study and performed the statistical analysis.
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DK participated in the design of the study and helped to draft the manuscript. MK participated in the examination of the adolescents, in the design and coordination of the study and helped to draft the manuscript. All authors read and approved the final manuscript. The data must not be shared, because it contains highly sensitive information about the behavior of imprisoned juveniles. Skip to main content Skip to sections. Advertisement Hide.