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This brief report presents group processes and the treatment protocol of intensive, transdiagnostic group cognitive-behavior therapy for anxiety with comorbid personality disorders in a day clinic. It describes the history of and rationale for the development of this 3-month, 15-hour a week group treatment and the utilization of group processes during this therapy. The authors argue that the group format presented here allows the treatment of personality disorders that are frequently comorbid with anxiety disorders. [ABSTRACT FROM PUBLISHER]

A systematic review of reactive attachment disorder (RAD)/disinhibited social engagement disorder (DSED) in adolescence highlighted that young people with the disorder had indiscriminate friendliness with difficulties in establishing and maintaining stable relationships. Most reported experiences of rejection. We were struck by similarities between the above and features of emergence of personality disorders (EPD). This feasibility study aimed to determine best ways of recruiting and retaining vulnerable young people and the proportion of participants with RAD/DSED who might have emerging borderline personality disorder (EBPD). Participants were referred to the study by their treating clinicians from local mental health teams. Results showed strong association between RAD/DSED and EBPD. Participant characteristics showed high levels of out of home placements, early termination of school careers, suicide attempts, quasipsychotic symptoms, and multiagency involvements. They experienced the project as an opportunity to talk about relationships and reported that they would like more of this in usual clinical contacts. They all agreed to be contacted for future studies. Previous studies have shown that early detection and treatment of emergent personality traits can alter trajectory. Future research will continue to explore these trajectories, explore detection of vulnerability factors, and evaluate interventions. [ABSTRACT FROM AUTHOR]

In the present study, we assess the extent to which patient personality features and prototypes are associated with early treatment therapist-rated alliance. The study sample consisted of 94 patients receiving psychodynamic psychotherapy at an outpatient clinic. Clinicians completed the Working Alliance Inventory (J Couns Psychol 36:223-233; Psychother Res 9:405-423) to assess their views of early alliance and the Shedler-Westen Assessment Procedure 200 (SWAP-200; Assessment 5:333-353, Am J Psychiatry 161:1350-1365, 1743-1754; Am J Psychiatry 156:258-272, 273-285) to assess patient personality. The SWAP-200 Narcissistic Clinical Prototype, Dysphoric Q-Factor, and Dysphoric/High-Functioning Neurotic Q-Subfactor significantly correlated with early therapist-rated alliance. Correlations that trended toward significance were also found. Also identified were specific SWAP-200 items that were found to relate to high early therapist-rated alliance scores. These results demonstrate some relationship, albeit small, between patient personality characteristics and therapists' views of the alliance that may serve to further a conceptual understanding of the alliance, specific personality syndromes, and the associated impact on the therapeutic interaction. [ABSTRACT FROM AUTHOR]

Clinicians generally find individuals with personality disorders to be challenging to treat, especially compared to clients who have only a straightforward depression or anxiety disorder. In this article we will summarise research on the efficacy of cognitive behaviour therapy (CBT) for personality disorders. Then we will focus on the conceptualisation and treatment of CBT for personality disorders that is based on the work of Aaron Beck and colleagues; that is, it is predicated upon the cognitive model of psychopathology. Next, we will describe two other forms of treatment with cognitive behavioural roots: schema therapy and dialectical behaviour therapy. A final section will suggest future directions. [ABSTRACT FROM PUBLISHER]

Background: Concurrent personality disorder (PD) and substance use disorder (SUD) are common in clinical practice. However, SUD is the main criterion for study exclusion in most psychotherapeutic studies of PD. As a result, data on treatment outcomes in patients with concurrent PD/SUD are scarce. Methods: The study sample consisted of 51 patients diagnosed with severe PD and admitted for psychotherapeutic treatment as a part of routine mental health care. All patients were diagnosed with PD according to the Structured Clinical Interview for PD. Patients were further assessed (DSM-IV diagnostic criteria) to check for the presence of concurrent SUD, with 28 patients diagnosed with both disorders (PD-SUD). These 28 cases were then compared to the 23 patients without SUD (PD-nSUD) in terms of psychiatric hospitalizations and psychiatric emergency room (ER) visits before and during the 6-month therapeutic intervention and every 6 months thereafter for a total of 36 months. Results: The baseline clinical characteristics correspond to a sample of PD patients (78% met DSM-IV criteria for borderline PD) with poor general functioning and a high prevalence of suicide attempts and self-harm behaviors. Altogether, the five outcome variables - the proportion and the number of psychiatric inpatient admissions, the number of days hospitalized, and the proportion and the number of psychiatric ER visits - improved significantly during the treatment period, and this improvement was maintained throughout the follow-up period. Although PD-SUD patients had more psychiatric hospitalizations and ER visits than PD-nSUD patients during follow-up, the differences between these two groups remained stable over the study period indicating that the treatment was equally effective in both groups. Conclusion: Specialized psychotherapy for severe PD can be effectively applied in patients with concurrent PD-SUD under usual practice conditions. These findings suggest that exclusion of patients with dual disorders from specialized treatments is unjustified. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including history of depression and of cognitive therapy (CT); history of behavioral couple therapy (BCT); and treatments for sleep problems.

Perfectionism can present as a clinical problem in its own right or it can interfere with the successful treatment of Axis I disorders. In the past 15 years, a cognitive behavioral analysis of 'clinical perfectionism' has been proposed. This approach and the measurement of the construct of clinical perfectionism have proved controversial. Nevertheless, the approach has experimental support and clinical utility; the derived treatment has been shown to lead to significant improvement on both measures of perfectionism and Axis I disorders. The cognitive behavioral intervention for perfectionism has been evaluated in a range of formats (group, individual, face-to-face, and online) and all show promise. Further work is required to address clinically important questions such as when to treat clinical perfectionism if it occurs in the context of single and multiple Axis I disorders. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic stress disorder (PTSD) is often comorbid with alcohol dependence (AD), but little is known about the characteristics of AD treatment-seeking inpatients with PTSD. We examined differences between treatment-seeking alcohol dependent inpatients with and without comorbid PTSD. We hypothesized that those with AD and PTSD would have higher levels of: (1) alcohol use and AD severity; (2) anxiety and mood disorders; (3) neuroticism.Methods: Individuals (N=411, mean age=41.7±10.0years) with AD were monitored over 30days in a suburban inpatient alcohol treatment setting. Patients were evaluated to identify AD and comorbid PTSD, mood and anxiety disorders, alcohol use and dependence severity, personality, and aggression.Results: Those with PTSD (19% of the sample) did not differ in the amount of alcohol consumed, but had greater: (1) severity of AD (p=0.001, d=0.44); (2) diagnosis of anxiety (p=0.000, OR=3.64) and mood (p=0.000, OR=4.83) disorders; and (3) levels of neuroticism (p<0.001, d=0.67) and aggression (p<0.001, d=0.81).Conclusions: AD patients with comorbid PTSD present a more severe phenotype across AD severity, frequency of anxiety and mood disorders, and levels of neuroticism and aggression. This group may benefit from concurrent treatment of both AD and PTSD. Future research can investigate neuroticism as a potential treatment target. [ABSTRACT FROM AUTHOR]

The article discusses the schema therapy developed by psychologist Jeffrey Young for the treatment of personality disorders and axis 1 type-disorders. Topics include the benefits of using schema therapy than the traditional cognitive behavioral therapy approaches, the lack of evidence-based studies about the use of schema therapy and the factors that made the author interested in the field, including the struggle of mental health services to provide adequate care to people with such disorders.

The goal of this article is to describe, characterize, and differentiate personality disorders by connecting their conceptual features to their foundations in the natural sciences. What is proposed is akin to Freud's abandoned Project for a Scientific Psychology and Wilson's (1975) highly controversial Sociobiology. Both were worthy endeavors to advance our understanding of the styles and traits of human nature; this was to be done by exploring interconnections among the diverse disciplines of nature that evolved ostensibly unrelated bodies of research and manifestly dissimilar languages. [ABSTRACT FROM AUTHOR]

It is important to understand the change processes involved in psychotherapies for patients with personality disorders (PDs). One patient process that promises to be useful in relation to the outcome of psychotherapy is emotional processing. In the present process-outcome analysis, we examine this question by using a sequential model of emotional processing and by additionally taking into account a therapist's appropriate responsiveness to a patient's presentation in clarification-oriented psychotherapy (COP), a humanistic-experiential form of therapy. The present study involved 39 patients with a range of PDs undergoing COP. Session 25 was assessed as part of the working phase of each therapy by external raters in terms of emotional processing using the Classification of Affective-Meaning States (CAMS) and in terms of the overall quality of therapist-patient interaction using the Process-Content-Relationship Scale (BIBS). Treatment outcome was assessed pre- and post-therapy using the Global Severity Index (GSI) of the SCL-90-R and the BDI. Results indicate that the good outcome cases showed more self-compassion, more rejecting anger, and a higher quality of therapist-patient interaction compared to poorer outcome cases. For good outcome cases, emotional processing predicted 18% of symptom change at the end of treatment, which was not found for poor outcome cases. These results are discussed within the framework of an integrative understanding of emotional processing as an underlying mechanism of change in COP, and perhaps in other effective therapy approaches for PDs. [ABSTRACT FROM AUTHOR]

This article describes a prison-based service for men with personality needs. A background to the service is provided alongside staff's reflections on service implementation. First-person resident accounts offer the reader an insight into the perspective of the residents. [ABSTRACT FROM AUTHOR]

Objective: There are six strategies or validation levels in dialectical behavior therapy (DBT), yet there are no measures designed to code for them. This absence limits our understanding of the relationship between validation strategies and treatment outcome. The DBT-Validation Level Coding Scale (DBT-VLCS) was developed to overcome this limitation. Method: This research reports on the interrater reliability and content validity for the DBT-VLCS. Results: Overall, interrater reliability was excellent for all items, with the exception of two items that demonstrated good reliability. Good content validity was demonstrated for six of the seven items. Conclusions: This preliminary study suggests that the DBT-VLCS is a reliable and valid measure to code the presence of validation in DBT. This measure creates the opportunity for research that has not previously been possible. [ABSTRACT FROM AUTHOR]

Countertransference (CT) awareness is widely considered valuable for differential diagnosis and the proactive management of ethical dilemmas. We predicted that the more practitioners' theoretical orientation (TO) emphasizes insight into the dynamics of subjective mental life, the better they will be at using their CT expectations in differential diagnosis with high-risk patients. To test this hypothesis, we compared psychodynamic therapy (PDT) practitioners who emphasize insight into subjective mental life with practitioners who do not emphasize this epistemology. Results indicated that PDT practitioners expected significantly more CT than practitioners of cognitive-behavioural therapy (CBT) and other practitioners (e.g., family systems, humanistic/existential and eclectic) to patients with borderline personality organization overall. PDT practitioners had significantly more CT expectations to patients with borderline-level pathologies as compared with neurotic-level patients than both CBT and other practitioners. PDT practitioners were significantly more expectant of CT issues than CBT practitioners with respect to the personality disorders most associated with acting out and risk management problems (e.g., paranoid, psychopathic, narcissistic, sadistic, sadomasochistic, masochistic, hypomanic, passive-aggressive, counterdependent and counterphobic). The other practitioners generally had CT expectations between PDT and CBT. These findings suggest that clinical training into CT may be useful in differential diagnoses and in helping to avoid ethical dilemmas regardless of one's theoretical preference. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Insight into countertransference can be used to help with differential diagnoses and to help prevent possible management problems with acting out patients. The Psychodynamic Diagnostic Manual is a useful taxonomy in that it includes countertransference as a diagnostic aid. [ABSTRACT FROM AUTHOR]

Stroke survivors are often affected by psychological distress and neuropsychiatric disturbances. About one-third of stroke survivors experience depression, anxiety or apathy, which are the most common neuropsychiatric sequelae of stroke. Neuropsychiatric sequelae are disabling, and can have a negative influence on recovery, reduce quality of life and lead to exhaustion of the caregiver. Despite the availability of screening instruments and effective treatments, neuropsychiatric disturbances attributed to stroke are currently underdiagnosed and undertreated. Stroke severity, stroke-related disabilities, cerebral small vessel disease, previous psychiatric disease, poor coping strategies and unfavourable psychosocial environment influence the presence and severity of the psychiatric sequelae of stroke. Although consistent associations between psychiatric disturbances and specific stroke locations have yet to be confirmed, functional MRI studies are beginning to unveil the anatomical networks that are disrupted in stroke-associated psychiatric disorders. Evidence regarding biochemical and genetic biomarkers for stroke-associated psychiatric disorders is still limited, and better understanding of the biological determinants and pathophysiology of these disorders is needed. Investigation into the management of these conditions must be continued, and should include pilot studies to assess the benefits of innovative behavioural interventions and large-scale cooperative randomized controlled pharmacological trials of drugs that are safe to use in patients with stroke. [ABSTRACT FROM AUTHOR]

Dialectical behavior therapy (DBT) and dynamic deconstructive psychotherapy (DDP) are listed in the National Registry of Evidence-Based Programs and Practices based on their performances in randomized controlled trials. However, little is known about their effectiveness in real-world settings. In the present study, the authors observed the naturalistic outcomes of 68 clients with borderline personality disorder (BPD) who were treated at a medical university clinic by experienced therapists using either comprehensive DBT (n = 25) or DDP (n = 27), with 16 clients treated with unstructured psychotherapy serving as a control. We found both DBT and DDP achieved significant reductions in symptoms of BPD, depression, and disability by 12 months of treatment, and showed effect sizes consistent with controlled trials. However, attrition from DBT was high and DDP obtained better outcomes than DBT (d = .53). Larger effectiveness studies are needed to replicate these findings, delineate common and unique treatment processes, and determine therapist and patient characteristics predicting positive outcomes. [ABSTRACT FROM AUTHOR]

Objective: Patients with major depressive disorder (MDD) and a comorbid personality disorder (PD) have been found to exhibit relatively poor outcomes in cognitive therapy (CT) and other treatments. Adaptations of CT focusing heavily on patients' core beliefs have yielded promising findings in the treatment of PD. However, there have been no investigations that have specifically tested whether increased focus on maladaptive beliefs contributes to CT's efficacy for these patients. Method: CT technique use from an early CT session was assessed for 59 patients (33 without PD, 26 with PD-predominantly Cluster C) who participated in a randomized controlled trial for moderate to severe MDD. Scores were calculated for directive CT techniques (CT-Concrete) and a set of belief-focused items (CT-Belief) as rated by the Collaborative Study Process Rating Scale. Robust regressions were conducted to estimate relations between scores on each of these measures and change in depressive and PD symptoms. A PD status by CT-Belief use interaction tested the hypothesis that therapist use of CT-Belief techniques would exhibit a stronger association with symptom change in the PD group relative to the non-PD group. Results: As hypothesized, a significant interaction between PD status and use of CT-Belief techniques emerged in the prediction of depressive and PD symptom change. Among PD patients, higher early CT-Belief interventions were found to predict significantly greater improvement. CT-Belief use did not predict greater symptom change among those without PD. Conclusions: Early focus on CT-Belief interventions may facilitate changes in depression and PD symptoms for patients with MDD-PD comorbidity. [ABSTRACT FROM AUTHOR]

Background: Attempted suicide is the main risk factor for suicide and repeated suicide attempts. However, the evidence for follow-up treatments reducing suicidal behavior in these patients is limited. The objective of the present study was to evaluate the efficacy of the Attempted Suicide Short Intervention Program (ASSIP) in reducing suicidal behavior. ASSIP is a novel brief therapy based on a patient-centered model of suicidal behavior, with an emphasis on early therapeutic alliance.Methods and Findings: Patients who had recently attempted suicide were randomly allocated to treatment as usual (n = 60) or treatment as usual plus ASSIP (n = 60). ASSIP participants received three therapy sessions followed by regular contact through personalized letters over 24 months. Participants considered to be at high risk of suicide were included, 63% were diagnosed with an affective disorder, and 50% had a history of prior suicide attempts. Clinical exclusion criteria were habitual self-harm, serious cognitive impairment, and psychotic disorder. Study participants completed a set of psychosocial and clinical questionnaires every 6 months over a 24-month follow-up period. The study represents a real-world clinical setting at an outpatient clinic of a university hospital of psychiatry. The primary outcome measure was repeat suicide attempts during the 24-month follow-up period. Secondary outcome measures were suicidal ideation, depression, and health-care utilization. Furthermore, effects of prior suicide attempts, depression at baseline, diagnosis, and therapeutic alliance on outcome were investigated. During the 24-month follow-up period, five repeat suicide attempts were recorded in the ASSIP group and 41 attempts in the control group. The rates of participants reattempting suicide at least once were 8.3% (n = 5) and 26.7% (n = 16). ASSIP was associated with an approximately 80% reduced risk of participants making at least one repeat suicide attempt (Wald χ21 = 13.1, 95% CI 12.4-13.7, p < 0.001). ASSIP participants spent 72% fewer days in the hospital during follow-up (ASSIP: 29 d; control group: 105 d; W = 94.5, p = 0.038). Higher scores of patient-rated therapeutic alliance in the ASSIP group were associated with a lower rate of repeat suicide attempts. Prior suicide attempts, depression, and a diagnosis of personality disorder at baseline did not significantly affect outcome. Participants with a diagnosis of borderline personality disorder (n = 20) had more previous suicide attempts and a higher number of reattempts. Key study limitations were missing data and dropout rates. Although both were generally low, they increased during follow-up. At 24 months, the group difference in dropout rate was significant: ASSIP, 7% (n = 4); control, 22% (n = 13). A further limitation is that we do not have detailed information of the co-active follow-up treatment apart from participant self-reports every 6 months on the setting and the duration of the co-active treatment.Conclusions: ASSIP, a manual-based brief therapy for patients who have recently attempted suicide, administered in addition to the usual clinical treatment, was efficacious in reducing suicidal behavior in a real-world clinical setting. ASSIP fulfills the need for an easy-to-administer low-cost intervention. Large pragmatic trials will be needed to conclusively establish the efficacy of ASSIP and replicate our findings in other clinical settings.Trial Registration: ClinicalTrials.gov NCT02505373. [ABSTRACT FROM AUTHOR]

Objective The objective of this paper was to examine the relationships between perceived parental bonding, Early Maladaptive Schemas (Young et al., 2003), and outcome of schema therapy of Cluster C personality problems and whether the perceptions of parental bonding could be influenced by schema therapy. Method The sample consisted of 45 patients with panic disorder and/or agoraphobia and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Cluster C personality traits who participated in an 11-week inpatient programme consisting of two phases; the first was a 5-week panic/agoraphobia-focused cognitive therapy, whereas the second phase was a personality-focused schema therapy. The patients were assessed at pre-treatment, mid-treatment and post-treatment and at 1-year follow-up. Results Opposite to our hypothesis, lower paternal care at pre-treatment was related to more reduction in Cluster C personality traits from pre-treatment to 1-year follow-up. Maternal protection was related to the schema domains of impaired autonomy and exaggerated standards. Overall schema severity and the schema emotional inhibition at pre-treatment were associated with less change in Cluster C traits. Perceived maternal care was reduced from pre-treatment to 1-year follow-up, and more reduction in maternal care was related to less reduction in Cluster C traits. Discussion Parental bonding failed to predict treatment outcome in the expected direction, but maternal protection was related to two of the schema domains. Overall schema severity and the particular schema emotional inhibition predicted outcome. Furthermore, perceived maternal care was reduced from before to after treatment. Future studies should examine these questions in larger samples of Cluster C patients receiving schema therapy of a longer duration. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Most schemas within the impaired autonomy domain and the schema self-sacrifice seem to be related to low perceived maternal protection., Overall schema severity and the schema emotional inhibition predict a poorer outcome of schema therapy of Cluster C personality problems, and therapy should give priority to emotional inhibition when this schema is endorsed., Therapists should be aware that schema therapy carries the risk to lead to a more negative view of mother's care during upbringing and this risk is accentuated with less benefit of therapy. [ABSTRACT FROM AUTHOR]

Growing evidence supporting the effectiveness of Collaborative/Therapeutic Assessment (C/TA) has led clinicians and researchers to apply C/TA to a variety of clinical populations and treatment settings. This case example presents a C/TA inpatient adaptation illustrated with narcissistic personality disorder. After a brief overview of salient concepts, I provide a detailed account of the clinical interview, test interpretation paired with diagnostic considerations specific to narcissism, planned intervention, and discussion of assessment results. Throughout the case study, I attempt to demonstrate defining features of C/TA, inpatient adaptations, and clinical techniques that encourage meaningful engagement with a “hard to reach” personality. [ABSTRACT FROM PUBLISHER]

Controversy surrounds the diagnosis of Borderline Personality Disorder (BPD) in youth. This meta-analysis summarised evidence regarding the aetiological and psychopathological validity of youth BPD (the extent to which youth and adult BPD share common risk factors and psychopathology). We identified 61 studies satisfying predetermined inclusion criteria. Statistically significant pooled associations with youth (19 years of age and under) BPD were observed for sexual abuse (all youth: odds ratio = 4.88; 95% confidence interval = 3.30, 7.21; children: OR = 3.97; 95% CI = 1.51, 10.41; adolescents: OR = 5.41; 95% CI = 3.43, 8.53); physical abuse (all youth: 2.79 [2.03, 3.84]; children: 2.86 [1.98, 4.13]; adolescents: 2.60 [1.38, 4.90]); maternal hostility/verbal abuse (all youth: 3.28 [2.67, 4.03]; children: 3.15 [2.55, 3.88]; adolescents: 4.71 [1.77, 12.53]); and neglect (all youth: 3.40 [2.27, 5.11]; children: 2.87 [1.73, 4.73]; adolescents: 4.87 [2.24, 10.59]). Several psychopathological features were also associated with youth BPD, including comorbid mood (3.21 [2.13, 4.83]), anxiety (2.30 [1.44, 3.70]) and substance use (2.92 [1.60, 5.31]) disorders; self-harm (2.81 [1.61, 4.90]); suicide ideation (all youth: 2.02 [1.23, 3.32]; children: 6.00 [1.81, 19.84]; adolescents: 1.75 [1.20; 2.54]) and suicide attempt (2.10 [1.21, 3.66]). Results demonstrate that adult and youth BPD share common aetiological and psychopathological correlates. This offers some support for the diagnostic validity of youth BPD and indicates the need for clinical recognition in this age group. [ABSTRACT FROM AUTHOR]

The present study examined the reliability and validity of the Italian translation of the UPPS-P Impulsive Behavior Scale (UPPS-P) in a clinical sample of 268 consecutively admitted psychotherapy patients (43.3% male; mean age = 40.48 ( SD = 12.52); 38.8% inpatient). The Italian UPPS-P replicated the internal consistency coefficients of the original UPPS-P (0.84 to 0.92 across the five subscales). Moreover, confirmatory factor analyses evidenced an adequate fit for the a-priori five-factor model of the scale (WLSMV CFA χ 2 (1642) = 2833.06, p < .001; RMSEA = 0.052, 95% confidence interval = 0.049 to 0.055, p > .10; CFI = .90; TLI = .90). Furthermore, the UPPS-P scales were significantly related to the Barratt Impulsiveness Scale-11 total score ( rs = 0.23 to 0.60 across the five scales). Finally, the five UPPS-P scales showed distinct associations with domain scores and interview-based dimensional scores of personality disorders. These findings suggest that the Italian version of the UPPS-P can be considered a valid and reliable alternative to the original UPPS-P and can be a useful diagnostic tool in a clinical sample. [ABSTRACT FROM AUTHOR]

This review focuses on recent research on diagnostic aspects, etiology, and treatment of avoidant personality disorder (AVPD). Current studies stress the close relation between AVPD and social anxiety disorder, the influence of genetic factors in the development of AVPD, and the relative stability of symptoms. Treatment approaches should target the pervasive patterns of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Empirical evidence for cognitive-behavior and schema therapy is promising. Few other therapeutic approaches have been developed, but until now, these have only been investigated in case studies. We conclude that AVPD qualifies as a neglected disorder and that more research specifically on avoidant personality disorder symptoms and its treatment is needed. [ABSTRACT FROM AUTHOR]

Background: With regard to cluster B personality disorders, most psychotherapeutic treatments focus on borderline personality disorder. Evidence-based treatments for patients with other cluster B personality disorders are not yet available. Psychoanalytic-interactional therapy (PIT) represents a transdiagnostic treatment for severe personality disorders. PIT has been applied in clinical practice for many years and has proven effective in open studies. In a randomized controlled trial, we compared manual-guided PIT to nonmanualized pychodynamic therapy by experts in personality disorders (E-PDT) in patients with cluster B personality disorders.Methods: In an inpatient setting, patients with cluster B personality disorders were randomly assigned to manual-guided PIT (n = 64) or nonmanualized E-PDT (n = 58). In addition, a quasi-experimental control condition was used (n = 46) including both patients receiving treatment as usual and patients waiting for treatment. Primary outcomes were level of personality organization and overall psychological distress. As secondary outcomes, depression, anxiety and interpersonal problems were examined.Results: No significant improvements were found in the control patients. Both PIT and E-PDT achieved significant improvements in all outcome measures and were superior to the control condition. No differences were found between PIT and E-PDT in any outcome measure at the end of treatment. The type of cluster B personality disorder had no impact on the results.Conclusions: In an inpatient setting, both PIT and E-PDT proved to be superior to a control condition in cluster B personality disorders. In a head-to-head comparison, both treatments appeared to be equally effective. Further research on the treatment of cluster B personality disorders is required. [ABSTRACT FROM AUTHOR]

Improving your understanding of these disorders will help you identify specific diagnoses, ensure appropriate treatment, and reduce frustration during office visits. [ABSTRACT FROM AUTHOR]

The major challenge for a clinician is integration of the wisdom available in the wide range of therapeutic paradigms available. I have found the principles guiding dialectic behaviour therapy (DBT; see Miller, Rathus, & Linehan, 2007, for applying DBT to adolescents) extremely useful in my practice running a general adolescent unit; similarly, the understanding of the different information processing and learning principles associated with each of the Type A and C attachment strategies, as understood in dynamic maturational model (DMM), has guided me through the dark corners of treatment. Specifically, how does DMM inform practice of DBT? As a ‘DBTer’ might say, ‘Where is the wisdom in both points of view?’ Nevertheless, DMM is not primarily about treatment. It concerns how different ways of adapting to developmental contingencies bias perceptual propensities, and hence the information available for reflective brain function. Recognition of these twists to knowing what is going on can then be used to inform a variety of therapeutic approaches. The purpose of this article is to look for the signposts in DBT and DMM which together help navigate the comprehensive approach necessary in complicated therapy. In the process, hopefully some more general principles for addressing discomfited adolescents arise for informing future practice. Although many steer shy of using personality disorder diagnoses for adolescents, clinicians are nevertheless addressing, directly or indirectly, the personality development of all adolescents in treatment, regardless of their classical axis I diagnoses, including both those with developing emotional instability and a group of avoidant over-controlled adolescents, which in Norway is growing in prominence. [ABSTRACT FROM AUTHOR]

In this study, we set out to extend empirical research on the Life-Death Implicit Association Test (IAT) by administering the measure to an adult psychiatric inpatient population with suicidal ideation. We sought to examine its association with other suicide-relevant measures and to determine whether it adds predictive utility beyond that offered by other measures of suicide risk. The IAT was administered (N = 124) at biweekly intervals as part of an assessment battery at an inpatient facility for complex, treatment resistant psychiatric disorders (average length of stay: approximately 6 weeks). Multiple regression procedures were utilized to examine relationships among the measures and their predictive utility with respect to suicidal ideation at discharge. Consistent with prior research with other populations, significant associations were found between IAT performance and explicit (self-report and interview) measures of suicide risk. Moreover, the IAT was found to predict suicidal ideation at discharge above and beyond number of prior suicide attempts and admission scores on measures of depression, suicidal ideation, and hopelessness. Change in IAT performance over the course of treatment was observed. The IAT shows promise as an addition to explicit measures conventionally used to estimate suicide risk in psychiatric patients. These findings are consistent with a cognitive vulnerability model of suicide risk. [ABSTRACT FROM PUBLISHER]

Psychiatric unit inpatients often have serious mental illnesses with comorbid personality disorders. Mental illnesses usually respond favorably to medication and psychotherapy, but personality disorders do not. Two personality disorders are commonly seen on inpatient units: borderline and antisocial. These personality disorders may destabilize the milieu with disruptive behaviors and present a challenge to nurses. Difficult patient behaviors and therapeutic responses by nurses are examined. Dialectical behavior therapy techniques and good communication skills may be used by nurses to (a) interact therapeutically with patients with personality disorders and (b) protect other patients and the milieu. [ABSTRACT FROM AUTHOR]

There is an increasing interest in mentally ill offenders' (MIOs) treatment experiences in forensic settings. This study focuses on the treatment perspectives of MIOs in treatment as well as in prison settings in Flanders. Seventeen MIOs were interviewed about the treatment they received. Data were analyzed using thematic analysis to derive key themes while acknowledging the individuality of the participants' experiences. Treatment perspectives of MIOs in both settings revolved around similar themes, including "good" staff and privacy. However, their views differed on two themes: MIOs in treatment settings reported on feelings of lacking control and experiencing too much pressure, whereas MIOs in prison settings reported the opposite. The positive experiences in prison settings may complicate the transition from prison to a forensic treatment setting. The study further underscores the major challenge to create more opportunities for MIOs to meet their needs of self-determination in secure forensic treatment settings. [ABSTRACT FROM AUTHOR]

The formerly named "Dangerous and Severe Personality Disorder" (DSPD) units are no longer standalone services within the criminal justice system in England and Wales. These sites now provide personality disorder treatment services in the high-security prison estate as part of the new national Offender Personality Disorder (OPD) Pathway Strategy. The OPD Pathway intends to take responsibility for the assessment, treatment, and management of offenders who are likely to have a personality disorder and who present a high risk of re-offending (men and women) and serious harm to others (men). Further PD treatment and progression services are being commissioned in lower security prisons and in the community as part of the new PD Strategy. While the suitability criteria for the two male high-security PD treatment sites are the same, the individual units have their own assessment and treatment methods. This article aims to communicate the referral, assessment, and treatment methods employed within the prison-based Westgate Personality Disorder Treatment Service, HMP Frankland. [ABSTRACT FROM AUTHOR]

Objectives. Previous electrophysiological studies have confirmed impaired reward processing in patients with BPD. However, it is not clear which aspects of reward processing are affected and which brain regions are involved. The present study investigated both evoked and induced event-related oscillations (EROs) to feedback events (thought to represent different aspects of feedback processing), and used source localization (sLORETA) to assess activity in two areas known to contribute to reward processing, the dorsomedial prefrontal/anterior cingulate cortex (dmPFC/ACC) and the orbitofrontal cortex (OFC). Methods. Eighteen patients with BPD and 22 healthy controls performed a gambling task, while 64-channel electroencephalographic activity was recorded. Evoked and induced theta and high-beta band EROs as well as activity in the two regions of interest were investigated depending on the valence and magnitude of feedback events. Results. Theta-band responses to negative feedback were reduced in BPD, an effect that involved only evoked responses and the dmPFC/ ACC region, and was associated with trait impulsivity in patients. sLORETA analyses revealed disturbed evoked responses depending on feedback magnitude in the theta (OFC) and high-beta (dmPFC/ACC and OFC) frequency range. Conclusions. The results indicate multiple dysfunctions of feedback processing in patients with BPD, implicating several distinct subsets of reward-processing mechanisms. [ABSTRACT FROM AUTHOR]

Aim of the study. The main purpose of this paper was to present a model of psychological diagnosis, aimed at establishing the fundamental criteria for qualifying patients with symptoms of various mental disorders (including neurotic and personality disorders) for outpatient psychodynamic therapy. Subject or material and methods. Rorschach Inkblot Test, clinical interview Results. The research was conducted in the years 2010-2013 in the Neurosis Treatment Centre and in the Mental Health Outpatient Clinic A study population comprised 38 males and 42 females. Discussion. The structure of personality characteristics and their impact on a patient's eligibility to participate in a particular type of psychotherapy was assessed based on the major assumptions of psychodynamic approach, with special focus on the criteria put forward by Gabbard; the Big Five personality dimensions; as well as on the diagnostic criteria for personality disorders, developed by the American Psychiatric Association. Conclusions. Analysis of the result of this research allowed to develop a model of fundamental criteria for selecting an appropriate form of psychotherapy designed for patients with various types of personality disorders. Eight criteria were found to be significant in the process of qualifying the aforementioned individuals for outpatient psychotherapy. They included two psychological dimensions: intrapsychic (describing psychological indicators of the self-structure and maturity level of the patient's identity) and interpersonal (describing indicators of the person's capacity for establishing emotional relations with others). Diagnosis of the aforementioned indicators proves to contribute significantly to the process of selecting effective therapeutic methods for neurotic patients as well as individuals who exhibit symptoms of more severe destabilization of personality organization. [ABSTRACT FROM AUTHOR]

The article discusses personality disorders along with its signs, symptoms, behaviors, traits, and functional outcomes. Topics discussed include determination of the phenotypic and genetic relationships of DSM-IV/DSM-5 personality disorders; hierarchical relationships of Psychopathology; and characterization of personality disorders by high neuroticism, low agreeableness, and low conscientiousness.

Parkinson’s disease and deep brain stimulation procedures sometimes used to treat it can alter personality, including key traits that make a person, in essence, who they are. While many patients and families report positive changes, there is a need to better identify exactly what personality characteristics may be affected and to what degree personality is altered. [ABSTRACT FROM AUTHOR]

Background: Patients diagnosed with a personality disorder (PD) are often stigmatized by the healthcare staff who treat them. Aims: This study aimed to compare the impact on front-line staff of a self-management Acceptance and Commitment Therapy-based training intervention (ACTr) with a knowledge- and skills-based Dialectical Behaviour Training intervention (DBTr). Method: A service-based randomized controlled trial was conducted comparing the effects of 2-day ACTr (N = 53) and DBTr (N = 47) staff workshops over 6 months. Primary outcome measures were staff attitudes towards patients and staff-patient relationships. Results: For both interventions, staff attitudes, therapeutic relationship, and social distancing all improved pre- to postintervention, and these changes were maintained at 6-month followup. Conclusions: Although offering different resources to staff, both ACTr and DBTr were associated with an improved disposition towards PD patients. Future research could evaluate a combined approach, both for staff working with PD patients and those working with other stigmatized groups. [ABSTRACT FROM AUTHOR]

Existing treatments for maladaptive interpersonal dependency and dependent personality disorder do not meet basic scientific standards for effectiveness. The present investigation tested the efficacy of a mindfulness-based approach: mindfulness therapy for maladaptive interpersonal dependency (MT-MID). Forty-eight participants who reported consistently high levels of maladaptive dependency (i.e., scored higher than 1 standard deviation above the mean on the Interpersonal Dependency Inventory at two separate assessments) were randomized to either 5 sessions of MT-MID or a minimal contact control. Five self-reported outcomes (mindfulness, maladaptive interpersonal dependency, helplessness, fears of negative evaluation, and excessive reassurance seeking) were assessed at pretreatment, posttreatment, and a 4-week follow-up. Intent-to-treat analyses indicated that MT-MID yielded greater improvements than the control on all 5 outcomes at posttreatment (median d=1.61) and follow-up (median d=1.51). Participants assigned to MT-MID were more likely than control participants to meet criteria for clinically significant change at posttreatment (56.5% vs. 0%) and follow-up (42.9% vs. 0%). There was also evidence that increases in mindfulness mediated the dependency-related improvements. These results provide preliminary support for the efficacy of a mindfulness-based approach for treating the symptoms of maladaptive dependency. [ABSTRACT FROM AUTHOR]

Patients with personality disorders who did not respond to previous outpatient treatment are among the most challenging patients to treat and are often referred to specialized settings. Acceptance and commitment therapy (ACT) is an innovative therapy that has shown effectiveness in treatment‐resistant cases with chronic or recurrent depression with or without co‐morbid personality disorders. The central role that ACT accords to positive values and experiential avoidance may enhance treatment responsivity in patients with personality disorders that did not respond to previous treatments. The current nonrandomized study explored the effectiveness of a 26‐week ACT‐based group treatment (n = 60) for personality disorders compared to treatment‐as‐usual (n = 21) based on cognitive behaviour therapy (CBT‐TAU) at a specialized setting for patients with personality disorders. Individuals in both treatment conditions demonstrated small to moderate decreases in general psychological functioning and personality pathology. There was no main effect of therapy condition. Overall, results suggest that ACT is a possible treatment option for individuals with difficult‐to‐treat personality pathology and further outcome research is warranted. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Mindfulness-based interventions (MBIs) are at a pivotal point in their future development. Spurred on by an ever-increasing number of studies and breadth of clinical application, the value of such approaches may appear self-evident. We contend, however, that the public health impact of MBIs can be enhanced significantly by situating this work in a broader framework of clinical psychological science. Utilizing the National Institutes of Health stage model (Onken, Carroll, Shoham, Cuthbert, & Riddle, 2014), we map the evidence base for mindfulness-based cognitive therapy and mindfulness-based stress reduction as exemplars of MBIs. From this perspective, we suggest that important gaps in the current evidence base become apparent and, furthermore, that generating more of the same types of studies without addressing such gaps will limit the relevance and reach of these interventions. We offer a set of 7 recommendations that promote an integrated approach to core research questions, enhanced methodological quality of individual studies, and increased logical links among stages of clinical translation in order to increase the potential of MBIs to impact positively the mental health needs of individuals and communities. [ABSTRACT FROM AUTHOR]

Controlled studies on the effectiveness of inpatient psychotherapy with patients with personality disorders (PD) are rare. This study aims to compare 3-month short-term inpatient psychotherapy based on transactional analysis (STIP-TA) with other psychotherapies (OP) up to 36-month follow-up. PD patients treated with STIP-TA were matched with OP patients using the propensity score. The primary outcome measure was general psychiatric symptomatology; secondary outcomes were psychosocial functioning and quality of life. In 67 pairs of patients, both STIP-TA and OP showed large symptomatic and functional improvements. However, STIP-TA patients showed more symptomatic improvement at all time points compared to OP patients. At 36 months, 68% of STIP-TA patients were symptomatically recovered compared to 48% of OP patients. STIP-TA outperformed OP in terms of improvements in general psychiatric symptomatology and quality of life. Superiority of STIP-TA was most pronounced at 12-month follow-up, but remained intact over the course of the 3-year follow-up. [ABSTRACT FROM AUTHOR]

Since the wars in Iraq and Afghanistan began, the U.S. military has sent millions of troops into battlefield operations—some without proper training, some without rigorous preservice mental health checks, and many without experience. Many were given waivers that allowed them to skirt previously rigorous recruiting standards to bolster troop numbers. A significant amount of returning soldiers have been diagnosed with posttraumatic stress disorder (PTSD), and associated benefits and lifelong payouts for these soldiers have and will continue to cost the military hundreds of millions of dollars each year. The military has been accused of purposely changing PTSD diagnoses or instead issuing diagnoses of personality disorders—which the military considers a preexisting condition—for dodging these costs and as a mechanism for forcing soldiers out of service. This article explores how and why these diagnoses, or changes to existing diagnoses, are (allegedly) made, what purpose they serve the military, and the implications of each diagnosis for veterans and active duty soldiers. After reviewing this information, the question of whether or not the military should be ethically responsible for the continued mental health care of those soldiers after service, despite their condition, is addressed. [ABSTRACT FROM PUBLISHER]

Background: Although personality disorders are associated with increased overall mortality, less is known about cause of death and personality type.Aims: To determine causes of mortality in ICD personality disorders.Method: Based on data from Swedish nationwide registers, individuals admitted to hospital with a primary diagnosis of personality disorder between 1987 and 2011 were followed with respect to mortality until 31 December 2011. Standardised mortality ratios (SMRs) with 95% confidence intervals and underlying causes of death were calculated.Results: All-cause SMRs were increased, overall and in all clusters, for natural as well as unnatural causes of death. The overall SMR was 6.1 in women and 5.0 in men, as high as previously reported for anorexia nervosa, with higher rates in cluster B and mixed/other personality disorders. The SMR for suicide was 34.5 in women and 16.0 in men for cluster B disorders. Somatic and psychiatric comorbidity increased SMRs.Conclusions: The SMR was substantially increased for all personality disorder clusters. Thus, there was an increased premature mortality risk for all personality disorders, irrespective of category. [ABSTRACT FROM AUTHOR]

Background: Little is currently known about the presence and impact of personality disorder in adolescents who self-harm.Aims: To evaluate personality disorder in repeated self-harm in adolescence and its impact on self-harm psychopathology and adaptation outcomes over 1 year.Method: A clinical referral sample (n = 366) of adolescents presenting with repeated self-harm aged 12-17 years, as part of a randomised controlled trial (Assessment of Treatment in Suicidal Teenagers study, ASSIST). Personality disorder was assessed using the Structured Clinical Interview for DSM-IV Axis II (SCID-II). One-year outcomes included frequency and severity of repeat self-harm, self-reported suicidality, mood and functional impairment.Results: About 60% of the referred adolescents showed one or more forms of personality disorder. Personality disorder was associated with significantly greater severity of self-harm, overall psychopathology and impairment. There was a complex association with treatment adherence. Personality disorder predicted worse 1-year outcomes in relation to self-harm frequency and severity, as well as impairment, suicidality and depressive symptoms.Conclusions: Personality disorder can be reliably measured in adolescence and showed high prevalence in this clinical self-harm sample. Controlling for other variables, it showed a strong independent association with self-harm severity at referral and predicted adherence to treatment and clinical outcomes (independent of treatment) over 1 year. Consideration of personality disorder diagnosis is indicated in the assessment and management of adolescents who repeatedly self-harm. [ABSTRACT FROM AUTHOR]

Schizoid Personality Disorder (SZPD) is among the most under-researched, difficult to treat of the personality disorders. It is difficult to research and treat clinically because the asocial nature of the condition predisposes the afflicted to avoid professional help and most other social contact. Near-total isolation associated with the Schizoid condition is problematic because it increases risk for mental decompensation, violence, and substance abuse. Most of what is known about this condition comes from psychoanalytic theory, an approach that is rich in the depth of understanding it can apart, though may be insufficient to treat more severe and co-occurring disorder cases that frequent community mental health. With these limitations in mind, a proposed treatment integrates the psychoanalytic-object relations approach with Alcoholics Anonymous principles. The integrated approach is illustrated in the case of Will: An individual with Schizoid personality, long term involvement with Alcoholics Anonymous, and a significant propensity for violence. [ABSTRACT FROM AUTHOR]

Accessible summary One third of people diagnosed with PD do not complete treatment and non-completion is associated with poorer clinical outcomes., Equipping staff to be better able to engage this client group is important, and web-based, self-directed learning is a potentially cost-effective way to train staff., This study examined the implementation of a web-based training programme called Readiness Enhancement Management Strategies (REMS) in three types of service., Completion rates were 94.4% in community health services; 92.3% in prison offender health services; and 46.5% in probation services. Staff found the content of REMS acceptable and useful., This study demonstrated that staff in NHS and criminal justice settings can complete REMS, but staff in probation services are challenged by time pressures and limited computer access. Staff at probation sites were less familiar with PD issues compared with the NHS staff., Abstract A web-based staff training programme called Readiness Enhancement Management Strategies ( REMS) was developed to promote the engagement of people with personality difficulties in treatment. This 'proof of concept' study examined the REMS implementation process, its acceptability and the feasibility of using service data for future evaluation. Staff in six services working with people diagnosed with personality disorder or undiagnosed people with personality difficulties were eligible to participate: two community health services, two prison offender health services and two probation services. Of 92 eligible staff, 74 were available to undertake REMS. These staff completed knowledge and acceptability surveys and rated service user engagement with treatment. The proportion of treatment sessions attended by service users was collected for a 30-week period. REMS completion rates were community - 94.4%, prison - 92.3% and probation - 46.5%. Three quarters of participants rated REMS as 7 out of 10 or higher. All teams were able to provide service data for the study period. REMS can be implemented by National Health Services ( NHS) staff in community and prison settings, but technology issues need to be resolved in probation services. REMS may be useful for NHS staff working with difficult to engage clients, and an evaluation is a feasible prospect. [ABSTRACT FROM AUTHOR]

Art therapy (AT) is frequently used in the treatment of patients diagnosed with cluster B/C personality disorders, but there is little evidence for its efficacy. This study aimed to provide insight into the perceived effects of AT. We interviewed 29 adult patients in individual and focus-group in-depth interviews, including a ‘negative case’, starting with a topic list coming from the literature study. Data were gathered and analysed using the Grounded Theory Approach in order to generate concepts and interrelated categories. The constructed theoretical model of effects of AT consisted of five core categories: improved sensory perception; personal integration; improved emotion/impulse regulation; behaviour change; and insight/comprehension. Compared to verbal therapy (VT), patients experienced AT as an experiential therapeutic entry with a complementary quality next to VT and a more direct way to access emotions, which they attributed to the appeal of art materials and art making to bodily sensations and emotional responses. AT was found to fit well the core problems of patients with personality disorders, to offer a specific pathway to more emotional awareness and constructive emotion regulation. The perceived effects give input for further development and research and the development of an assessment tool to examine the efficacy of AT and within clinical practice. [ABSTRACT FROM AUTHOR]

Cognitive behavior therapy (CBT) has come to be a widely practiced psychotherapy throughout the world. The present article reviews theory, history, and evidence for CBT. It is meant as an effort to summarize the forms and scope of CBT to date for the uninitiated. Elements of CBT such as cognitive therapy, behavior therapy, and so-called 'third wave' CBT, such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT) are covered. The evidence for the efficacy of CBT for various disorders is reviewed, including depression, anxiety disorders, personality disorders, eating disorders, substance abuse, schizophrenia, chronic pain, insomnia, and child/adolescent disorders. The relative efficacy of medication and CBT, or their combination, is also briefly considered. Future directions for research and treatment development are proposed. [ABSTRACT FROM AUTHOR]

Background The study investigated the effectiveness of an Intensive Short-Term Dynamic (ISTDP) residential treatment program for patients with treatment resistant anxiety- and/or depressive disorders, with and without comorbid personality disorders. Method A non-randomized controlled trial examined the effects of an eight week intensive residential treatment program based on principles from ISTDP. Patients ( N =60), who had repeated prior treatment failure for current mental disorder, sufficient dysfunction to warrant hospitalization, and evidencing capacity to take an intrapsychic perspective on own problems, were included. Outcome variables included measures of target complaints (depression/anxiety, social role dysfunction, and interpersonal distress), general symptom distress, and interpersonal functioning. Measures were administered throughout and after treatment. Change was assessed by multilevel growth curve modeling. Changes during and after treatment were compared to those reported by a sub-sample of wait-list controls taking treatment as usual ( N =30). Results The treatment group evidenced significant improvements on all measures. By contrast, receiving treatment as usual while on the wait-list did not yield significant changes. Effect sizes in the treatment group were consistently large at both termination and follow-up. Fourteen months after treatment 50.0% of patients had recovered in terms of target complaints. Approximately 53.3% and 48.3%, respectively, had recovered in terms of general symptom distress and interpersonal functioning. Limitations Limitations included a relatively small sample size, inability to discern the effectiveness of separate components of the treatment program, and lack of randomization of patients to wait-list and treatment. Conclusion ISTDP-based residential treatment with an eight-week time-limit appears to be effective for alleviating common and severe, treatment resistant mental disorders. The treatment program was superior to receiving treatment as usual while on the wait-list. Participation in the program quickly reduced target complaints, symptoms and interpersonal problems for patients who, based on previous treatment experiences, were expected to fare poorly in treatment. Gains were consistently maintained or improved further at follow-up. Results are promising for patients with chronic debilitating problems who often do not profit from traditional psychiatric treatment. [ABSTRACT FROM AUTHOR]

Background: Psychodynamic and cognitive-behavioral group therapies are frequently applied in day hospitals for the treatment of anxiety disorders and comorbid depressive or personality disorders in Poland and other Eastern European countries. Yet there is not enough evidence as to their effectiveness in this environment; this study addresses this gap. The aim of the study is to determine the effectiveness of these two kinds of day treatment care consisting of intensive, short-term group psychodynamic and cognitive-behavioral therapy, for patients with anxiety disorders and/or comorbid depressive or personality disorders. Our objectives are to: 1) show the effectiveness of each treatment in a day-care setting relative to the wait-list control group; 2) demonstrate the relative short- and long-term effectiveness of the two active treatments; 3) carry out a preliminary examination of the predictors and moderators of treatment response; 4) carry out a preliminary examination of the mediators of therapeutic change; and 5) compare the impact of both methods of treatment on the outcome of the measures used in this study. Methods/Design: In this randomized controlled trial, a total of 199 patients with anxiety disorders and comorbid depressive and/or personality disorders will be assigned to one of three conditions: 1) psychodynamic group therapy; 2) cognitive-behavioral group therapy; or 3) wait-list control group. The therapy will last 12 weeks. Both treatments will be manualized (the manuals will address comorbidity). Primary outcome measures will include self-reported symptoms of anxiety, observer-rated symptoms of anxiety, global improvement, and recovery rate. Secondary outcome measures will include the number of pathological personality traits, depression, self-esteem, defense mechanisms, beliefs about self and others, interpersonal problems, object relations, parental bonding, meta-cognition, and quality of life. Measures will be taken at baseline, post-treatment, and at six months following the end of therapy. Discussion: The rationale is to investigate how effectively anxiety disorders and/or comorbid depressive or personality disorders can be treated in a day hospital setting, typical of the Polish health care system, during a three-month treatment period. [ABSTRACT FROM AUTHOR]

Following over a decade of treatment refusal by 'risky' offenders preventively detained in Dangerous and Severe Personality Disorder hospital and prison units, the coalition government now aims to improve treatment engagement in high secure prisons by clarifying pathways out of detention. This article asks whether the reconfiguration will end reliance upon preventive detention for public protection. Drawing on original empirical data collected by the author, it is argued that the government is unaware that offenders with 'severe personality disorder' appear to engage with treatment only if it increases their chances of achieving expedited parole. Hitherto, this incentive was provided by the Indeterminate Sentence for Public Protection; its replacement with determinate sentences under the Legal Aid, Sentencing and Punishment of Offenders Act 2012 will worsen treatment engagement, because they provide offenders with a prison release date. The troubling result may be increased reliance by the Secretary of State for Justice on his inherent jurisdiction under the Mental Health Act 1983 to transfer offenders due for prison release to secure psychiatric hospitals. To counter this limitation of riskfocused decision-making, it is proposed that judges be able to impose a new hybrid order combining a custodial term with a subsequent community mental health treatment requirement. [ABSTRACT FROM AUTHOR]

Treatment of personality disorders (PDs) in older adults is a highly underexplored topic. In this article clinical applicability of the findings from a recent Delphi study regarding treatment aspects of PDs in older adults is explored. This concerns the relevance of three psychotherapeutic treatment levels for PDs in later life: (a) personality-changing treatment, (b) adaptation-enhancing treatment, and (c) supportive-structuring treatment. By means of three cases concerning the three levels, all from a cognitive behavioral perspective, namely (a) schema therapy, (b) cognitive behavioral therapy, and (c) behavioral therapy, we illustrate the usefulness of the different levels in the selection of treatment for older adults with PDs. Throughout all treatment levels, attention to specific age-related psychotherapeutic topics—such as loss of health and autonomy, cohort beliefs, sociocultural context, beliefs about and consequences of somatic comorbidity, intergenerational linkages, and changing life perspectives—is crucial, as they often cause an exacerbation of personality pathology in later life. Suggestions as to how to adapt existing treatments within a cognitive behavioral framework in order to better mold them to the needs and experiences of older adults with PDs are discussed. [ABSTRACT FROM PUBLISHER]