The first aim of the study was to identify when deliberate self-harm behavior ceased in patients with borderline symptoms undergoing dialectical behavioral treatment. The second aim was to compare patients who ceased their self-harm behavior early or late in the course of treatment, with regard to demographics, comorbidity, and symptom severity. The study used a naturalistic design and included 75 treatment completers at an outpatient DBT clinic. Of these 75 patients, 46 presented with self-harming behavior at pre-treatment. These 46 participants (...) where split into two groups, based on median amount of time before ceasing self-harm behavior, termed early and late responders. Treatment duration varied from 16 to 160 weeks. Patients were assessed pre- and post-treatment using measures of depression, hopelessness, personality traits, quality of life, and global assessment of symptoms and functioning. The majority ceased their self-harming within the first year, and the average number of weeks was 15.5. Twenty-five percent of patients ceased their DSH behavior during the first week of treatment. For the remaining patients, the cessation of DSH continued gradually across a 1 year period. We found no differences between early and late responders with respect to demographics, comorbidity, symptom severity, or treatment outcome. None of the patients committed suicide. The findings indicate that self-harming behavior decreases gradually across the first year after starting DBT. (shrink)

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first account of mentalization (...) treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimed at mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder. (shrink)

Although digital breast tomosynthesis has higher sensitivity than digital mammography and at least as high specificity, digital mammography remains the most common method for conducting mammographic screening. At the same time, mammography systems are now delivered “DBT-ready” and can be used for either digital mammography or digital breast tomosynthesis. In this paper, we ask whether it is ethically permissible to use such equipment for digital mammography, given its lower sensitivity. We argue it is not, and that clinics are ethically required (...) to use their DBTready equipment to screen with digital breast tomosynthesis whenever this is practically possible. Our argument relies on a comparison between digital breast tomosynthesis and a hypothesized improvement in the image quality of digital mammography. (shrink)

Switzerland is internationally known for its progressive animal laws and for its innovative tools in law enforcement. In 1992, the Canton of Zurich introduced a public lawyer vested with the task of representing animals’ interests in criminal procedure, known as the Animal Protection Lawyer. The APL had the power to access information about court proceedings, study pending court cases, and intervene on behalf of victim animals. This enforcement tool set a precedent across the world. It amounted to a recognition of (...) animals as de facto victims and created an “equality of arms” for human and animal parties in criminal procedure. In a historic move in 2014, the Zurich parliament removed the APL from office—by mistake, as some maintain. Meanwhile—unnoticed by many—the Canton of Berne maintained a state agency vested with the very same powers as those the APL had, called the Dachverband Berner Tierschutzorganisationen. Though the DBT operated as an established agency for over 2 decades, in August 2017, a criminal court in Berne denied the DBT standing, arguing that the laws conferring on it the right to represent animals violate the federal law on criminal procedure. In July 2018, the Supreme Court delivered its judgment, and effectively stripped the DBT of its rights to represent animals in criminal proceedings. This article describes these recent shifts in criminal animal law in detail and analyzes the sociopolitical factors that gave rise to them. Special attention is paid to the question of what is left for Switzerland as a role model in animal law given ongoing deregulations, particularly as recent cases in the United States point to an incremental emancipation of animals as victims. The article discusses current alternatives to the APL and the DBT and puts their promises under scrutiny. The analysis reveals that these alternatives skirt the main obstacles faced by animals in criminal procedure and threaten the democratic will of the Swiss people. Two alternatives are discussed that can help Switzerland overcome its insufficiencies: the organizational right to appeal and victim rights for animals in criminal procedure. Using these alternatives, the article calls for the global emancipation of animals as the proper victims of crimes and for furnishing them with correlating rights to enforcement, including rights to representation. (shrink)

This perspective paper aims at discussing theoretical principles that could explain how emotion regulation and physical diseases mutually influence each other in the context of borderline personality disorder (BPD). Furthermore, this paper discusses the clinical implications of the functional relationships between emotion regulation, BPD and medical conditions considering dialectical behavior therapy (DBT) as a well-validated therapeutic intervention, which encompasses these issues. The inflexible use of maladaptive emotion regulation strategies (e.g., suppression, experiential avoidance, and rumination) might directly increase the probability of (...) developing physical diseases through a physiological pathway, or indirectly through a behavioral pathway. Some metabolic and chronic medical conditions could significantly impact emotional functioning through biological alterations involved in emotion regulation. Several empirical studies have shown high co-occurrence rates between BPD and several chronic physical diseases, especially ones linked to emotion-based maladaptive behaviors. DBT addresses physical diseases reported by individuals with BPD reducing problematic behaviors functionally associated to emotion dysregulation and identifying physical health as a goal forBuilding a Life Worth Living. (shrink)

This case study of the feminist drag troupe the Disposable Boy Toys examines the relationship between drag and gender identity. Drawing on multiple methods, the author explores the range of gender identities that emerged through participation in DBT. Members saw DBT as the central catalyst for their own identity shifts. The author suggests that these identity transformations occurred through four collective mechanisms: imaginative possibility, information and resources, opportunities for enactment, and social support. The author finds that DBT served as an (...) identity incubator in which participants were able and encouraged to interrogate, play with, and sometimes adopt new gender identities. The author concludes that context is critical in understanding the meaning and importance of drag. Performing gender in this politicized, feminist context shaped the gender identities of the troupe's members in fundamental and varied ways, suggesting that oppositional communities can be an important venue for identity work. (shrink)

In 1995, a Swedish pilot study of Dialectical Behaviour Therapy (DBT) was launched to investigate its therapeutic efficacy and cost-effectiveness as treatment for Borderline Personality Disorder (BPD) in suicidal women. In the same year, a sweeping reform of psychiatric care commenced, dramatically reducing the number of beds by the end of the decade. The psychiatry reform was presented as an important factor prompting the need for a community-based treatment for Borderline patients. This article suggests that the introduction of DBT in (...) Sweden, and its relationship to the reform, can only be adequately explained with reference to the wider political shift occurring at the time, whereby the Swedish welfare state and its guiding ethos of egalitarianism were abandoned in favour of a neoliberal ‘choice revolution’. With the new liberalism, hard work and individual responsibility replaced the idea of a Swedish ‘people’s home’, a nationwide community and social support network. This language was reflected in DBT, which sought to teach patients the ‘skills’ necessary ‘to create a life worth living’. In this context, therapy was constituted as a form of ‘work’ that the patient had to undertake to improve. Moreover, DBT rejected the prevailing view of Borderline patients as ‘manipulative’ and ‘aggressive’, suggesting instead that they were ‘helpless’, ‘weak’ and unable to regulate their emotions. This new Borderline persona fit neatly into the new liberal discourse: she could be taught to become a rational and independent person able to cope in a society that valued individual responsibility over social support. (shrink)

Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, twenty-nine actively self-harming patients with (...) BPD completed brain-imaging procedures probing activation of the prefrontal cortex during impulse control prior to beginning DBT and after seven months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex prior to beginning treatment, and they showed the greatest increases in activity within this region after seven months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial prefrontal cortex and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right dorsolateral prefrontal cortex even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the prefrontal cortex underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT. (shrink)

Dutch Book Arguments. B is susceptibility to sure monetary loss (in a certain betting set-up), and F is the formal role played by non-Pr b’s in the DBT and the Converse DBT. Representation Theorem Arguments. B is having preferences that violate some of Savage’s axioms (and/or being unrepresentable as an expected utility maximizer), and F is the formal role played by non-Pr b’s in the RT.

This critical review of the literature examines recovery from borderline personality disorder to inform a deeper understanding, identifying supports and barriers to recovery, through the exploration of historical and socio-political influences. It critically evaluates research literature for the effectiveness of recovery concept implementation. This review presents the strengths of current evidence and suggestions for future considerations to better support the recovery of whaiora (people seeking wellness) by taking concepts of connection, empowerment, hope, identity and meaning-making, and interweaving them with aspects (...) of established therapies, such as Dialectal Behaviour Therapy, focussing on interpersonal effectiveness, distress tolerance, creating a life worth living, the reconstruction of stable self-image and the use of mindfulness practice. The focus is on developing interventions and responses that support self-management. (shrink)