Motive-Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder: A Case Study

Motive-oriented therapeutic relationship (MOTHER), a prescriptive concept based on an integrative form of case formulation, the Plan Analysis (PA) method (Caspar, in: Eells (ed.), Handbook of psychotherapy case formulations, 2007), has shown to be of particular relevance for the treatment of patients presenting with personality disorders, in particular contributing to better therapeutic outcome and to a more constructive development of the therapeutic alliance over time (Kramer et al., J Nerv Ment Dis 199:244–250, 2011). Several therapy models refer to MOTHER as intervention principle with regard to borderline and Narcissistic Personality Disorder (NPD) (Sachse et al., Clarification-oriented psychotherapy of narcissistic personality disorder, 2011; Caspar and Berger, in: Dulz et al. (eds.), Handbuch der Borderline-Störungen, 2011). The present case study discusses the case of Mark, a 40-year-old patient presenting with NPD, along with anxious, depressive and anger problems. This patient underwent a seven-session long pre-therapy process, based on psychiatric and psychotherapeutic principles complemented with PA and MOTHER, in preparation for further treatment. MOTHER will be illustrated with patient–therapist verbatim from session 4 and the links between MOTHER and confrontation techniques will be discussed in the context of process-outcome hypotheses, in particular the effect of MOTHER on symptom reduction.

Personality disorders in the community: Results from the Australian National Survey of Mental Health and Well-Being Part III - Relationships between specific type of personality disorder, Axis 1 mental disorders and physical conditions with disability and health consultations

Background The aims of this study were threefold. First, to ascertain whether personality disorder (PD) was a significant predictor of disability (as measured in a variety of ways) over and above that contributed by Axis I mental disorders and physical conditions. Second, whether the number of PD diagnoses given to an individual resulted in increasing severity of disability, and third, whether PD was a significant predictor of health and mental health consultations with GPs, psychiatrists, and psychologists, respectively, over the last 12 months. Method Data were obtained from the National Survey of Mental Health and Wellbeing, conducted between May and August 1997. A stratified random sample of households was generated, from which all those aged 18 and over were considered potential interviewees. There were 10 641 respondents to the survey, and this represented a response rate of 78%. Each interviewee was asked questions indexing specific ICD-10 PD criteria. Results Five measures of disability were examined. It was found that PD was a significant predictor of disability once Axis I and physical conditions were taken into account for four of the five disability measures. For three of the dichotomously-scored disability measures, odds ratios ranged from 1.88 to 6.32 for PD, whilst for the dimensionally-scored Mental Summary Subscale of the SF-12, a beta weight of -0.17 was recorded for PD. As regards number of PDs having a quasi-linear relationship to disability, there was some indication of this on the SF-12 Mental Summary Subscale and the two role functioning measures, and less so on the other two measures. As regards mental consultations, PD was a predictor of visits to GPs, psychiatrists and psychologists, over and above Axis I disorders and physical conditions. Conclusion The study reports findings from a nationwide survey conducted within Australia and as such the data are less influenced by the selection and setting bias inherent in other germane studies. However, it does support previous findings that PD is a significant predictor of disability and mental health consultations independent of Axis I disorders and physical conditions.

Historical Roots of Histrionic Personality Disorder

Histrionic Personality Disorder is one of the most ambiguous diagnostic categories in psychiatry. Hysteria is a classical term that includes a wide variety of psychopathological states. Ancient Egyptians and Greeks blamed a displaced womb, for many women's afflictions. Several researchers from the 18th and 19th centuries studied this theme, namely, Charcot who defined hysteria as a "neurosis" with an organic basis and Sigmund Freud who redefined "neurosis" as a re-experience of past psychological trauma. Histrionic personality disorder (HPD) made its first official appearance in the Diagnostic and Statistical Manual of Mental Disorders II (DSM-II) and since the DSM-III, HPD is the only disorder that kept the term derived from the old concept of hysteria. The subject of hysteria has reflected positions about health, religion and relationships between the sexes in the last 4000 years, and the discussion is likely to continue.

Personality Disorder: A Diagnosis for Inclusion - The Northern Ireland Personality Disorder Strategy - The Way Forward - June 2010

Personality Disorder: A Diagnosis for Inclusion - The Northern Ireland Personality Disorder Strategy - The Way Forward - June 2010

Assimilation process in a psychotherapy with a client presenting schizoid personality disorder

The assimilation of problematic experiences has been studied as change processes in psychotherapies of different client populations. Several theory-building case studies using the assimilation model have shown how important a meaning bridge is in such change processes. In a client presenting schizoid personality disorder the creation of meaning as an affect-evoking process may be a particularly important stage in the change process. The present case study aims to apply the assimilation model to a psychotherapy process with a highly disturbed client and focuses on the creation of a meaning bridge in the process. Moreover, the assimilation analysis focuses on the effect of an external person, i.e. the partner or the therapist, when responding to the client's unassimilated problematic experiences. Their effects on the client's assimilation processes are discussed.

Creep show suivi de "Je est des autres" : de l'esthétique borderline chez Marie-Sissi Labrèche

Dans Creep show, un narrateur présente ses creeps, les malades de son entourage, des schizophrènes inadéquatement nommés, afin de les ramener à la vie par ses mots. En se souvenant de certains moments où la folie se manifestait à lui, il veut déterrer ses ensevelis, les faire parler en leur prêtant son écriture. Dans un récit morcelé pouvant évoquer une galerie de portraits en mouvement, les protagonistes sont présentés comme des monstres, des rêveurs ou des sources d’inspiration selon le moment relaté par un narrateur affecté qui se replonge littéralement dans un passé s’échelonnant entre l’enfance et l’âge de dix-huit ans. Portant autant sur la maladie mentale que sur la honte et la peur des mots, Creep show est un texte sur le silence et l’impuissance, sur l’incapacité de nommer adéquatement la folie ; il s’agit d’un court récit de dix-sept scènes encadrées par un prologue et un épilogue où l’écriture d’un traumatisme se vit comme une histoire d’amour. L’essai intitulé “Je est des autres.” De l’esthétique borderline chez Marie-Sissi Labrèche décrit la genèse d’une esthétique « borderline ». Dans une approche à la fois psychanalytique et narratologique, fondée sur les concepts de la mélancolie, du kitsch et de la crypte, l’analyse tente de montrer quel type de construction thématique et formelle soutient cette esthétique. À partir d’éléments représentatifs de l’univers de Marie-Sissi Labrèche (la question de la limite, la pulsion de mort, le rapport au corps et l’instabilité), l’essai s’intéresse à la façon dont la narratrice de Borderline (2000) donne à lire une identité sédimentaire, un autoportrait masqué-fêlé, où « Je est [des] autre[s] ». En regard de ces éléments, l’hypothèse d’une machine textuelle fonctionnant – thématiquement et formellement – dans et par l’instabilité et l’altérité oriente la réflexion vers l’idée d’une écriture du trauma qui pourrait représenter une tentative de réappropriation identitaire passant par l’esthétique dite « borderline ».

Examining the incremental validity of psychopathy versus antisocial personality disorder in understanding patterns of criminal behavior

La psychopathie et le trouble de personnalité antisociale sont deux syndromes reliés qui ont été identifiés comme prédicteurs importants de comportements violents et de criminalité. Cependant, la recherche indique que les facteurs de la psychopathie centrés sur la personnalité ne sont pas des prédicteurs fiables de récidive violente chez les personnes atteintes de maladies mentales. Toutefois, peu d’études se sont centrées sur l’identification des facteurs associés au patron des antécédents criminels. Les 96 hommes de l’étude ont été déclarés non criminellement responsables en raison de troubles mentaux. Ils ont été évalués quant au trouble de la personnalité antisociale ainsi qu’à la psychopathie. Les dossiers criminels de la Gendarmerie Royale du Canada ont également été consultés afin de reconstituer l’histoire criminelle. Les résultats suggèrent que ni les traits de personnalité antisociaux, ni les facteurs de la psychopathie ne démontrent une validité prédictive incrémentielle les uns sur les autres quant au nombre ou à la sévérité des délits. La présence d’un grand nombre de traits antisociaux est associée à un plus grand nombre et à une plus importante sévérité d’actes criminels non-violents. Les résultats sont discutés en termes de l’utilité d’une classification du trouble de personnalité antisociale, et de la pertinence du construit de la psychopathie pour les personnes atteintes de maladies mentales graves.