Diagnosing borderline personality disorder : examination of how clinical indicators are used by professionals in the health setting

This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline personality disorder. The current study examines how clinical indicators used to screen for this complex disorder differ across service settings, professions, specialised training and years of clinical experience. A purpose-designed survey was administered to 108 mental and emergency medicine health practitioners across an Australian health service and a New Zealand health service to record the level of significance placed on different clinical indicators in the application of the diagnosis of borderline personality disorder. A heavy reliance was placed on observable behavioural symptoms, such as self-mutilation and impulsive behaviours that are self-damaging, in the screening of borderline personality disorder as a psychiatric diagnosis. Statistically significant differences were found between emergency medical staff and mental health clinicians in their use of diagnostic indicators of borderline personality disorder, χ²(4) = 17.248, p = .002. Implications of these findings for the screening, assessment and diagnosis of patients with borderline personality disorder are discussed.

A clarification of the ERI model : the importance of personality

The present study aimed to investigate the role of personality in the etfort-reward imbalance model along with the construct validity of overcommitment in relation to Type A behaviour. The study sample consisted of 898 operational law enforcement persolllel from a large Australian police service. Factor analysis revealed that the overcommitment construct was psychologically related to, but distinct from, the Type A dimensions achievement striving, impatience-irritability and hostility despite the hypothesised interrelatedness of the measures. Multiple regression analyses including tests for curvilinear effects revealed that the Type A dimensions made a significant improvement to the prediction of employee wellbeing and job satisfaction, The results of the study provide theoretical implications in terms of the augmentation of the effort-reward imbalance model.

Quantum bioenergetics, mental boundaries and affective response : a randomized placebo-controlled pilot study

Previous research has demonstrated the effects of ostensible subtle energy on physical systems and subjective experience. However, one subtle energy technique that has been neglected by previous studies, despite anecdotal support for its efficacy, is Quantum BioEnergetics (QBE). Furthermore, personality traits that influence subtle energy effects remain unclear, and previous experimental studies have not investigated the constructs of Love and Joy, despite qualitative and anecdotal reports indicating that these variants of positive affect are essential elements of the subtle energy experience. The aim of the present study was to investigate experimentally the effects of QBE, and the personality trait Mental Boundaries, on positive and negative affect. Participants (N = 69) were administered the Boundary Questionnaire Short Form to quantify Boundaries, and then randomly assigned to one of three conditions: QBE, Placebo ("sham"), or Control. Affect was retrospectively assessed using the Positive and Negative Affect subdimensions of the Phenomenology of Consciousness Inventory (PCI). As predicted, a significant multivariate effect for condition was found with regards to the PCI subdimensions: Joy, Sexual Excitement, Love, Anger, Sadness, and Fear. In contrast to our expectations, a significant multivariate effect was not found for Boundaries with regards to the combined PCI-Affect variables. As hypothesized, significant interactions were found between condition and Boundaries with regards to Positive Affect, Love and Joy, with the QBE/Thin Boundaries factorial combination associated with the highest mean scores for these dependent variables. It will be prudent to ascertain whether these results are replicated in a larger sample and a placebo condition that improves on the standard randomized placebocontrolled protocols of previous subtle energy research.

Personality change and personality disorder : some initial thoughts on the application of McAdams' triarchic model to the treatment of personality disorder

It is increasingly accepted that psychological therapies have an important role to play in the management and treatment of those who are considered to have disorders of personality, particularly those with forensic histories. Whilst there appears to be an emerging evidence base supporting the effectiveness of treatment for this group, there have been relatively few attempts to link treatment approaches to current models of normal personality. In this paper we use McAdams' (1994) triarchic model of personality as a basis for understanding the effective treatment of personality disorders. We conclude that the model may be useful in assisting clinicians to engage patients in treatment, identify innovative methods of intervention, and conceptualise therapeutic progress.

Readiness for treatment in high risk offenders with personality disorders

Low engagement and non-completion of therapeutic interventions are important issues in the treatment and rehabilitation of offenders and mentally disordered offenders. Such factors influence a range of outcomes, including the reduction of clinical and criminogenic needs. In this paper it is proposed that low engagement and non-completion are usefully viewed as a consequence of low readiness for treatment. The dimensions of readiness are summarized (from the Multifactor Offender Readiness Model) and applied to high risk offenders with severe personality disorders. A readiness analysis has implications for the assessment and treatment of this patient/offender population and is useful in identifying future research and clinical priorities.

Personality : social issues and personal growth

In this chapter, we will look at the application of personality to social problems and personal growth.  we have chosen two examples of social problems, anger (and aggression) and crime, to illustrate areas where personality has had an impact.

Borderline personality disorder - an overview for emergency clinicians

The diagnosis of borderline personality disorder frequently underlies self-harm and suicidal presentations to the emergency department. Borderline pathology combined with high levels of comorbidity, stigma, and treatment uncertainty, increase the challenges of caring for someone with this diagnosis in an emergency setting. Attributes such as black-and-white thinking and splitting may compromise an already precarious situation. The maintenance of safety requires prioritisation and necessitates a practical and respectful approach, which avoids notions of attention-seeking behaviour. Clinical assessment should distinguish between self-harm and suicide attempts where possible and take into account acute on chronic risk. The emergency clinician will need to consider the degree of containment required in the emergency department and is encouraged to maintain transparency and honesty with the client regarding treatment decisions. If hospitalisation needs to be considered, clinicians should take into account immediate therapeutic benefit versus the counter-therapeutic risk of dependency and regression. Overall, it is reasonable for clinicians to aim for clients to return to their pre-crisis level of functioning, and beneficial for clinicians to approach this client group with therapeutic optimism.

Crisis and triage clinicians' attitudes toward working with people with personality disorder

PURPOSE. This study aimed to investigate the attitudes of Australian psychiatric triage and crisis clinicians toward those with a diagnosis of personality disorder.
DESIGN AND METHODS. The design of the study was exploratory descriptive research. The study employed a survey method using Bowers and Allan's (2006) Attitude to Personality Disorder Questionnaire, which was designed to identify global attitudes toward those with a diagnosis of personality disorder.
FINDINGS. The findings of this study indicate that psychiatric crisis and triage clinicians hold negative attitudes toward those with a diagnosis of personality disorder.
PRACTICE IMPLICATIONS. Education and clinical supervision is required to address negative clinician attitudes.

Modified life cycle inventory of aluminium die casting

Aluminium die casting is a process used to transform molten aluminium material into automotive gearbox housings, wheels and electronic components, among many other uses. It is used because it is a very efficient method of achieving near net shape with the required mechanical properties. Life Cycle Assessment (LCA) is a technique used to determine the environmental impacts of a product or process. The Life Cycle Inventory (LCI) is the initial phase of an LCA and describes which emissions will occur and which raw materials are used during the life of a product or during a process. This study has improved the LCI technique by adding in manufacturing and other costs to the ISO standardised methods. Although this is not new, the novel application and allocation methods have been developed independently. The improved technique has then been applied to Aluminium High Pressure Die Casting. In applying the improved LCI to this process, the cost in monetary terms and environmental emissions have been determined for a particular component manufactured by this process. A model has been developed in association with an industry partner so this technique can be repeatedly applied and used in the prediction of costs and emissions. This has been tested with two different products. Following this, specialised LCA software modelling of the aluminium high pressure die casting process was conducted. The variations in the process have shown that each particular component will have different costs and emissions and it is not possible to generalise the process by modelling only one component. This study has concentrated on one process within die casting but the techniques developed can be used across any variations in the die casting process.

Using input-output data in life cycle inventory analysis

The impacts on the environment from human activities are of increasing concern. The need to consider the reduction in energy consumption is of particular interest, especially in the construction and operation of buildings, which accounts for between 30 and 40% of Australia's national energy consumption. Much past and more recent emphasis has been placed on methods for reducing the energy consumed in the operation of buildings. With the energy embodied in these buildings having been shown to account for an equally large proportion of a building's life cycle energy consumption, there is a need to look at ways of reducing the embodied energy of buildings and related products. Life cycle assessment (LCA) is considered to be the most appropriate tool for assessing the life cycle energy consumption of buildings and their products. The life cycle inventory analysis (LCIA) step of a LCA, where an inventory of material and energy inputs is gathered, may currently suffer from several limitations, mainly concerned with the use of incomplete and unreliable data sources and LCIA methods. These traditional methods of LCIA include process-based and input-output-based LCIA. Process-based LCIA uses process specific data, whilst input-output-based LCIA uses data produced from an analysis of the flow of goods and services between sectors of the Australian economy, also known as input-output data. With the incompleteness and unreliability of these two respective methods in mind, hybrid LCIA methods have been developed to minimise the errors associated with traditional LCIA methods, combining both process and input-output data. Hybrid LCIA methods based on process data have shown to be incomplete. Hybrid LCIA methods based on input-output data involve substituting available process data into the input-output model minimising the errors associated with process-based hybrid LCIA methods. However, until now, this LCIA method had not been tested for its level of completeness and reliability. The aim of this study was to assess the reliability and completeness of hybrid life cycle inventory analysis, as applied to the Australian construction industry. A range of case studies were selected in order to apply the input-output-based hybrid LCIA method and evaluate the subsequent results as obtained from each case study. These case studies included buildings: two commercial office buildings, two residential buildings, a recreational building; and building related products: a solar hot water system, a building integrated photovoltaic system and a washing machine. The range of building types and products selected assisted in testing the input-output-based hybrid LCIA method for its applicability across a wide range of product types. The input-output-based hybrid LCIA method was applied to each of the selected case studies in order to obtain their respective embodied energy results. These results were then evaluated with the use of a number of evaluation methods. These evaluation methods included an analysis of the difference between the process-based and input-output-based hybrid LCIA results as an evaluation of the completeness of the process-based LCIA method. The second method of evaluation used was a comparison between equivalent process and input-output values used in the input-output-based hybrid LCIA method as a measure of reliability. It was found that the results from a typical process-based LCIA and process-based hybrid LCIA have a large gap when compared to input-output-based hybrid LCIA results (up to 80%). This gap has shown that the currently available quantity of process data in Australia is insufficient. The comparison between equivalent process-based and input-output-based LCIA values showed that the input-output data does not provide a reliable representation of the equivalent process values, for material energy intensities, material inputs and whole products. Therefore, the use of input-output data to account for inadequate or missing process data is not reliable. However, as there is currently no other method for filling the gaps in traditional process-based LCIA, and as input-output data is considered to be more complete than process data, and the errors may be somewhat lower, using input-output data to fill the gaps in traditional process-based LCIA appears to be better than not using any data at all. The input-output-based hybrid LCIA method evaluated in this study has shown to be the most sophisticated and complete currently available LCIA method for assessing the environmental impacts associated with buildings and building related products. This finding is significant as the construction and operation of buildings accounts for a large proportion of national energy consumption. The use of the input-output-based hybrid LCIA method for products other than those related to the Australian construction industry may be appropriate, especially if the material inputs of the product being assessed are similar to those typically used in the construction industry. The input-output-based hybrid LCIA method has been used to correct some of the errors and limitations associated with previous LCIA methods, without the introduction of any new errors. Improvements in current input-output models are also needed, particularly to account for the inclusion of capital equipment inputs (i.e. the energy required to manufacture the machinery and other equipment used in the production of building materials, products etc.). Although further improvements in the quantity of currently available process data are also needed, this study has shown that with the current available embodied energy data for LCIA, the input-output-based hybrid LCIA appears to provide the most reliable and complete method for use in assessing the environmental impacts of the Australian construction industry.