A test of the therapeutic mechanism in social skills training with avoidant personality disorder

Article Abstract:

Social skills training is part of treatment for many psychiatric patients. It has been assumed that some individuals lack these skills and simply need training. Social skills training (SST) is usually successful, but it is not clear how the training works to improve the patient's social functioning. Perhaps skill-building is not the underlying mechanism of this improvement; the anxiety-reducing effects of acquiring skills or some other aspect of SST may be the crucial factor. A study was designed to take the skill-building component out of SST, and to compare SST with skill-building to the components of SST that remain after skill-building is removed. These remaining components are modeling, role rehearsal, and feedback. The subjects were 21 individuals diagnosed with avoidant personality disorder, which is characterized by avoidance of social situations and relationships (even though patients want them) and a chronic tendency to withdraw. Each subject served as his or her own control, being treated for five sessions in both SST and group discussion. The two approaches included homework assignments. The group discussion program dealt with social skills, but not skill training per se. The goals were individualized and usually involved facing social situations such as introducing oneself, asking a question, or expressing disagreement. No significant differences were found between group discussion and SST programs, despite the expectation that SST would be more effective. The findings suggest that a combination of SST and group discussion may be useful for improving patients' social functioning, but long-term follow-up has not been completed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Study and teaching, Social skills, Avoidant personality disorder

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Borderline personality disorder in young Swedish suicides

Article Abstract:

Borderline personality disorder (BPD) is a psychiatric disorder characterized by impulsiveness, unstable personal relationships, and feelings of emptiness. To determine the distribution of BPD in young people who committed suicide, 58 cases of suicide in Sweden were studied. The victims were between the ages of 15 and 29. Face-to-face interviews were conducted with subjects' parents, siblings, friends, or other informants, and medical records were reviewed. For 40 subjects, psychiatric records were available. Information useful for making a psychiatric diagnosis, according to the criteria of DSM-III-R (Diagnostic and Statistical Manual, third edition, revised), was elicited. Results showed that 19 subjects had BPD; most of these subjects had additional disorders, such as antisocial personality disorder (APD) or substance abuse. Compared with subjects who did not have BPD, those with the disorder had a higher rate of exposure to early parental absence (of at least one year before the child reached 15), parental divorce, or alcohol or drug abuse by first-degree relatives. They also had more unstable employment histories (had changed jobs more than twice) and more financial problems. Seventy-nine percent of the BPD subjects had undergone inpatient or outpatient psychiatric care during the two years prior to their suicides; this proportion was not different from the proportion of treated patients among non-BPD suicides. The results indicate that BPD and APD are associated with suicide threats and attempts, and with completed suicide, as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sweden, Complications and side effects, Suicide, Borderline personality disorder

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The diagnosis of multiple personality disorder based on subtle dissociative signs

Article Abstract:

Multiple personality disorder (MPD) is a manifestation of severe dissociation in which there are consistent, alternating, multiple separate identities and problems with memory. MPD occurs in patients who have experienced severe, repeated, psychological, physical or sexual abuse during early childhood. These alternative personalities vary in intensity and recurrently take full control of a person's behavior. Since most patients with MPD have symptoms of other mental illness, the MPD can remain concealed and these patients are frequently misdiagnosed. The average amount of time it takes to accurately diagnose MPD is seven years, and this diagnosis is usually made during an episode where one of the personalities displays common symptoms of the disease. During the time when obvious symptoms are not apparent, MPD patients show subtler symptoms of dissociation such as disorders of thought, emotion, memory, and behavior, and problems in their relations with people and with transference of emotions from prior authority figures to current authority figures. Therapists often observe transient changes in facial expression, voice, posture, and feelings. These milder symptoms of dissociation should lead the therapist to suspect MPD and to probe for further evidence of this disorder. An awareness of the more subtle symptoms could alert the therapist to suspect the presence of MPD when the more obvious symptoms are not present. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Diagnosis, Causes of, Multiple personality

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