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The Trauma Symptom Inventory (TSI; Briere, 1995) is the most commonly used self-report measure of posttraumatic symptomatology in adults, as rated by professionals specializing in the study and treatment of trauma-related impacts (Elhai, Gray, Kashdan, & Franklin, 2005). This normed and standardized test is commonly used to assess a range of trauma-related symptoms, including those arising from sexual and physical assault, spousal abuse, combat, war exposure, major accidents, natural disasters, and a history of childhood abuse. Individuals with histories of especially severe, chronic, or multiple traumatic exposures and/or early trauma, particularly those of an interpersonal nature, often report relatively intense symptomatology that may or may not include symptom clusters described by a diagnosis of posttraumatic stress disorder (PTSD), that is, flashbacks, numbing, avoidance behaviors, and autonomic hyperarousal. These more complex presentations are associated with a variety of symptoms and behaviors, including dissociation, identity disturbance, self-injury, interpersonal problems, aggression, and sexually dysfunctional behaviors (Briere & Spinazzola, 2005). The TSI was developed to address this wide range of trauma-related impacts. Keywords: trauma symptom inventory; trauma; assessment

Background The term “identity” has a much longer tradition in Western philosophy than in psychology. However, the philosophical discourse addresses very different meanings of the term, which should be distinguished to avoid misunderstandings, but also to sharpen the key meanings of the term in psychological contexts. These crucial points in the philosophical concepts of identity in the sense of singularity, individuality, or self-sameness may structure the ongoing discussion on identity in psychiatric diagnoses (as in DSM-5, Child Adolesc Psychiatry Ment, this issue, 2013), in psychology, psychoanalysis, but also neuroscience and neurophilosophy (Child Adolesc Psychiatry Ment, this issue, 2013). Method The concept of identity is subjected to a systematic philosophical analysis following some milestones in its history to provide a background for recent discussions on identity in psychiatry and psychology. Results The article focuses first on the philosophical core distinctions of identity in the different meanings to be addressed, second, briefly on some of the diverse psychological histories of the concept in the second half of the 20th century. Finally some reflections are presented on borderline personality disorder, considered as a mental disorder with a disturbance or diffusion of identity as core feature, and briefly on a newly developed instrument assessing identity development and identity diffusion in adolescence, the AIDA that is also presented in the special issue of this journal (Child Adolesc Psychiatry Ment, this issue, 2013). Conclusion As a conclusion, different points of view concerning identity are summarized in respect to treatment planning, and different levels of description of identity in phenomenology, philosophy of mind, cognitive science, and social science and personality psychology are outlined.

The aim of this paper is a thorough explication of the concept of identity. We have synthesized the scattered psychiatric and psychoanalytic literature on the topic to shed light on the historical origins, development, phenomenology, clinical relevance, and methods of assessing identity. Our review revealed that: (1) The concept of identity has persisted over eight decades. (2) Identity originates in the earliest interplay of the infant's temperament with the mother's attitude, gains structure from primitive introjections, refines itself through later selective identifications, acquires filiation and generational continuity in passage through the Oedipus complex, and arrives at its more or less final shape through synthesis of contradictory identifications and greater individuation during adolescence. It remains subject to further refinements during young adulthood, midlife, and even old age. (3) A cohesive identity comprises a realistic body image, subjective self-sameness, consistent attitudes, temporality, gender, authenticity, and ethnicity. (4) Disturbance of identity suggests psychopathology, with greater identity disturbance being associated with more-severe conditions (e.g., severe personality disorders, multiple personality, psychosis). (5) Clinical and psychometric assessment is therefore relevant and might indicate treatment strategies and outcome expectations. Findings from the literature are elucidated, and areas needing further research are identified.

Axis II diagnoses of 50 applicants for long-term inpatient treatment were obtained using the Personality Diagnostic Questionnaire, Revised. Clinical records were coded for evidence of a history of childhood abuse or neglect. Seventy-five percent of patients with a diagnosis of Borderline Personality Disorder (BPD) had histories of some type of abuse, compared with 33 percent of the nonborderline patients. A principal components analysis of the eight DSM-III-R criteria for BPD and histories of abuse and neglect showed that abuse history is correlated with the criteria of unstable relationships, feelings of emptiness, and abandonment fears, whereas neglect history is correlated with suicidal behavior. Affective instability, intense anger, and identity disturbance were uncorrelated with abuse or neglect. Thus, the affective symptoms of BPD appear to be unrelated to aversive childhood events, consistent with the concept of a subtype of BPD dominated by affective dysregulation.

OBJECTIVE: The aim of this study was to test, in terms of impulsivity, the hypothesis that borderline personality disorder “burns out” with age. METHOD: Linear regression analyses, with age as a predictor variable, were conducted on subsection scores of the Revised Diagnostic Interview for Borderlines (DIB-R) for 123 individuals with a diagnosis of borderline personality disorder who were accepted into an outpatient-based psychotherapy program. The subsection scores of the DIB-R allow quantification of the core features of the disorder: affective disturbance, relationship disturbance, cognitive disturbance, and impulsive behavior. RESULTS: Older patients with borderline personality disorder showed less impulsivity than younger patients, but there was no difference in terms of affect disturbance, identity disturbance, and interpersonal problems. CONCLUSIONS: The view that borderline personality disorder burns out with age is supported in terms of impulsivity.

IntroductionIdentity disturbance is one of the DSM- IV criteria for borderline personality disorder, but there has been little attention to its nature. Four subset of identity disturbance (role absorption, painful incoherence, inconsistency, lack of commitment) have been assessed.AimsAssess the role of these subsets in patients with borderline personality disorder and examine the relation between identity disturbances with substance- dependency.BackgroundThis case- control study was conducted on 40 patients with borderline personality disorder referring to Beheshti Hospital in Kerman during 2007-2008; and 40 healthy people who were matched with case group in term of gender, and educational level. Data gathering was done with three questionnaire including a demographic- related questionnaire, disturbance questionnaire (included 35 items), and a questionnaire related to substance- dependency and its related factors. Data analysis was performed using SPSS software (version 11) by mean calculation and t-test and ANOVA.MethodsMean score of 33 items of identity disturbance questionnaire were greater with significant difference in case group (p < 0.05). Means differences in two groups in all subsets were statistically significant except for role absorption (p < 0.05). Means differences in all subsets in substance- dependent subjects and substance- independent people in both groups were not statistically significant.FindingsIdentity disturbance is one of the major criteria for borderline personality disorder, but in different societies the role of its subsets are different. Assessing subsets of identity disturbance has no value in assessing substance- dependency in patients with borderline personality disorder.

Some symptoms that are benchmarks of borderline personality disorder in the younger patient--identity disturbance, impulsivity, self-mutilation, risk taking, and substance abuse--do not appear to define the disorder in late life. However, changes in the environment or social context of elderly persons may cause core symptoms to manifest differently. Identity disturbance in old age may be evidenced by an inability to formulate future plans or pursue goal-directed activities. Anorexia may be a substitute for more obvious forms of self-mutilation. Elderly patients with severe personality disorders may disrupt nursing homes and other service delivery systems. The authors suggest that staff who work with these patients receive special training and that more research is needed to identify which symptoms of personality disorders are maintained into old age.

The reliability of DSM-III-R diagnoses of personality disorders is poor and their validity has yet to be established. There is little evidence that the features of personality pathology cluster into these diagnostic entities. For these reasons, it is important to explore alternative ways of classifying personality disorders. In this preliminary study, reliable scales were developed to assess 100 personality dimensions which were systematically developed. The factorial structure underlying the dimensions was evaluated in a heterogeneous sample of 110 subjects from the general population. Sixteen components, accounting for 81.4% of the variance, were retained for rotation to oblique structure. The components were labelled social avoidance, narcissism, insecure attachment, compulsive behaviours, interpersonal disesteem, mobility, anxiousness, conduct problems, stimulus seeking, identity disturbance, self-harm, rejection, diffidence, and hypersensitivity. Two components were not interpreted because they only had one or two salient loadings.

Randlov C, Parnas J. The concept of 'borderline conditions' among Danish psychiatrists -a questionnaire study.In order to give a clearer conceptualization of “borderline” diagnosis among Danish psychiatrists, a questionnaire was mailed to all the Danish specialists in psychiatry, querying which psychopathological items were important for the “borderline” diagnosis. The responses indicated that identity disturbance and intact reality testing were emphasized as crucial to this diagnosis. A factor analysis revealed three dimensions. One related to unstable personality, one related to psychosis, and one reflecting schizotypal features. Younger and psychoanalytically oriented psychiatrists were more likely to utilize the unstable concept of the “borderline” diagnosis.Borderline concept, Danish psychiatrists, DSM-Ill, Factor analysis, Questionnaire study

A controlled study of families with an obese child showed a small but significantly greater impairment in family functioning when this was elicited and rated using clinical methods. However no significant impairment was found when functioning was elicited with standardized objective methods. Mothers of obese children rated their families as more dysfunctional than mothers of control children. Although the emotional health of individual members in obese families was not worse than in control families, significant differences in the family patterning of emotional health were found. The more overweight the obese child, the healthier the mother rate the family, and the better her own mental health as assessed by a self-report method; and in families of obese girls, the greater the degree of overweight, the worse the rated family functioning. The findings are integrated with the literature and a theoretical explanation in which obesity is seen as an identity disturbance is offered.

A variety of identity disturbances has been described in psychiatric patients. Although such disturbances possess some common features linked to shared or core psychological structures, qualitative differences that allow them to be distinguished from one another also exist. The cases reported are intended to draw attention to a severe and striking type of identity disturbance observed in psychotic patients, for which we have proposed the eponym, ‘the Zelig phenomenon’. The discussion focuses upon the issue of the coexistence in psychopathology of continuity and discontinuity. This apparent paradox can be regarded as an example of parallax, in which two quite different, yet equally valid, perspectives are possible and may be brought alternately into play. It is, however, argued that in the delineation of psychopathological entities it is necessary to adopt the perspective that considers discontinuities and matters of form, even though they may be at times overshadowed by continuities that derive from the alternate perspective.

Summary Thirty-eight children who were aged between 4 and 121/2 years were referred for potential gender disturbances and received independent assessments of sex-role behaviour and identity. Ratings of sex-role behaviour were based on psychodynamic, behavioural and psychometric procedures, with the behavioural and psychodynamic ratings most highly correlated. Two ratings of sex-role identity disturbance, derived from psychodynamic and behavioural orientations, yielded a strong interrelated agreement. The mean ratings of sex-role identity and behaviour disturbance were moderately correlated and provided a high degree of internal consistency. An overall diagnosis was derived for each subject by combining the behaviour and identity mean ratings. The findings are discussed in terms of the limitations of present knowledge on normal and deviant sex-role developmental processes.

Background Non-suicidal self-injury (NSSI) is a major concern in both clinical and non-clinical populations. It has been approximated that 65-80% of individuals with borderline personality disorder (BPD) engage in some form of NSSI. Despite such high co-morbidity, much still remains unknown about the relationship between NSSI and BPD symptomatology. The goal of the current study was to identify individual BPD symptoms and higher order BPD factors that increase one’s vulnerability of NSSI engagement among a college sample. It was hypothesized that the BPD factor of emotion dysregulation and the BPD symptoms of affect instability and intense anger/aggression would be associated with the presence and frequency of NSSI. Method Seven hundred twenty four undergraduates (61.2% female) completed self-report measures of BPD symptomology and NSSI history. Results Regression analyses revealed that among the individual BPD symptoms, past suicidality, impulsivity, chronic emptiness, and identity disturbance were each significantly, positively associated with lifetime history of NSSI, whereas unstable relationships were negatively associated with lifetime history of NSSI. The BPD symptom associated with NSSI frequency was dissociation. Among the BPD factors, emotion dysregulation and disturbed relatedness were both associated with NSSI history, but only disturbed relatedness was associated with NSSI frequency. Conclusion Findings show partial support for the importance of emotion dysregulation in the relationship between NSSI and BPD symptomatology, but also suggest that the relationship may be more complex and not solely based on emotion dysregulation.