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Clarkin JF. Commentary: Special Issue on Interpersonal Trust. J Pers Disord 2024; 38:1-9. [PMID: 38324248 DOI: 10.1521/pedi.2024.38.1.1] [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] [Indexed: 02/08/2024]
Abstract
This commentary reviews the Journal of Personality Disorders special issue "Interpersonal Trust and Borderline Personality Disorder: Insights From Clinical Practice and Research," published in Volume 37, Number 5, October 2023.
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Affiliation(s)
- John F Clarkin
- Weill Cornell Medical College-New York Presbyterian Hospital Psychiatry
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Meehan KB, Cain NM, Roche MJ, Fertuck EA, Sowislo JF, Clarkin JF. Evaluating Change in Transference, Interpersonal Functioning, and Trust Processes in the Treatment of Borderline Personality Disorder: A Single-Case Study Using Ecological Momentary Assessment. J Pers Disord 2023; 37:490-507. [PMID: 37903025 DOI: 10.1521/pedi.2023.37.5.490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Transference-focused psychotherapy (TFP) is an empirically supported treatment for borderline personality disorder (BPD) that improves functioning via targeting representations of self affectively relating to others, particularly as evoked in the therapeutic relationship. If change in TFP operates as theorized, then shifts in patterns of "self affectively relating to others" should be observed in the transference prior to shifts in daily relationships. Using ecological momentary assessment (EMA), a patient with BPD rated daily interpersonal events for 2-week periods during 18 months of TFP; at 9 and 18 months these ratings included interactions with the therapist. Results suggest that positive perceptions of her therapist that ran counter to her negatively biased perception in other relationships preceded changes in her perceptions of others. EMA shifts corresponded to improvements in self-reported symptoms, interview-based personality functioning, and therapist assessments. Implications for assimilation of a trusting experience with the therapist as a mechanism of change in TFP are discussed.
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Affiliation(s)
- Kevin B Meehan
- Long Island University - Brooklyn, NY
- Weill Medical College of Cornell University, New York, New York
| | | | | | - Eric A Fertuck
- The City College and Graduate Center of CUNY, New York, New York
| | - Julia F Sowislo
- Weill Medical College of Cornell University, New York, New York
| | - John F Clarkin
- Weill Medical College of Cornell University, New York, New York
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Clarkin JF, Meehan KB, De Panfilis C, Doering S. Empirical Developments in Transference-Focused Psychotherapy. Am J Psychother 2023; 76:39-45. [PMID: 36221977 DOI: 10.1176/appi.psychotherapy.20220017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Transference-focused psychotherapy (TFP) is an empirically supported individualized psychotherapy for patients with borderline personality disorder. This review highlights its development and current status. METHODS A review of the theoretical background underpinning TFP and empirical advances in the development of TFP provide perspective. RESULTS Otto Kernberg's object relations model of personality and its implications for assessment and diagnosis of personality disorders are described. The authors review the programmatic research that has been developed and has demonstrated the efficacy of TFP. In view of the empirical studies that have demonstrated the successful outcomes and processes of TFP for patients with borderline personality disorder, compared with other approaches, TFP has been applied to a broader range of difficulties related to patients' self-functioning and interpersonal functioning across the range of severities in personality pathology, consistent with the Alternative DSM-5 Model for Personality Disorders. The authors discuss borderline personality organization in the context of interpersonal, neurocognitive, and self-regulatory dysfunction, including preliminary findings. CONCLUSIONS The theoretical and empirical advances in TFP lead to future directions for research evaluating personality disorder and its treatment.
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Affiliation(s)
- John F Clarkin
- Department of Psychiatry, Weill Medical College, Cornell University, New York City (Clarkin); Department of Psychology, Long Island University Brooklyn, New York City (Meehan); Department of Medicine and Surgery, University of Parma, Parma, Italy (De Panfilis); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Doering)
| | - Kevin B Meehan
- Department of Psychiatry, Weill Medical College, Cornell University, New York City (Clarkin); Department of Psychology, Long Island University Brooklyn, New York City (Meehan); Department of Medicine and Surgery, University of Parma, Parma, Italy (De Panfilis); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Doering)
| | - Chiara De Panfilis
- Department of Psychiatry, Weill Medical College, Cornell University, New York City (Clarkin); Department of Psychology, Long Island University Brooklyn, New York City (Meehan); Department of Medicine and Surgery, University of Parma, Parma, Italy (De Panfilis); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Doering)
| | - Stephan Doering
- Department of Psychiatry, Weill Medical College, Cornell University, New York City (Clarkin); Department of Psychology, Long Island University Brooklyn, New York City (Meehan); Department of Medicine and Surgery, University of Parma, Parma, Italy (De Panfilis); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Doering)
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Meehan KB. Clinical Applications: What Can Multimethod Designs Tell Us about Personality Functioning? J Pers Assess 2021; 103:716-717. [PMID: 34313514 DOI: 10.1080/00223891.2021.1955696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The goal of this commentary is to highlight clinical applications of personality assessment research via two recent studies that are distinguished by their use of innovative experimental, multimethod designs. These studies evaluate implicit behaviors as predicted by clinically relevant facets of personality functioning. Parallels to implicit behaviors evoked in the context of psychotherapy are discussed, as is the value of assessing and intervening on the subtle manifestations of personality dysfunction observed by clinicians, especially when they do not comport to the patient's self-assessment.
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Fitzpatrick S, Liebman RE, Monson CM. The borderline interpersonal-affective systems (BIAS) model: Extending understanding of the interpersonal context of borderline personality disorder. Clin Psychol Rev 2021; 84:101983. [PMID: 33517245 DOI: 10.1016/j.cpr.2021.101983] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/16/2020] [Accepted: 01/19/2021] [Indexed: 01/10/2023]
Abstract
Prominent explanatory models for borderline personality disorder (BPD) are intrapersonal in nature and hold that it is an emotional disorder. However, the empirical support for emotional models of BPD is mixed. Refinements to BPD explanatory models are needed to increase the precision with which BPD can be understood and treated. Drawing on existing theoretical and empirical research in BPD, this manuscript presents the Borderline Interpersonal-Affective Systems (BIAS) model. The BIAS model purports that harmful early life relationships and subsequent conflictual relationships lead individuals with BPD to develop a sensitivity to interpersonal threat in the form of attentional and appraisal biases. Individuals with BPD are posited to 1) experience heightened emotional reactivity specifically to perceived interpersonal threat and 2) engage in destructive behaviors both to regulate increasing emotion and to meet interpersonal needs. We review the empirical support for each component of the BIAS model, along with the role of the cognitions, emotions, and behaviors of significant others in influencing BIAS model processes in individuals with BPD over time. The BIAS model highlights a novel way of understanding and integrating interpersonal and emotional components of the disorder. Key directives for future research and clinical implications are discussed.
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Affiliation(s)
- Skye Fitzpatrick
- Department of Psychology, York University, Behavioural Science Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
| | - Rachel E Liebman
- Department of Psychology, York University, Behavioural Science Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Candice M Monson
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
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Meehan KB, Siefert C, Sexton J, Huprich SK. Expanding the Role of Levels of Personality Functioning in Personality Disorder Taxonomy: Commentary on “Criterion A of the AMPD in HiTOP”. J Pers Assess 2019; 101:367-373. [DOI: 10.1080/00223891.2018.1551228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Caleb Siefert
- Department of Behavioral Sciences, University of Michigan, Dearborn
| | - James Sexton
- Professional Psychology Program, George Washington University
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Mulay AL, Waugh MH, Fillauer JP, Bender DS, Bram A, Cain NM, Caligor E, Forbes MK, Goodrich LB, Kamphuis JH, Keeley JW, Krueger RF, Kurtz JE, Jacobsson P, Lewis KC, Rossi GMP, Ridenour JM, Roche M, Sellbom M, Sharp C, Skodol AE. Borderline personality disorder diagnosis in a new key. Borderline Personal Disord Emot Dysregul 2019; 6:18. [PMID: 31827801 PMCID: PMC6886204 DOI: 10.1186/s40479-019-0116-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD). METHOD Raters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined. RESULTS Inter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes. CONCLUSIONS Results show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.
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Affiliation(s)
- Abby L Mulay
- 1Medical University of South Carolina, 29C Leinbach Drive, Charleston, SC 29407 USA
| | - Mark H Waugh
- 2Oak Ridge National Laboratory (ORNL) & University of Tennessee Knoxville, Knoxville, TN 37996 USA
| | | | - Donna S Bender
- 4Tulane University, 6823 St. Charles Ave., Bldg. 92, New Orleans, LA 70118 USA
| | | | - Nicole M Cain
- 6Rutgers University, Graduate School of Applied and Professional Psychology, 152 Frelinghuysen Rd, Piscataway, NJ 08854-8020 USA
| | - Eve Caligor
- 7Columbia University, 1501 Riverside Drive, New York, NY 10032 USA
| | - Miriam K Forbes
- 8Macquarie University, Balaclava Rd., Macquarie Park, NSW 2109 Australia
| | | | - Jan H Kamphuis
- 10University of Amsterdam (UvA), Nieuwe Achtergracht, 129B, 1001 NK Amsterdam, Netherlands
| | - Jared W Keeley
- 11Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA 23284-2018 USA
| | - Robert F Krueger
- 12University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455 USA
| | - John E Kurtz
- 13Villanova University, 800 Lancaster Avenue, Villanova, PA 19085 USA
| | - Peter Jacobsson
- 14Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katie C Lewis
- 15Austen Riggs Center, 25 Main Street, P.O. Box 962, Stockbridge, MA 01262 USA
| | - Gina M P Rossi
- 16Department of Psychology, Personality and Psychopathology Research group Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jeremy M Ridenour
- 15Austen Riggs Center, 25 Main Street, P.O. Box 962, Stockbridge, MA 01262 USA
| | - Michael Roche
- 17Penn State Altoona, 3000 Ivyside Park, Altoona, PA 16601 USA
| | - Martin Sellbom
- 18University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Carla Sharp
- 19University of Houston, 3695 Cullen Boulevard Room 126, Houston, TX 77204-5022 USA
| | - Andrew E Skodol
- 20University of Arizona, 1501 N. Campbell Avenue, PO Box 245017, Tucson, AZ 85724 USA
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