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Short R, Jolliffe D, Carter B, Campbell C. Mediators of change in psychological interventions for adult offenders with personality disorders: A scoping review of the literature. Personal Ment Health 2024; 18:177-187. [PMID: 38425242 DOI: 10.1002/pmh.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/09/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
Offenders with personality disorder cause disproportionate harm to society and pose significant challenges for those responsible for their care and rehabilitation. Personality disorders are heterogeneous in terms of symptoms, as well as their pathways to offending behaviour. Thus, there is limited evidence regarding effective interventions. One solution might be to focus on how interventions are delivered as well as what is delivered. Within the non-offender personality disorder literature, the identification of potential mediators of change has enabled interventions to focus on 'how' they are delivered (e.g., therapeutic alliance) rather than the intervention itself. We explore the evidence and present a scoping review of the available literature on the mechanisms of change in psychological treatments for offenders with personality disorder. Only one study was found in the scoping review, highlighting a significant gap in the evidence base. We discuss the implications of this finding and potential future directions.
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Affiliation(s)
- Roxanna Short
- Department of Forensic and Neurodevelopmental Sciences, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Darrick Jolliffe
- Department of Law and Criminology, Royal Holloway University of London, Egham, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Colin Campbell
- Department of Forensic and Neurodevelopmental Sciences, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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2
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Flaaten E, Langfeldt M, Morken KTE. Antisocial personality disorder and therapeutic pessimism - how can mentalization-based treatment contribute to an increased therapeutic optimism among health professionals? Front Psychol 2024; 15:1320405. [PMID: 38449745 PMCID: PMC10915228 DOI: 10.3389/fpsyg.2024.1320405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Antisocial personality disorder (ASPD) is associated with therapeutic pessimism among health professionals. Several variables are associated with obstacles in therapist's willingness to treat ASPD. Variables that are relevant are (i) confusion associated with the term ASPD, (ii) characteristics of the disorder, (iii) attitudes, experiences, and knowledge clinicians possess, and (iv) insufficient management of countertransference. We assume that therapeutic pessimism is related to the lack of evidence-based, effective treatment for individuals with ASPD. This is problematic because ASPD is associated with large socio-economic costs and considerable suffering for the individual and the society. Mentalization-based treatment (MBT) was developed in treating borderline personality disorder (BPD) and is now considered an effective treatment for this group. Mentalization is defined as the process by which individuals make sense of themselves and others in terms of subjective states and mental processes. This ability affects an individual's psychological functioning, mental health, self-organization, and interpersonal relationships. The overall goal of MBT is to strengthen the individual's mentalizing abilities and facilitate more adaptive handling of problematic, internal states. Recently, a version of MBT tailored for individuals with ASPD (MBT-ASPD) has been developed. The purpose of this review is to investigate how MBT-ASPD relates to the major obstacles that contribute to the therapeutic pessimism toward this group. Despite a limited evidence base, preliminary studies indicate promising results for MBT-ASPD. More research is still required, this review suggests MBT-ASPD can contribute to increased therapeutic optimism and demonstrate specific characteristics of MBT-ASPD that contribute to management of therapeutic pessimism.
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Affiliation(s)
- Emilie Flaaten
- Drammen Hospital, Outpatient Team for Addiction and Mental Health, Vestre Viken Hospital Trust, Drammen, Norway
| | - Maria Langfeldt
- Blakstad Hospital, Section of Security Psychiatry, Vestre Viken Hospital Trust, Drammen, Norway
| | - Katharina T. E. Morken
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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3
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Blay M, Duarte M, Dessouli MA, Durpoix A, Rüfenacht E, Weibel S, Speranza M, Perroud N. Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles. Front Psychiatry 2024; 15:1260138. [PMID: 38384590 PMCID: PMC10879599 DOI: 10.3389/fpsyt.2024.1260138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Emotion dysregulation (ED) has primarily been described in patients suffering from borderline personality disorder (BPD) and is an integral part of this diagnosis, but it is also a transdiagnostic construct that can be found in several other psychiatric disorders. The strong relationships between ED and BPD may lead clinicians to underestimate ED associated to other clinical contexts. This can lead to difficulties in diagnostic and treatment orientation, especially in the context of comorbidities. In this article, after reviewing the literature on the development and functioning of emotion dysregulation, and on the evidence for emotion dysregulation in eight disorders (borderline personality disorder, pathological narcissism with/without narcissistic personality disorder, obsessive-compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, and adult attention deficit hyperactivity disorder), we present a transdiagnostic processual model of emotion dysregulation based on core triggers and interpersonal styles to try to address this issue and to provide a simple but technical tool to help clinicians in their diagnostic assessment and treatment orientation. By focusing more on typical patterns and interpersonal dynamics than only on categories, we believe that this model may contribute to the actual need for improvement of our current psychiatric classifications, alongside other well-studied and under-used dimensional models of psychopathology (e.g., HiTOP, AMPD), and may be useful to build more specific treatment frameworks for patients suffering from ED.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Santé Basque Développement Group, Lyon, France
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
| | - Miguel Duarte
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie-Alix Dessouli
- Department of Emergency Psychiatry, University Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Amaury Durpoix
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
| | - Eva Rüfenacht
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Sébastien Weibel
- Department of Psychiatry, University Hospitals of Strasbourg, Strasbourg, France
- U1114, INSERM, Strasbourg, France
| | - Mario Speranza
- Centre de recherche en Epidemiologie et Sante des Populations Team ‘DevPsy’, INSERM, Universite Paris-Saclay, UVSQ, Villejuif, France
- University Department of Child and Adolescent Psychiatry, Versailles Hospital Center, Le Chesnay-Rocquencourt, France
| | - Nader Perroud
- Psychiatric Specialties Unit, University Hospitals of Geneva, Geneva, Switzerland
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4
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Sveen CA, Pedersen G, Ulvestad DA, Zahl KE, Wilberg T, Kvarstein EH. Societal costs of personality disorders among treatment-seeking patients in Norway: the relative contribution of specific DSM-5 categories. Eur Arch Psychiatry Clin Neurosci 2024; 274:139-149. [PMID: 37598131 PMCID: PMC10786999 DOI: 10.1007/s00406-023-01655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/17/2023] [Indexed: 08/21/2023]
Abstract
Personality disorders (PDs) are associated with high levels of societal costs, regardless of whether a single PD or a broad range of PDs have been studied. However, research on the relative contribution of specific PD-types on societal costs is limited. The aim of this study was to explore the possible contributions of the individual DSM-5 categories of PDs on the level of societal costs and its components (health service costs and productivity loss), while controlling for the impact of comorbid mental health and substance use disorders on these outcomes. Participants (n = 798) were retrieved from the quality register of the Norwegian Network for Personality Disorders-a collaboration of PD-treatment units within specialist mental health services. The patients were referred to treatment in the time-period 2017-2020. Costs were assessed using a structured interview covering the 6-month period prior to assessment. Diagnoses were determined by semi-structured diagnostic interviews (SCID-5-PD and M.I.N.I.). Statistics included multiple regression analyses. The main result was that no specific PD had a unique contribution to the high level of societal costs generally found among treatment-seeking patients with PDs. Borderline PD (BPD) was the only PD with significantly higher health service costs than the other PDs, while BPD, avoidant PD, and unspecified PD were independently associated with enhanced productivity loss. The differential cost-effects of specific PDs on the cost components were small. Several comorbid mental health and substance use disorders were significant contributors to costs, irrespective of PD status. The results underscore the importance of developing and implementing effective treatments for a broader range of PDs, to reduce the high levels of societal costs associated with all PDs.
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Affiliation(s)
- C A Sveen
- Department of Child and Adolescent Psychiatry, Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway.
| | - G Pedersen
- Network for Personality Disorder, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - D A Ulvestad
- Outpatient Clinic for Specialized Treatment of Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - K E Zahl
- Group Therapy Section, Follo District Psychiatric Centre, Akershus University Hospital, Ski, Norway
| | - T Wilberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Treatment Research, Department for Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - E H Kvarstein
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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5
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Esposito CM, Ceresa A, Auxilia AM, Zanelli Quarantini F, Caldiroli A, Capuzzi E, Clerici M, Buoli M. Which Clinical and Demographic Factors are Related to Incarceration in Male Patients With Antisocial Personality Disorder? INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:1630-1641. [PMID: 36495101 DOI: 10.1177/0306624x221139073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Antisocial Personality Disorder (APD) is a condition largely represented in detention centers where can reach a prevalence of 60% in male prisoners. The objective of this study is to identify the clinical and demographic factors that differentiate subjects with APD and hosted in penitentiary with respect to those are treated in outpatient psychiatric clinics. We recruited 65 male patients affected by APD, whose 26 were followed up in community mental health services and 39 were serving their sentence in a detention center located in Monza. Socio-demographic and clinical data were obtained through a review of the clinical charts, and interviews with patients or their relatives (if available). We performed descriptive analyses on the total sample, then we compared the two groups identified by the type of setting (outpatient clinic vs. penitentiary) by independent sample t tests (quantitative variables) or χ2 tests (qualitative ones). For qualitative variables odds ratios (ORs) were also calculated. Outpatients with APD (with respect to those hosted in the detention center) resulted: to be older (p = .02), to be less likely married (p = .01), to have more pre-onset psychiatric comorbidity (p = .05), to have more pre-onset substance poly-misuse (p = .01), to have more previous psychiatric hospitalizations (p < .01), and to be less likely to have received lifetime psychotherapy (p < .01). Globally, the results of this study show how the presence of psychiatric comorbidity or substance abuse (with the probable access to psychiatric services) before the onset of APD prevents imprisonment. This aspect is even more surprising when we consider that the two groups of patients show no differences in the frequency of crimes. Future research will have to confirm if early mental health care can really limit the access to penitentiary of subjects affected by APD.
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Affiliation(s)
| | - Alessandro Ceresa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | - Massimo Clerici
- University of Milano Bicocca, Monza, Italy
- Azienda Socio Sanitaria Territoriale Monza, Italy
| | - Massimiliano Buoli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan, Italy
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6
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Øvstebø RB, Pedersen G, Wilberg T, Røssberg JI, Dahl HSJ, Kvarstein EH. Countertransference in the treatment of patients with personality disorders: A longitudinal study. Psychother Res 2023:1-15. [PMID: 37963354 DOI: 10.1080/10503307.2023.2279645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE This study examines how therapist emotional response/countertransference (CT) develops during treatment for patients with personality disorders (PDs) and how pre-treatment patient factors (severity of personality pathology, PD category, level of symptom distress) predict CT responses. Secondly, we explored associations between patient clinical outcome and CT. METHOD A longitudinal, observational study including 1956 patients with personality pathology treated at psychotherapy units within specialist mental health services. Therapists' emotional response was repeatedly assessed by the Feeling Word Checklist-Brief Version (FWC-BV) with three subscales-Inadequate, Confident, and Idealized. RESULTS Levels of Inadequate CT were lowest and stable over time while Confident and Idealized increased over time. Greater severity of personality pathology and borderline PD predicted higher initial Inadequate, lower initial Confident and decreasing Inadequate over time. Antisocial PD predicted decreasing Confident. Number of PD criteria had higher impact on therapist CT than level of symptom distress. Clinical improvement was associated with decreasing Inadequate. CONCLUSION Therapists reported predominantly Confident CT when working with PD patients. More severe personality pathology, and borderline PD, specifically, predicted more negative CT initially, but the negative CT decreased over time. Patients who did not improve were associated with increasing Inadequate.
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Affiliation(s)
- R B Øvstebø
- Section for Treatment and Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - G Pedersen
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - T Wilberg
- Section for Treatment and Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J I Røssberg
- Section for Treatment and Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - H S J Dahl
- Department of Psychology, University of Oslo, Oslo, Norway
| | - E H Kvarstein
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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7
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Kolla NJ, Tully J, Bertsch K. Neural correlates of aggression in personality disorders from the perspective of DSM-5 maladaptive traits: a systematic review. Transl Psychiatry 2023; 13:330. [PMID: 37884552 PMCID: PMC10603082 DOI: 10.1038/s41398-023-02612-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, includes an alternative model of personality disorders (AMPD) focusing on a maladaptive trait model utilized to diagnose several personality disorders. Borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are two conditions categorized by AMPD that exhibit high rates of violence and aggression. Several of the traits outlined in the AMPD, including hostility, impulsivity, risk-taking, and callousness, have been previously linked to aggression in BPD and ASPD. However, to the best of our knowledge, there has never been a synthesis of neuroimaging studies that have investigated links between these traits and aggression in BPD and ASPD. To overcome this gap, we conducted a systematic review under the PRISMA framework to locate neuroimaging articles published since the release of AMPD linking trait anger/hostility, impulsivity, risk-taking, and callousness to aggression in BPD and ASPD. Key findings included the following: i) anger/hostility, associated with alterations in the interplay between prefrontal and subcortical regions (primarily the amygdala), may be a common factor explaining aggressive reactions to response to interpersonal threat or provocation; ii) alterations of fronto-temporal-limbic regions and serotonergic and endocannabinoid signaling systems may link impulsivity to aggression in BPD and ASPD; iii) weaker cortico-striatal connectivity could relate to greater risk taking and greater proclivity for violence. Insufficient evidence from neuroimaging articles was discerned to describe a relationship between callousness and aggression. Overall, results of this review reveal a relative paucity of neuroimaging studies examining AMPD traits relevant to aggression in BPD and ASPD. In addition to encouraging further investigation of neuroimaging markers of AMPD traits linked to aggression, we recommend multi-methodological designs, including the incorporation of other biomarkers, such as hormones and indices of physiological arousal, to fully expand our understanding of aggression in BPD and ASPD.
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Affiliation(s)
- Nathan J Kolla
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada.
| | - John Tully
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University, Munich, Germany
- NeuroImagine Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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8
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Panagiotopoulos A, Despoti A, Varveri C, Wiegand MCA, Lobbestael J. The Relationship Between Early Maladaptive Schemas and Cluster C Personality Disorder Traits: A Systematic Review and Meta-Analysis. Curr Psychiatry Rep 2023; 25:439-453. [PMID: 37870687 PMCID: PMC10627891 DOI: 10.1007/s11920-023-01439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE OF REVIEW We systematically reviewed and meta-analyzed the literature on the relationship between early maladaptive schemas (EMSs) and Cluster C personality disorders (PDs). Our aim was to clarify which of the 18 EMSs exhibit the strongest associations and are most frequently endorsed in clinical and non-clinical samples with Cluster C PDs and traits. RECENT FINDINGS After initially screening 2622 records, 12 studies were selected with 5310 participants. Meta-analyses of the raw correlation coefficients for each EMS-Cluster C PD link (3-8 studies per meta-analysis) indicated that the 18 EMSs were significantly related to all three Cluster C PDs with r's ranging from .13 to .63. However, when considering endorsement rates among multiple regression studies that controlled for the EMSs intercorrelations and the effects of other PD traits and demographics, specific EMS constellations emerged for each Cluster C PD. Overall, the findings of the current paper suggest that Cluster C PDs might be conceptualized on the basis of a hybrid EMS model, in which all EMSs contribute to global personality dysfunction whereas specific EMS patterns reflect unique personality disorder style expressions. Longitudinal research with appropriate methodology is needed to draw more definite conclusions on the EMSs-Cluster C PDs relationships.
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Affiliation(s)
- Angelos Panagiotopoulos
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
- Institute of Behavioural Research and Therapy, Athens, Greece
| | - Akylina Despoti
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Intensive Care Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Marie C A Wiegand
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, University single 40, 6229 ER, Maastricht, the Netherlands
| | - Jill Lobbestael
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, University single 40, 6229 ER, Maastricht, the Netherlands.
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9
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Gómez AS, Durán N. Association between Callous-Unemotional Traits, Empathy, and Moral Disengagement Mechanisms in Juvenile Offenders. ANUARIO DE PSICOLOGÍA JURÍDICA 2023. [DOI: 10.5093/apj2023a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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10
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De Wit-De Visser B, Rijckmans M, Vermunt JK, van Dam A. Pathways to antisocial behavior: a framework to improve diagnostics and tailor therapeutic interventions. Front Psychol 2023; 14:993090. [PMID: 36844347 PMCID: PMC9947159 DOI: 10.3389/fpsyg.2023.993090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
The Antisocial Personality Disorder (ASPD), and antisocial behavior (ASB) in general, is associated with significant impact on individuals themselves, their environment, and society. Although various interventions show promising results, no evidence-based treatments are available for individuals with ASPD. Therefore, making informed choices about which treatment can be applied to an individual patient is complicated. Furthermore, contradictory findings on therapy effectiveness and underlying factors of ASB, such as cognitive impairments and personality traits, fuel the debate whether the conceptualization of ASPD in the DSM-5 is accurate and whether this population can be seen as homogeneous. A conceptual framework, based on the reciprocal altruism theory, is presented in which we propose different pathways to ASB. These pathways suggest underlying dynamics of ASB and provide an explanation for previous contradictory research outcomes. This framework is intended to serve as a clinically relevant model that provides directions for improving diagnostics and matching treatments to underlying dynamics in the antisocial population.
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Affiliation(s)
- Brenda De Wit-De Visser
- GGZ WNB, Research and Innovation, Halsteren, Netherlands,Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands,*Correspondence: Brenda De Wit-De Visser,
| | - Madeleine Rijckmans
- Fivoor, Fivoor Science and Treatment Innovation, Poortugaal, Netherlands,Clinical and Forensic Psychology, Department of Developmental Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Jeroen K. Vermunt
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Arno van Dam
- GGZ WNB, Research and Innovation, Halsteren, Netherlands,Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
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11
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Morken KT, Øvrebø M, Klippenberg C, Morvik T, Gikling EL. Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing. RESEARCH IN PSYCHOTHERAPY (MILANO) 2022; 25:649. [PMID: 36373390 PMCID: PMC9893041 DOI: 10.4081/ripppo.2022.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
Patients with antisocial personality disorder (ASPD) are known for being difficult to treat. Treatment for ASPD is debated and lacking evidence. Among several reasons for treatment difficulties concerning ASPD, negative countertransference in health personnel is one central topic. Mentalization based treatment (MBT) is a reasonable candidate treatment for ASPD. From an ongoing pilot-study on MBT with substance using ASPD patients, we explore therapist experiences. Four experienced MBT therapists together with the principal investigator performed a focus group together. The therapists were themselves involved in performing this study and analyses are made as an autoethnographic study, with thematic analyses as methodological approach. As this study involved a qualitative investigation of own practice, reflexivity of the processes was performed. The aim was to explore in depth: therapist experiences and therapist wellbeing in MBT-ASPD. We found four main themes on therapist experiences: i) gaining safety by getting to know them better; ii) gaining cooperation through clear boundaries and a non-judgmental stance; iii) shifting inner boundaries; and iv) timing interventions in a high-speed culture. These four themes point to different therapist experiences one can have in MBT-ASPD. Our findings resonate well with the clinical literature on ASPD, the findings imply that clinical teams should have a focus on therapist countertransference and burnout, ensure that therapists uphold boundaries and open-mindedness in treatment of ASPD and that therapists experience vitalizing feelings in this line of work.
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Affiliation(s)
- Katharina T.E. Morken
- Department of Clinical Psychology, University of Bergen, Bergen, Norway,Department of Addiction Medicine, Research Section, Haukeland University Hospital, Bergen, Norway,Department of Clinical Psychology, University of Bergen, Bergen; Department of Addiction Medicine, Research Section, Haukeland University Hospital, Bergen, Norway.
| | - Morten Øvrebø
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Therese Morvik
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
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12
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Griem J, Kolla NJ, Tully J. Key challenges in neurocognitive assessment of individuals with antisocial personality disorder and psychopathy. Front Behav Neurosci 2022; 16:1007121. [PMID: 36119943 PMCID: PMC9478175 DOI: 10.3389/fnbeh.2022.1007121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Julia Griem
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
- *Correspondence: Julia Griem
| | - Nathan J. Kolla
- Department for Psychiatry, University of Toronto, Toronto, ON, Canada
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
- Research and Academics, Division, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - John Tully
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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13
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Ho W, Kolla NJ. The endocannabinoid system in borderline personality disorder and antisocial personality disorder: A scoping review. BEHAVIORAL SCIENCES & THE LAW 2022; 40:331-350. [PMID: 35575169 DOI: 10.1002/bsl.2576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/06/2022] [Accepted: 03/31/2022] [Indexed: 06/15/2023]
Abstract
Individuals with borderline personality disorder (BPD) or antisocial personality disorder (ASPD) are overrepresented in forensic settings. Yet, despite the burden these disorders place on healthcare and criminal justice systems, there remains a lack of evidence-based pharmacological treatments. Epidemiological data have shown that comorbid cannabis use disorders are common in BPD and ASPD. ∆9 -Tetrahydrocannabinol, the primary psychoactive constituent of cannabis, is an exogenous cannabinoid that stimulates the endocannabinoid system (ECS). Hence, an investigation of the ECS in these conditions is warranted. This scoping review screened 105 records and summarized the extant research on the ECS in ASPD (n = 69) and BPD (n = 61) participants. Preliminary results suggest that alterations of the ECS may be present in these disorders. Although research examining the ECS in personality disorders is still in its infancy, more research is warranted given initial positive findings.
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Affiliation(s)
- Wilson Ho
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nathan J Kolla
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
- Waypoint/University of Toronto Research Chair in Forensic Mental Health Science, Penetanguishene, ON, Canada
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Tully J. Management of ADHD in Prisoners-Evidence Gaps and Reasons for Caution. Front Psychiatry 2022; 13:771525. [PMID: 35370827 PMCID: PMC8973692 DOI: 10.3389/fpsyt.2022.771525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/04/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- John Tully
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
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15
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Janković M, Masthoff E, Spreen M, de Looff P, Bogaerts S. A Latent Class Analysis of Forensic Psychiatric Patients in Relation to Risk and Protective Factors. Front Psychol 2021; 12:695354. [PMID: 34354640 PMCID: PMC8329083 DOI: 10.3389/fpsyg.2021.695354] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/29/2021] [Indexed: 01/06/2023] Open
Abstract
Forensic psychiatric patients form a very heterogeneous population regarding psychopathology, criminal history, and risk factors for reoffending. Therefore, the present study aimed to investigate whether there are more homogeneous classes of forensic patients based on DSM-IV-TR Axis I and II diagnoses and previously committed offenses, by means of explorative latent class analysis (LCA). It was also investigated which risk and protective factors are significantly more prevalent in one class compared to other classes. The study sample contained 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from high-security forensic clinics. Data were retrospectively derived from electronic patient files. Five distinctive patient classes emerged: class with only Axis II diagnosis, class with multiple problems, antisocial class, psychotic class, and intellectually disabled class. These classes differed significantly in risk and protective factors. This study contributes to the understanding of patient classes and provides directions for future, class-tailored interventions.
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Affiliation(s)
- Marija Janković
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
| | - Erik Masthoff
- Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
| | - Marinus Spreen
- Department of Social Work, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Peter de Looff
- Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
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