Metacognitive improvement and symptom change in a 3-month treatment for borderline personality disorder.

Recognizing and reflecting on one's own and other people's mental states represent a major difficulty for patients with borderline personality disorder (BPD). Only recently have studies begun exploring whether these capacities increase with successful therapies and if such an improvement is linked with outcome. The present study investigated whether metacognition would improve and if its improvement was related with symptom change in BPD patients. The transcripts from the first and the penultimate session of a ten-session version of good psychiatric management were analysed with the MAS-R scale in a N = 37 BPD sample. Patients, selected from a previously published RCT (Kramer et al., 2014), were assigned either to the good psychiatric management treatment or to the same treatment with the addition of the Motive-Oriented Therapeutic Relationship (Caspar, 2007), a form of therapeutic relationship based on an individualized case formulation. Symptoms were assessed with the OQ-45. Findings partially support the hypotheses. First, improvement in capacities to understand others' mind, to take a critical distance from one's own rigid and maladaptive beliefs, and to use behavioural and attentional strategies to face adversities is found in both treatment groups. Controlling for marital status, only the ability to differentiate between reality and representations remains significant. Second, no link between metacognitive change and symptom change during treatment is found. However, a link is observed between the increase in metacognition and symptom reduction at 6-month follow-up. Results invite to further investigate the role of metacognition in therapy change through different modalities and in longer-term treatments. The development of metacognitive processes and their links with symptom change were examined during a short-term treatment in 37 borderline patients Improvement was found in capacities to understand others' mind, to take a critical distance from own rigid and maladaptive beliefs, and to use behavioural and attentional strategies even in a short-term treatment Controlling for marital status, only the ability to take a critical distance from representations remained significant A link was observed between increase in metacognition and symptom reduction at 6-month follow-up Understanding and tailoring interventions to specific metacognitive difficulties could be associated with symptom change during treatment for BPD patients

Raising children with high self-esteem (but not narcissism)

With the rise of individualism since the 1960s, Western parents have become increasingly concerned with raising children’s self-esteem. This is understandable, given the benefits of self-esteem for children’s psychological health. However, parents’ well-intentioned attempts to raise self-esteem, such as inflated praise, may inadvertently breed narcissism. How, then, can parents raise self-esteem without breeding narcissism? Here, we propose a tripartite model of self-regard, which holds that the development of self-esteem without narcissism can be cultivated through realistic feedback (rather than inflated praise), focus on growth (rather than on outperforming others), and unconditional regard (rather than regard that is conditional). We review evidence in support of these practices and outline promising research directions. The tripartite model integrates existing research, stimulates theory development, and identifies leverage points for intervention concurrently to raise self-esteem and curtail narcissism from a young age

Psychoanalysis as the Patient: High in Feeling, Low in Energy

This paper examines the increasingly important role that affect is assuming in psychoanalytic research and practice. This rise in the centrality of affect has been at the expense of an independent role for motivation and a dismissal of any energy concept. Difficulties with this affect-first approach are identified and an alternative offered that accords motivation an independent role and accommodates a useful energy concept. Research on esophageal atresia, addiction, and infant suckling are cited in support of this position.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66624/2/10.1177_00030651970450031101.pd

On the Meaning and Measure of Narcissism

For three decades, social-personality research on overt narcissism has relied almost exclusively on the Narcissistic Personality Inventory (NPI). However, the NPI suffers from a host of psychometric and validity concerns that make composite NPI scores (summed across its subscales) difficult to interpret. The present studies propose that narcissistic characteristics tend to fall under two general clusters: grandiosity and entitlement. The studies show that measures of grandiosity and entitlement interact to predict scores on the NPI, controlling for gender, self-esteem, and basic personality (Study 1), but also that grandiosity and entitlement function independently with respect to mental health (Study 2) and ethical misconduct (Study 3). Together, these results challenge the view of overt narcissism as a unidimensional construct and underscore the importance of distinguishing between grandiose and entitled aspects of the narcissistic self-concept.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Borderline Personality Disorder Symptoms in College Students: The Complex Interplay between Alexithymia, Emotional Dysregulation and Rumination.

Both Emotional Cascade Theory and Linehan's Biosocial Theory suggest dysregulated behaviors associated with Borderline Personality Disorder (BPD) emerge, in part, because of cycles of rumination, poor emotional recognition and poor emotion regulation. In this study we examined relationships between rumination, alexithymia, and emotion regulation in predicting dysregulated behaviors associated with BPD (e.g. self-harm, substance use, aggression), and explored both indirect and moderating effects among these variables. The sample comprised 2261 college students who completed self-report measures of the aforementioned constructs. BPD symptoms, stress, family psychological illness, and alexithymia exerted direct effects on behaviors. Symptoms had an indirect effect on behaviors through rumination, alexithymia and emotional dysregulation. In addition, the relationship between symptoms and dysregulated behaviors was conditional on level of rumination and alexithymia. Implications for early identification and treatment of BPD and related behaviors in college settings are discussed

Regret: A Theoretical and Conceptual Analysis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73569/1/j.1468-5914.1987.tb00092.x.pd