To evaluate the possibility of an underlying dimension of organicity in borderline personality disorder (BPD), a carefully diagnosed group of borderline patients was assessed across a wide range of neuropsychological functions and then was compared to an age-and education-matched nonpatient control group. The BPD group had significantly lower Verbal, Performance, and Full Scale IQ scores on the WAIS-R. The BPD group also was impaired significantly on motor skills, figural memory, complex visuomotor integration, social or interpersonal intelligence, and on a measure of susceptibility to interference. This pattern of deficits localized to the fronto-temporal regions and became more pronounced when a subgroup analysis was performed. This study suggests that subtle organic factors may be operative in some, but not all, BPD patients. The clinical literature on borderline personality disorder (BPD) contains frequent references to problems these patients have with attention/concentration (M. Murray,

The aim of this paper is a thorough explication of the concept of identity. We have synthesized the scattered psychiatric and psychoanalytic literature on the topic to shed light on the historical origins, development, phenomenology, clinical relevance, and methods of assessing identity. Our review revealed that: (1) The concept of identity has persisted over eight decades. (2) Identity originates in the earliest interplay of the infant's temperament with the mother's attitude, gains structure from primitive introjections, refines itself through later selective identifications, acquires filiation and generational continuity in passage through the Oedipus complex, and arrives at its more or less final shape through synthesis of contradictory identifications and greater individuation during adolescence. It remains subject to further refinements during young adulthood, midlife, and even old age. (3) A cohesive identity comprises a realistic body image, subjective self-sameness, consistent attitudes, temporality, gender, authenticity, and ethnicity. (4) Disturbance of identity suggests psychopathology, with greater identity disturbance being associated with more-severe conditions (e.g., severe personality disorders, multiple personality, psychosis). (5) Clinical and psychometric assessment is therefore relevant and might indicate treatment strategies and outcome expectations. Findings from the literature are elucidated, and areas needing further research are identified.

Surveys indicate that between 6% and 10% of psychiatrists report sexual contact with patients. Surveys also indicate that only a small minority of psychiatrists feel that they have received adequate teaching about this unethical behavior. Educational efforts aimed at reducing sexual exploitation of patients would be of value to trainees, patients, academic programs, and the profession. The authors report their experience with a pilot 6-session course for residents, and a longer model course is outlined. Such education should be mandatory in U.S. residencies. Mandated instruction would be consistent with both the high priority training directors have reported placing on the subject of sexual misconduct in ethics teaching, and with the widespread calls for increased education on this important subject.

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All directors of psychology internships accredited by the American Psychological Association (N = 410) were surveyed about the status of internship education related to prevention of psychologistpatient sexual exploitation. Virtually all responding directors (99% of 230) reported that thenprogram provides at least 1 session on this topic, and the same number indicated that such education should be part of the mandatory internship curriculum. Ninety-four percent of responding programs had instituted the reported training within the prior 10 years and 60% had done so within 4 years. A national mandate requiring education for prevention of psychologist-patient sexual exploitation can consolidate the apparent trend toward greater inclusion of this topic in training programs.Sexual feelings in the course of psychotherapy, both transferential and countertransferential, are ubiquitous. In one survey, 87% of psychologists reported experiencing sexual attraction toward a client at some point during their career (Pope, Keith-Spiegel, & Tabachnick, 1987). Yet, 55% of these same respondents also reported they had received no education on the issue of sexual attraction, and 24% reported ' 'very little'' such education; only 9% of survey respondents believed that they had had "adequate" training to deal with such feelings. Thus, although the criteria for accreditation of doctoral training programs and internships in professional psychology include explicit requirements for instruction in ethics and in the ethical code of the profession (Committee on Accreditation, 1996), it is by no means clear that adequate instruction is actually being provided STEVEN E. SAMUEL received his PhD from Temple University in 1987. He is an associate clinical professor in the Department of Psychiatry and Human Behavior at Jefferson Medical College and is a member of two Pennsylvania Governor's Boards concerning domestic violence and child abuse-child neglect. He has a practice of psychotherapy, psychoanalysis, and forensic psychology in addition to teaching courses at Jefferson Medical College on minorities and psychotherapy, boundary violations, and psychological testing. His upcoming book on barbecue is titled Grilling in the Dark. GREGG E. GORTON received his MD from Tufts University in 1981. His residency training was at Boston City Hospital and The Cambridge Hospital, followed by a fellowship in psychoanalytic psychotherapy at The Austen Riggs Center in Stockbridge, Massachusetts. He is currently assistant professor of psychiatry and human behavior at Jefferson Medical College, where he codirects the Outpatient Training Clinic. His principal scholarly interests are ethics and personality disorders. PRELIMINARY RESULTS OF THESE SURVEY