A randomized controlled trial was conducted to determine whether a manual-based psychodynamic treatment, labeled dynamic deconstructive psychotherapy (DDP), would be feasible and effective for individuals with co-occurring borderline personality disorder (BPD) and alcohol use disorder. Thirty participants were assessed every 3 months during a year of treatment with either DDP or treatment as usual (TAU) in the community. DDP participants showed statistically significant improvement in parasuicide behavior, alcohol misuse, institutional care, depression, dissociation, and core symptoms of BPD, and treatment retention was 67% to 73%. Although TAU participants received higher average treatment intensity, they showed only limited change during the same period. The results support the feasibility, tolerability, and efficacy of DDP for the co-occurring subgroup and highlight the need for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

No abstract

This study examined the prevalence, willingness to report, and treatment preferences for suicidal ideation among state prison inmates. The Beck Scale for Suicide Ideation (BSS) and a novel questionnaire were completed by 67 inmate-patients. The BSS score was in the high range for 15% of general population (GP) and 40% of Intermediate Care Program (ICP) patients, with 19% of ICP inmates reporting a "moderate to strong" desire to commit suicide. A majority (64% GP, 86% ICP) had prior suicide attempt(s). Forty-two percent of GP and 31% of ICP inmate-patients were unlikely to tell mental health staff about suicidal thoughts. Family contact and talking with mental health staff were preferred interventions. ICP inmates preferred staff visits and observation in their own cells, but GP inmates did not. Only a small minority (14% GP, 21% ICP) favored transfer to a crisis observation cell, but the least desired option was talking to a corrections officer. While many inmate-patients reported experiencing suicidal thoughts, they preferred not to inform staff. Almost 80% did not favor the current primary intervention: the observation cell. Alternative or supplementary options should be considered.

Obsessive-compulsive disorder (OCD)

The child whose mother is diagnosed with borderline personality disorder (BPD) is at risk for developing this disorder. The mother with BPD may be limited in her ability to negotiate a secure attachment with her baby. Mothers with BPD may have difficulties with bonding, internalization, affect attunement, and attachment. Because it is through mirroring and mentalization that a child can learn emotional regulation and master the early stages of development, the child may fail to develop object constancy and master the tasks of separation and individuation. The authors present two cases of patients with BPD. The first case is of a patient with BPD who, after surrendering custody of her two children to their father, participated in weekly Dynamic Deconstructive Psychotherapy sessions for two years. The second case is a mother with BPD who presents for dyadic therapy with her three-month-old daughter. In each case the mother developed insight regarding her relationship with her mother and how that relationship affected the relationship with her own child. The author concludes that psychiatry should consider prepartum screening for BPD and if necessary, early dyadic intervention.