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Notes on the potential differentiation of borderline conditions.

It is argued that the borderline personality organization as now conceived embraces a spectrum of differentiable diagnostic groupings. Lumping these diagnostic clusters under a single descriptive heading contributes to continuing conceptual ambiguities and theoretical confusion in the understanding of borderline psychopathology. A potential differentiation of borderline entities on clinical grounds is suggested. The bases for discrimination of higher-order borderline conditions versus lower-order conditions are explored. Current accounts of borderline pathology tend to focus on lower-order pathology as characteristic, but do not account for the full range of the borderline spectrum. Other potential discriminations between an hysterical continuum and an obsessional-schizoid continuum are explored. Differential diagnoses suggested include pseudoschizophrenia, psychotic character, borderline personality, and primitive hysteric in the hysterical continuum; schizoid personality, false-self organization, and as-if personality in the schizoid continuum. The syndrome of identity diffusion is also suggested as part of the borderline spectrum.

Borderline Personality Disorder↗

A clinical study of violence in patients referred on a Form I to a general hospital psychiatric unit.

A retrospective examination of all patients referred by the emergency department of a medium sized general hospital for a mandated Form I psychiatric assessment during a 12 month period was conducted. The principal aim was an analysis of the clinical phenomena and especially the antecedents and course of violent behaviour (following admission and throughout the hospital stay) which in the majority of cases was the reason for the referral. Thirty percent had behaved violently prior to admission but within 24 hours all had settled and during the remainder of their hospital stay were indistinguishable from the generality of the ward population (for example, non-violent). Two-thirds of the patients were non-psychotic; that is, not suffering from a major mental illness; nevertheless, they required a disproportionate amount of time and effort in initial management. A high proportion had several prior admissions to the psychiatric ward, particularly for alcohol misuse and/or a personality disorder.

Adolescent↗

Clinical aspects of hysteria.

This is a clinical study of 80 patients, diagnosed as suffering from hysteria, who attended the psychiatric clinic in Khartoum Hospital over a period of 3 years. The incidence of hysteria was 10%, the female-male ratio 15:1, and young age-groups predominate. 60% were essentially of normal personality. The clinical picture was fairly consistent. Hysterical conversion was the commonest clinical form (76%) and the dissociative type was rare. The patients with recurrent and vague bodily complaints could be labeled as histrionic.

Adolescent↗

The terrorist mind: II. Typologies, psychopathologies, and practical guidelines for investigation.

Part I of this two-part article presents a psychological and political analysis of the terrorist mind. Part II describes the major current psychological classifications and typologies of domestic and foreign terrorism. Explanations are offered in terms of our current understanding of the personality and psychopathology of terroristic violence. A heuristic model of classifying terrorism in terms of personality and psychopathology is presented. In addition to guiding further research and theory on the psychology of terrorism, this model has immediate practical application to the investigation and interrogation of terrorist suspects.

Antisocial Personality Disorder↗

An approach to the study of analyzability and analyses: the course of forty consecutive cases selected for supervised analysis.

The cases of 40 consecutive patients, accepted for supervised psychoanalysis at the Treatment Center of The New York Psychoanalytic Institute, are reviewed. The process of the initial evaluation is examined as well as the nature of the patient group, the characteristics of the treatment, outcome, and follow-up data. A survey of a group of 42 patients from the private practice of a group of graduate analysts during the same period of time is also reported. Both studies are discussed in relation to methodological issues, and an approach is suggested for the study of assessment of analyzability and analyses through a systematic prospective study of analytic treatments conducted by experienced analysts.

Academies and Institutes↗

[Phenomenon of visualized images in children and adolescents].

The authors examined clinically and psychopathologically, and followed up 39 children and adolescents with various borderline nervous and psychic disorders in whom a super-worship fantasy or other psychic formations were accompanied with visualized imagination that consisted in fancying bright, sensual images localized within the patient's subjective space and having a dynamic subject character corresponding to the fantasies and other experiences subjectively important for the patient. The visualized imagination is regarded as an independent productive-dysontogenetic syndrome.

Adolescent↗

Dimensions of personality disorder. The DSM-III-R cluster B diagnoses.

This study describes a psychometric approach to refining descriptions of antisocial, borderline, histrionic, and narcissistic personality disorders in an attempt to achieve greater distinctiveness. We developed descriptions of each diagnosis from content analysis of the literature. Psychiatrists' ratings were used to organize the features of each diagnosis into a set of carefully defined behavioral dimensions. Self-report scales were developed to assess each dimension. Scales were administered to a general population sample (N = 274) and a sample of patients with a primary diagnosis of personality disorder (N = 133). Scales demonstrated satisfactory levels of internal consistency. Some dimensions showed a low correlation with other dimensions defining the same diagnosis. These dimensions could be eliminated without affecting reliability. The structure underlying the dimensions delineating each diagnosis was evaluated using factor analysis. For each diagnosis, the structure was highly similar in the two samples. Based on these results, specific proposals are made for redefining diagnoses.

Adult↗

Conversion hysteria.

Conversion hysteria differs from hysteria in that it arises suddenly, rather than being a lifelong disorder. It is monosymptomatic rather than polysymptomatic, and is seen in men almost as frequently as in women. La belle indifférence, when present, is a useful clue to diagnosis. Other clues are ambiguity in reporting of the symptoms, medically inconsistent symptoms and hysterical personality features. Treatment may include removing the patient from a stressful environment and removing the "payoff" yielded by the illness. A confrontation with the patient is generally to be avoided.

Affect↗

Racial and sexual bias in psychiatric diagnosis: psychiatrists and other mental health professionals compared by race, sex, and discipline.

In a study designed to test for sex- and race-related bias in psychiatric diagnosis, the responses of 173 mental health professionals to four hypothetical patient profiles were analyzed. Minimal racial bias was observed. In some instances, therapists appeared more likely to make judgments biased against patients who were of the same race and sex as themselves. The results support the contention that hysterical and antisocial personality disorders are sex-biased diagnoses. The race of the therapist strongly influenced diagnosis. It is argued that this finding reflects resistance of nonwhite therapists to a majority-group-dominated diagnostic theory. Professional discipline rarely affected diagnosis with the exception that psychiatrists were more prone to diagnose psychosis.

Adult↗

Female genital self-mutilation, dysorexia and the hysterical personality: the Caenis Syndrome.

A detailed case report of female genital self-mutilation associated with dysorexia and the hysterical personality is presented. This lends support to recent literature that has suggested the possibility that these clinical features may comprise a discrete syndrome. The usefulness of considering this triad as a syndrome is illustrated by its facilitating the recall of two previous patients who in retrospect appear to fulfil these criteria. It is suggested that the name Caenis syndrome be given to this triad of behaviour.

Adult↗

Hysterical personality: an appraisal in light of empirical research.

An overview of the term hysterical personality is presented and existing measures of this construct are described. Statistical studies of hysterical personality are then reviewed, emphasizing the extent to which they support theory, clinical observation, description, and prediction. Evidence is still needed to bolster claims of empirical validity and it remains an open question whether hysterical personality should be viewed as a legitimate concept in its own right or as a form of extraversion. Empirical data are also needed on etiological determinants, psychological correlates, and response to experimental manipulations. However, empirically based findings to date indicate that a premorbid hysterical personality is not a necessary or sufficient factor in the development of conversion reactions. It is concluded that relative to other well known personality types there has been only a modest amount of empirical research on hysterical personality. Suggestions for future research directions are made.

Adolescent↗

Morbidity risk for mood disorders in the families of borderline patients.

We analyzed the familial morbidity risk for mood disorders (MR) and the presence of a family history of alcoholism in a group of 58 patients with DSM-III borderline personality disorder (PD). The MR in the families of borderline subjects was not significantly different from that found in a control group of affective patients with other cluster II PD, or without PD. The MR in the families of borderline subjects who had never developed an affective episode was not significantly different from that found in the families of borderline PD with a history of mood disorders. Borderline subjects with mood disorders had higher rates of alcoholism in their families, mainly among parents. Our results support the hypothesis that borderline PD, even in absence of the codiagnosis of a mood disorder in the subject, may be a predictor of higher familial liability to mood disorders, although it may be more informative for the familial clustering of specific subgroups than for mood disorders as a whole.

Adult↗