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The possibility of using dissociation to identify mental health service users with more psychosocial intervention needs: rationale and preliminary evidence
- Authors:
- FUNG Hong Wang, ROSS Colin A., CHUNG Hei Man
- Journal article citation:
- Social Work in Mental Health, 18(6), 2020, pp.623-633.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The ability to predict which groups of mental health service users are more likely to require psychosocial care could facilitate intervention planning and optimize the utilization of resources. Dissociation may be a transdiagnostic indicator of psychosocial intervention needs because dissociation is theoretically and empirically associated with psychosocial adversities. This paper explains why that may be the case. We investigated the association of somatoform dissociation with indicators of psychosocial intervention needs (e.g., childhood trauma, poor family well-being, psychosocial-related symptoms) in a convenience sample of mental health service users (N = 111). The preliminary evidence supports the idea that dissociation is a transdiagnostic indicator of psychosocial intervention needs. Dissociation should be regularly assessed in mental health settings because it may help social workers and other psychosocial service providers identify service users who may especially need psychosocial care when there is a lack of resources. Further studies and discussions are needed. (Edited publisher abstract)
The new alternative DSM-5 Model for Personality Disorders: issues and controversies
- Author:
- PORTER Jeffrey S.
- Journal article citation:
- Research on Social Work Practice, 24(1), 2014, pp.50-56.
- Publisher:
- Sage
Purpose: Assess the new alternative Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) model for personality disorders (PDs) as it is seen by its creators and critics. Method: Follow the DSM revision process by monitoring the American Psychiatric Association website and the publication of pertinent journal articles. Results: The DSM-5 PD Work Group’s proposal was not included in the main diagnostic section of the new DSM, but it was published in the section devoted to emerging models. The alternative DSM-5 PD constructs are radically different from those found in DSM, fourth edition, text revision. Discussion: There are some positive conceptual changes in the new model, but reliability and validity are not generally improved. However, social workers may be able to benefit from the use of the personality trait domains/facets of the alternative model. (Publisher abstract)
Toward the integration of neuroscience and clinical social work
- Author:
- MONTGOMERY Arlene
- Journal article citation:
- Journal of Social Work Practice, 27(3), 2013, pp.333-339.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This article reviews recent findings in neuroscience in light of the history of social work, the scientific support for clinical social work interventions, and the challenges of integrating neuroscience into academic and practice settings. Illustrations of several critical neurophysiological underpinnings of important clinical phenomena are described, including disorders of personality, defence mechanisms, attachment styles, and the close relationship between ego functions and right hemisphere functions. (Edited publisher abstract)
DSM-5 and the general definition of personality disorder
- Author:
- WAKEFIELD Jerome C.
- Journal article citation:
- Clinical Social Work Journal, 41(2), 2013, pp.168-183.
- Publisher:
- Springer
- Place of publication:
- New York
There is a fundamental change proposed for DSM-5 in the general definition of personality disorder, representing a new conceptualisation that shapes how the DSM distinguishes personality pathology from other undesirable or negative personality features. The change is needed due to serious deficiencies in the current DSM-IV approach. Specifically, personality disorder is to be conceptualised as impairment in both self organisation and interpersonal relating, caused by pathological (extreme) personality traits. This represents progress in that marked impairment in self organisation and interpersonal relating are plausibly characteristic of personality disorder. However, the required level of impairment remains too low, and the kinds of impairment are not restricted to those which indicate disorder versus culturally undesirable features. Moreover, extreme traits are neither necessary nor sufficient for personality disorder because personality represents not the sum of traits but the holistic organisation of traits and other meanings. The DSM-5’s diagnostic focus on traits thus potentially opens the way to massive false positive diagnoses. An earlier proposal to reframe personality disorders using global similarity matching of the patient’s condition to prototypical descriptions of specific personality disorders is argued to also lead toward less valid diagnoses. (Publisher abstract)
Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis
- Authors:
- LEICHSENRING Falk, RABUNG Sven
- Journal article citation:
- British Journal of Psychiatry, 199(1), July 2011, pp.15-22.
- Publisher:
- Cambridge University Press
Psychodynamic psychotherapy is an umbrella concept encompassing treatments that include supportive-interpretive psychotherapeutic interventions. This meta-analysis focused on its use in complex mental disorders (defined as personality disorders, chronic mental disorders or multiple mental disorders). A literature search was used to identify relevant studies, and 10 controlled trial studies were identified as meeting the inclusion criteria, including psychodynamic psychotherapy lasting for at least one year or 50 sessions. The article discusses the analysis of the studies, including comparison of the effects of long-term psychodynamic psychotherapy with other forms of psychotherapy. The authors conclude that the analysis showed that long-term psychodynamic psychotherapy was superior to less intensive methods of psychotherapy in complex mental disorders, and that there were positive correlations between outcome and duration of therapy. They note that further research on long-term psychotherapy is needed.
Revisiting the structure of mental disorders: borderline personality disorder and the internalizing/externalizing spectra
- Authors:
- JAMES Lisa M., TAYLOR Jeanette
- Journal article citation:
- British Journal of Clinical Psychology, 47(4), November 2008, pp.361-380.
- Publisher:
- Wiley
Researchers have turned to dimensional models of psychopathology as a means of explaining robust patterns of comorbidity. A hierarchical model consisting of internalizing and externalizing dimensions has been a useful approach to understanding comorbidity among some mental disorders, although a limited number of disorders have been examined within this framework. The objective of the present study is to determine how borderline personality disorder fits into this framework. The dimensional measures of nine psychiatric disorders were used in a confirmatory factors analysis to compare five models of comorbidity in 1,197 members (N=541 women) of a population-based sample. Symptom composites were derived from the Michigan Composite International Diagnostic Interview and the International Personality Disorders Examination Questionnaire. Five models were fit to dimensional indicators of nine disorders. A model in which borderline personality disorder served as a multidimensional indicator of the externalizing factor and the anxious-misery subfactor of internalizing disorders provided the best fit to the data in the whole sample and in men. For women, this model also fit well but an alternative model in which borderline personality disorder served only as an indicator of the anxious-misery subfactor of internalizing disorders fit equally well.
Alexander Goldfeder Mezey
- Author:
- RUSSELL Gerald
- Journal article citation:
- Psychiatric Bulletin, 32(10), October 2008, pp.397-398.
- Publisher:
- Royal College of Psychiatrists
Alex Mezey's magnum opus was his book on the psychopathology of creativity – Muse in Torment. In this book he reviewed a huge number of poets and novelists writing in the all the main European languages. The aim of Muse in Torment was to demonstrate the continuity between the psychology of the author and his creation. His method was to provide a series of short but captivating biographies in which he revives the stories of the lives of writers and intertwines them with their main works. Alex related the experiences of writers whose lives were afflicted with mental illness, but he went well beyond this, drawing attention to their unusual personality traits and personalities. Although it is sometimes said that the writer’s personality should not obtrude into his work, Alex examined how unusual personality traits influenced the choice of subject matter. Thus, the work may betray the writer’s motives whether they be those of the confessional or in order to draw attention to himself. When discussing the roots of the writer’s creativity, Alex examined parental influence, especially in the case of writers who lost their parents in childhood. He identified the strange paradox of a writer whose life of dissipation, or disordered conduct, is not incompatible with refinements of artistic creation. He summarised his final conclusion by stating that mental distress or illness influences the what and when of creative writing. Knowing about the writer’s mental life can enrich our understanding and appreciation of his work.
Developmental trajectories associated with juvenile sexually abusive behaviour and emerging severe personality disorder in childhood: 3 – year study
- Authors:
- VIZARD Eileen, HICKEY Nicole, MCCRORY Eamon
- Journal article citation:
- British Journal of Psychiatry, 190(Supplement 49), May 2007, pp.s27-s32.
- Publisher:
- Cambridge University Press
Little is known about the developmental trajectories of juveniles presenting with sexually abusive behaviour or emerging severe personality disorder traits. The aim was to investigate whether `age at onset' of sexually abusive behaviour and whether emerging severe personality disorder traits are associated with specific developmental profiles. A retrospective file review of 280 juveniles presenting with sexually abusive behaviour was conducted and follow-up Offenders Index data were analysed. Juveniles with early onset (less than 11 years) of sexually abusive behaviour had higher levels of psychosocial adversity and early childhood antisocial behaviour compared with those with late onset. Emerging severe personality disorder traits were associated with higher levels of psychosocial adversity, antisocial behaviour, convictions and predatory sexually abusive behaviour. Preliminary evidence supports the existence of distinct developmental trajectories within this population and points to a key role for traits of emerging severe personality disorder.
Voices beyond the border
- Editors:
- ROBINSON Lucy, COX Vicky (eds.)
- Publisher:
- Chipmunkapublishing
- Publication year:
- 2006
- Pagination:
- 194p.
- Place of publication:
- Brentwood
In the UK today approximately 1.6 million people awoke to the same problem (that's if they'd managed to sleep) - how to survive another day alongside the torrid and turbulent emotions associated with Borderline Personality Disorder (BPD). Although you'd struggle to find a room big enough to house them all at once, it's not a 'popular' mental health problem and has received little publicity. The fact that you've heard of it at all probably means you have it or somebody close at hand does. In the immense isolating pain and confusion that BPD can bring with it, this book is here to remind you that you are not alone - there are at least 1,599,999 others who feel their own personal version of your suffering. This unique anthology brings you some of their voices. The included poetry and prose features not only pieces by people with BPD, but also the viewpoint of carers and treatment providers. This book won't teach you the facts and figures about BPD or the latest theories as to what causes or treats it, but it will provide the aspect of BPD that is almost always missed - how it feels.
Assessing adolescent personality pathology
- Authors:
- WESTEN Drew, DUTRA Lissa, SHEDLER Jonathan
- Journal article citation:
- British Journal of Psychiatry, 186(3), March 2005, pp.227-238.
- Publisher:
- Cambridge University Press
Personality pathology constitutes a major form of psychopathology in adolescents. This study aimed to examine the reliability and validity of a Q-sort instrument for assessing adolescent personality pathology designed for clinically experienced informants. A sample of 294 randomly selected psychiatrists and psychologists each provided data on a current patient aged 14-18. Clinicians completed several measures, including the Shedler-Westen Assessment Procedure for Adolescents (SWAP-200-A). Factor analysis identified 11 dimensions of adolescent personality: psychopathology/malignant narcissism, dysphoria/inhibition, psychological health, histrionic sexualisation, schizotypy, sexual conflict, emotional dysregulation, anxious obsessionality, peer rejection, delinquent behaviour and attentional dysregulation. These correlated in predicted ways with a range of criterion variables, including measures of adaptive functioning, Axis II pathology, the Five Factor Model and the Child Behavior Checklist. The SWAP-200-A shows promise as an instrument for assessing personality pathology in adolescents. Trait dimensions such as delinquent behaviour and emotional dysregulation may prove useful additions to a classification of personality.