Note

Hyperlinks for some authors' names lead to the relevant abstract in the PubMed Database of the National Library of Medicine. Abstracts from some of the more recent articles appearing in Cognitive and Behavioral Practice have been included with permission from the Association for Behavioral and Cognitive Therapies (formerly known as the Association for the Advancement of Behavior Therapy).

Personality Disorder Articles

Abraham, R.E., Van, H.L., van Foeken, I., Ingenhoven, T.J., Tremonti, W., Pieper-de Vries, I., de Groot, J., van't Spijker, A., & Spinhoven, P. (2001). The developmental profile. Journal of Personality Disorders, 15(5), 457-473.

Abrams, R.C. (1996). Personality disorders in the elderly. International Journal of Geriatric Psychiatry, 11(9), 759-763.

Alpert, J.E., & Spillmann, M.K. (1997). Psychotherapeutic approaches to aggressive and violent patients. Psychiatric Clinics of North America, 20(2), 453-472. Review.

Appelbaum, P.S. (2003). Law & psychiatry: Dangerous persons, moral panic, and the uses of psychiatry. Psychiatric Services, 54(4), 441-442.

Bajaj, P., & Tyrer, P. (2005). Managing mood disorders and comorbid personality disorders. Current Opinion in Psychiatry, 18(1), 27-31.

Ball, S.A., & Young, J.E. (2000). Dual focus schema therapy for personality disorders and substance dependence: Case study results. Cognitive and Behavioral Practice, 7, 270-281.

We review the theory, techniques, and development of a manual-guided individual psychotherapy for substance-dependent individuals diagnosed with personality disorders. Dual Focus Schema Therapy (DFST) integrates relapse prevention for substance dependence with targeted work on early maladaptive schemas (enduring negative beliefs about oneself, others, and events) and coping styles. The first 3 patients (one each from DSM-IV Axis II Cluster A, B, and C) treated during the pilot testing phase of the manual are summarized to illustrate differences in psychopathology, personality and interpersonal functioning, early maladaptive schemas and coping styles, and treatment response.

Bateman, A.W., & Fonagy, P. (2003). The development of an attachment-based treatment program for borderline personality disorder. Bulletin of the Menninger Clinic, 67(3), 187-211.

Bateman, A., & Fonagy, P. (2003). Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. American Journal of Psychiatry, 160(1), 169-71.

Beck, A.T., Butler, A.C., Brown, G.K., Dahlsgaard, K.K., Newman, C.F., & Beck, J.S. (2001). Dysfunctional beliefs discriminate personality disorders. Behaviour Research and Therapy, 39(10), 1213-1225.

Becker, C.B. (2002). Integrated behavioral treatment of comorbid OCD, PTSD, and Borderline Personality Disorder: A case report. Cognitive and Behavioral Practice, 9(2), 100-110.

Ben-Porath, D.D. (2004). Intersession telephone contact with individuals diagnosed with borderline personality disorder: Lessons from dialectical behavior therapy. Cognitive and Behavioral Practice, 11, 222-230.

Therapists often struggle with managing intersession contact with clients diagnosed with borderline personality disorder, particularly when dangerous and life-threatening symptoms are communicated (Gunderson, 1996). Difficulties have arisen, in part, because previous phone contacts with this population have failed to recognize the importance of learning principles when assisting therapists when managing out-of-session contact with this population. Dialectical Behavior Therapy (DBT), a comprehensive, cognitive-behavior treatment, offers promise by providing structured telephone contacts with individuals diagnosed with borderline personality disorder that emphasize the role of learning principles (Linehan, 1993). This article describes the functions of DBT telephone coaching and describes several phone coaching techniques. In addition, five impediments are identified that therapists are likely to encounter when conducting and implementing DBT telephone coaching. Solutions to overcoming these impediments are addressed using the DBT model as a reference.

Ben-Porath, D.D., Peterson, G.A., & Smee, J. (2004). Treatment of individuals with borderline personality disorder using dialectical behavior therapy in a community mental health setting: Clinical application and a preliminary investigation. Cognitive and Behavioral Practice, 11, 424-434.

This article describes an effort to implement and examine dialectical behavior therapy's (DBT) effectiveness in a community mental health setting. Modifications made to address unique aspects of community mental health settings are described. Barriers encountered in implementation of DBT treatment in community mental health settings, such as staff turnover, maintaining fidelity to the treatment model, staff selection, and structuring skills training, are discussed. Preliminary data are presented that examine the effectiveness of DBT in a group of indigent clients receiving treatment at a community mental health center who have comorbid diagnoses of borderline personality disorder and a severe mental illness on Axis I.

Bender, D.S., Farber, B.A., Sanislow, C.A., Dyck, I.R., Geller, J.D., & Skodol A.E. (2003). Representations of therapists by patients with personality disorders. American Journal of Psychotherapy, 57(2), 219-236.

Blum, N., Pfohl, B., John, D.S., Monahan, P., & Black, D.W . (2002). STEPPS: A cognitive-behavioral systems-based group treatment for outpatients with borderline personality disorder--A preliminary report. Comprehensive Psychiatry, 43(4), 301-310.

Bergman, B., & Eckerdal. A. (2000). Professional skills and frame of work organization in managing borderline personality disorder. Shared philosophy or ambivalence--a qualitative study from the view of caregivers. Scandinavian Journal of Caring Sciences, 14(4), 245-252.

Bertolote, J.M., Fleischmann, A., De Leo, D., & Wasserman, D. (2004). Psychiatric diagnoses and suicide: Revisiting the evidence. Crisis, 25(4), 147-155.

Black, D.W., & Noyes, R. (1997). Obsessive-compulsive disorder and axis II. International Review of Psychiatry, 9(1), 111-118.

Blackburn, R. (2000). Treatment or incapacitation? Implications of research on personality disorders for the management of dangerous offenders. Legal and Criminological Psychology, 5(Part1), 1-21.

Board, B.J. (2005). Disordered personalities at work. Psychology, Crime & Law, 11(1), 17-32.

Bond, M., & Perry, C.J. (2004). Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety, and personality disorders. American Journal of Psychiatry, 161(9), 1665-1671.

Borderline personality: New recommendations. Harvard Mental Health Letter, 18(9), 4-6. [No authors listed.]

Bourke, M.L., & Van Hasselt, V.B. (2001). Social problem-solving skills training for incarcerated offenders. A treatment manual. Behavior Modification, 25(2), 163-188.

Brieger, P., Ehrt, U., Bloeink, R., & Marneros, A. (2002). Consequences of comorbid personality disorders in major depression. Journal of Nervous and Mental Disorders, 190(5), 304-309.

Chiesa, M., Fonagy, P., Holmes, J., & Drahorad, C. (2004). Residential versus community treatment of personality disorders: A comparative study of three treatment programs. American Journal of Psychiatry, 161(8), 1463-1470.

Chiesa, M., & Fonagy, P. (2003). Psychosocial treatment for severe personality disorder. 36-month follow-up. British Journal of Psychiatry, 183, 356-362.

Chiesa, M., Fonagy, P., & Holmes, J. (2003). When less is more: An exploration of psychoanalytically oriented hospital-based treatment for severe personality disorder. International Journal of Psychoanalysis, 84(3), 637-650.

Daghestani, A.N., Dinwiddie, S.H., & Hardy, D.W. (2001). Antisocial personality disorders in and out of correctional and forensic settings. Psychiatric Annals, 31(7), 441-446.

Davies, S., & Campling, P. (2003). Therapeutic community treatment of personality disorder: Service use and mortality over 3 years' follow-up. British Journal of Psychiatry, 44, Supplement, 24s-27s.

DeBattista, C., & Mueller, K. (2001). Review of the literature: Is electroconvulsive therapy effective for the depressed patient with comorbid borderline personality disorder? Journal of ECT, 17(2), 91-98.

DeLeo, D., Scocco, P., & Meneghel, G. (1999). Pharmacological and psychotherapeutic treatment of personality disorders in the elderly. International Psychogeriatrics, 11(2), 191-206.

de Groot, M.H., Franken, I.H.A., van der Meer, C.W., & Hendriks, V.M. (2003). Stability and change in dimensional ratings of personality disorders in drug abuse patients during treatment. Journal of Substance Abuse Treatment, 24(2), 115-120.

Derks, F.C.H. (1996). A forensic day treatment program for personality-disordered criminal offenders. International Journal of Offender Therapy and Comparative Criminology, 40(2), 123-134.

Dersh, J., Polatin, P.B., & Gatchel, R.J. (2002). Chronic pain and psychopathology: Research findings and theoretical considerations. Psychosomatic Medicine, 64(5), 773-786.

Diamond, D., Stovall-McClough, C., Clarkin, J.F., & Levy, K.N. (2003). Patient-therapist attachment in the treatment of borderline personality disorder. Bulletin of the Menninger Clinic, 67(3), 227-259.

Duberstein, P.R. (2001). Are close-minded people more open to the idea of killing themselves? Suicide & Life-Threatening Behavior, 31(1), 9-14.

Endler, N.S., & Kocovski, N.L. (2002). Personality disorders at the crossroads. Journal of Personality Disorders, 16(6) 487-502.

Enns, M.W., Swenson, J.R., McIntyre, R.S., Swinson, R.P., Kennedy, S.H., & CANMAT Depression Work Group. (2001). Clinical guidelines for the treatment of depressive disorders. VII. Comorbidity. Canadian Journal of Psychiatry, 46, Supplement 1, 77S-90S.

Eskedal, G.A. (1998). Personality disorders and treatment: A therapeutic conundrum. Journal of Adult Development, 5(4), 255-260.

Farabaugh, A., Mischoulon, D., Fava, M., Guyker, W., & Alpert, J. (2004). The overlap between personality disorders and major depressive disorder (MDD). Annals of Clinical Psychiatry, 16(4), 217-224.

Farrell, J.M., & Shaw, I.A. (1994). Emotional Awareness Training: A prerequisite to effective cognitive-behavioral treatment of borderline personality disorder. Cognitive and Behavioral Practice, 1, 71-91.

Fava, M., Farabaugh, A.H., Sickinger, A.H., Wright, E., Alpert, J.E., Sonawalla, S., Nierenberg, A.A., & Worthington, J.J. 3rd. (2002). Personality disorders and depression. Psychological Medicine, 32(6), 1049-1057.

Fisher, M.S., & Bentley, K.J. (1996). Two group therapy models for clients with a dual diagnosis of substance abuse and personality disorder. Psychiatric Services, 47(11), 1244-1250.

Flannery, R.B., Perry, J.D., & Harvey, M.R. (1993). A structured stress-reduction group approach modified for victims of psychological trauma. Psychotherapy, 30(4), 646-650.

Frankenburg, F.R., & Zanarini, M.C. (2004). The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization. Journal of Clinical Psychiatry, 65(12), 1660-1665.

Freeman A, & Jackson, J. (1996). Single session treatment of a borderline personality disorder. Cognitive and Behavioral Practice, 3(1), 183-208.

Freeman, A., & Rosenfield, B. (2002). Modifying therapeutic homework for patients with personality disorders. Journal of Clinical Psychology, 58(5), 513-24.

Gabbard GO. (2003). Miscarriages of psychoanalytic treatment with suicidal patients. International Journal of Psycho-Analysis, 84(Pt 2), 249-261.

Gabbard, G.O. (2001). A contemporary psychoanalytic model of countertransference. Journal of Clinical Psychology, 57(8), 983-991. Review.

Galloway, V.A., & Brodsky, S.L. (2003). Caring less, doing more: The role of therapeutic detachment with volatile and unmotivated clients. American Journal of Psychotherapy, 57(1), 32-38.

Gomberoff, M.J., Noemi, C.C., & Pualuan de Gomberoff, L. (1990). The autistic object: Its relationship with narcissism in the transference and countertransference of neurotic and borderline patients. International Journal of Psycho-Analysis, 71, 249-259.

Golding, M., & Perkins, D.O. (1996). Personality disorders in HIV infection. International Review of Psychiatry, 8(2-3), 253-258.

Grande, T., Rudolf, G., Oberbracht, C., & Pauli-Magnus, C. (2003). Progressive changes in patients' lives after psychotherapy: Which treatment effects support them? Psychotherapy Research, 13(1), 43-58.

Green A. (2002). A dual conception of narcissism: Positive and negative organizations. The Psychoanalytic Quarterly, 71(4), 631-649.

Green, B. & Wood, S. (2004). Personality disorder: Attitudes, understanding and treatment. Nursing Times, 100(46), 40-43.

Harney, P.A., Lebowitz, L, & Harvey, M.R. (1997). A stage by dimension model of trauma recovery: Application to practice. In Session: Psychotherapy in Practice, 3(4), 91-103.

Hingley, S.M. (2001). Psychodynamic theory and narcissistically related personality problems: Support from case study research. The British Journal of Medical Psychology, 74 (Pt. 1), 57-72.

Hoffart, A., & Sexton, H. (2002). The role of optimism in the process of schema-focused cognitive therapy of personality problems. Behaviour Research and Therapy, 40(6), 611-623.

Hoffman, S.G., Lippe, W., & Bufka, L.F. (1999). Why do personality disorders change? Possible explanations from cognitive and psychodynamic models. Psychiatric Annals, 29(12), 725-729.

Horton, P.C. (1976). The psychological treatment of personality disorder. American Journal of Psychiatry, 133(3), 262-265.

Hudziak, J.J., Boffeli, T.J., Kriesman, J.J., Battaglia, M.M., Stanger, C., & Gruze, S.B. (1996). Clinical study of the relation of borderline personality disorder to Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders. American Journal of Psychiatry, 153(12), 1598-1606.

Huffman, J.C., Stern, T.A., Harley, R.M., & Lundy, N.A. (2003). The use of DBT skills in the treatment of difficult patients in the General Hospital. Psychosomatics, 44(5), 421-429.

Huprich, S.K. (2001). The overlap of depressive personality disorder and dysthymia, reconsidered. Harvard Review of Psychiatry, 9(4), 158-168.

Hyler, S.E., & Schanzer, B. (1997). Using commercially available films to teach about borderline personality disorder. Bulletin of the Menninger Clinic, 61(4), 458-468.

Jones, D., & Hollin, C.R. (2004). Managing problematic anger: The development of a treatment program for personality disordered patients in high security. International Journal of Mental Health, 3(2), 197-210.

Kazdin, A.E., & Whitley M.K. (2003). Treatment of parental stress to enhance therapeutic change among children referred for aggressive and antisocial behavior. Journal of Consulting and Clinical Psychology, 71(3), 504-515.

Kelly, K.A. (1993). Multiple personality disorders: Treatment coordination in a partial hospital setting. Bulletin of the Menninger Clinic, 57(3), 390-398.

Kernberg O.F. (2003). The management of affect storms in the psychoanalytic psychotherapy of borderline patients. Journal of the American Psychoanalytic Association, 51(2), 517-545.

Kernberg, O. (1998). Narcissistic personality disorders. Journal of European Psychoanalysis, 7, 7-18.

Kern, R.S., Kuehnel, T.G., Teuber, J., & Hayden, J.L. (1997). Multimodal cognitive-behavior therapy for borderline personality disorder with self-injurious behavior. Psychiatric Services, 48(9), 1131-1133.

Kohut, H., & Wolf, E.S. (1978). The disorders of the self and their treatment: An outline. International Journal of Psycho-Analysis, 59, 413-425.

Kirkman, C.A. (2002). Non-incarcerated psychopaths: Why we need to know more about the psychopaths who live amongst us. Journal of Psychiatric and Mental Health Nursing, 9(2), 155-160.

Kosky, N., & Thorne, P. (2001). Personality disorder: The rules of engagement. International Journal of Psychiatry in Clinical Practice, 5(3), 169-172.

Kunst, J.L. (2002). Fraught with the utmost danger: The object relations of mothers who kill their children. Bulletin of the Menninger Clinic, 66(1), 19-38.

Larsson, J.O., & Hellzen, M. (2004). Patterns of personality disorders in women with chronic eating disorders. Eating and Weight Disorders, 9(3), 200-205.

Leichsenring, F., & Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: A meta-analysis. American Journal of Psychiatry, 160(7), 1223-1232.

Leihener, F., Wagner, A., Haaf, B., Schmidt, C., Lieb, K., Stieglitz, R., & Bohus M. (2003). Subtype differentiation of patients with borderline personality disorder using a circumplex model of interpersonal behavior. Journal of Nervous and Mental Disease, 191(4), 248-254.

Lewis, S.F., Fremouw, W.J., Del Ben, K., & Farr, C. (2001). An investigation of the psychological characteristics of stalkers: Empathy, problem-solving, attachment and borderline personality features. Journal of Forensic Science, 46(1), 80-84.

Linehan, M.M., Cochran, B.N., Mar, C.M., Levensky, E.R., & Comtois, K.A. (2000). Therapeutic burnout among borderline personality disordered clients and their therapists: Development and evaluation of two adaptations of the Maslach Burnout Inventory. Cognitive and Behavioral Practice, 7, 329-337.

Providers of psychotherapy services are likely to become emotionally exhausted, to depersonalize their clients, and to have diminished personal accomplishment as a consequence of treating "difficult" clients. This pattern, termed burnout, has recently received considerable empirical attention. Whereas previous researchers have explored burnout as an occupational phenomenon, we propose that both therapists and clients experience burnout reciprocally; that is, both providers and recipients can become burned out from the therapy process. We administered a modified version of the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1986) to clients receiving psychosocial treatment for borderline personality disorder (BPD) both prior to therapy and 4 months into treatment and a modified therapist version of the MBI to their therapists. We predicted that client difficulty (depression, anger, and suicidality) would be related to therapist burnout, and that high expectancies of therapy would be related to increased burnout for both clients and therapists at 4 months. Whereas the first prediction was not supported, we did find some support for the relationship between expectancies and burnout. Post hoc analyses also revealed an interesting pattern: The most reliable predictor of therapist burnout at 4 months was client burnout at pretreatment. Implications of this interaction between client burnout and the therapists' responses are discussed.

Links, P.S., & Stockwell, M. (2002). The role of couple therapy in the treatment of narcissistic personality disorder. American Journal of Psychotherapy, 56(4), 522-38.

Livesley, W.J. (2000). A practical approach to the treatment of patients with borderline personality disorder. Psychiatric Clinics of North America, 23(1), 211-232. Review.

Maden, A., Williams, J., Wong, S.C.P., Leis, T.A. (2004). Treating dangerous and severe personality disorder in high security: Lessons from the Regional Psychiatric Centre, Saskatoon, Canada. Journal of Forensic Psychiatry & Psychology, 15(3), 375-390.

Martens, W.H.J. (2004). Therapeutic use of humor in antisocial personalities. Journal of Contemporary Psychotherapy, 34(4), 351-361.

Martens, W.H. (2001). Agitation therapy for antisocial and psychopathic personalities: An outline. American Journal of Psychotherapy, 55(2), 234-250.

Meares, R. (1996). The psychology of self: An update. Australian and New Zealand Journal of Psychiatry, 30(3), 312-316. Review.

Martens, W.H. (2003). A case study of an extremely violent serial rapist with borderline personality disorder in remission. Acta Psychiatrica Scandinavica, 107(6), 465-466; discussion 466-467.

McDonald Jr., J.J. (2002). Personality disorders in employment litigation. Psychiatric Times, 19(4); see http://www.mhsource.com/pt/p020459.html.

McGinn L.K., Young, J.E., & Sanderson, W.C. (1995). When and how to do longer-term therapy...without feeling guilty. Cognitive and Behavioral Practice, 2, 187-212.

McKay, J.R., & Buka, S.L. (1994). Issues in the treatment of antisocial adolescent substance abusers. Journal of Child and Adolescent Substance Abuse, 3(2), 59-81.

McNeal, S. (2003). A character in search of character: Narcissistic Personality Disorder and Ego State Therapy. American Journal of Clinical Hypnosis, 45(3) 233-243.

McQuillan, A., Nicastro, R., Guenot, F., Girard, M., Lissner, C., & Ferrero, F. (2005). Intensive dialectical behavior therapy for outpatients with borderline personality disorder who are in crisis. Psychiatric Services, 56(2), 193-197.

McVey D, & Murphy, N. (2001). Young's therapy for clients with personality disorders. Nursing Times, 97(16), 34-35.

Messina, N., Farabee, D., & Rawson R. (2003). Treatment responsivity of cocaine-dependent patients with antisocial personality disorder to cognitive-behavioral and contingency management interventions. Journal of Consulting and Clinical Psychology, 71(2), 320-329.

Miller, B.C. (1995). Characteristics of effective day treatment programming for persons with borderline personality disorder. Psychiatric Services, 46(6), 605-608.

Miller, A.L., Wyman, S.E., Huppert, J.D., Glassman, S.L., & Rathus, J.H. (2000). Analysis of behavioral skills utilized by suicidal adolescents receiving dialectical behavior therapy. Cognitive and Behavioral Practice, 7, 183-187.

Researchers are currently applying dialectical behavior therapy (DBT), originally developed for adult chronically parasuicidal women diagnosed with borderline personality disorder (BPD), to a suicidal adolescent population diagnosed with BPD or borderline features. The four characteristic problem areas often found among these multiproblem patients are (a) confusion about self, (b) impulsivity, (c) emotional instability, and (d) interpersonal problems. DBT employs four corresponding behavioral skills modules aimed at increasing adaptive behaviors while simultaneously reducing maladaptive behaviors. The four skill modules include mindfulness skills, distress tolerance skills, emotion-regulation skills, and interpersonal effectiveness skills. The present study examines adolescent self-report of the helpfulness and overall effectiveness of these skills by using pre- and posttreatment evaluations. Consistent with prior research with DBT with adolescents, this study found significant reductions in BPD symptoms in all four problem areas. The four most highly rated skills included distress tolerance and mindfulness skills. Relationships found between the helpfulness of specific skills and improvement in particular problem areas are discribed. Lastly, implications for future research of DBT skill comprehension and application among adolescents are discussed.

Miller, M.C. (2001). Personality disorders. The Medical Clinics of North America, 85(3), 819-837. Review.

Narud, K., Mykletun, A., & Dahl, A.A. (2003). Experienced therapists' opinions on central issues in psychodynamic psychotherapy of patients with personality disorders. Nordic Journal of Psychiatry, 57(6), 461-467.

Nemeroff, C.B., Compton, M.T., & Berger, J. (2001). The depressed suicidal patient. Assessment and treatment. Annals of the New York Academy of Sciences, 932, 1-23. Review.

Nehls, N. (2000). Recovering: A Process of empowerment. ANS. Advances in Nursing Science, 22(4), 62-70. (Review; discusses treatment of Borderline Personality Disorder).

Nehls, N. (2000). Being a case manager for persons with borderline personality disorder: Perspectives of community mental health center clinicians. Archives of Psychiatric Nursing, 14(1), 12-18.

Norton, J.W. (2000). Personality disorders in the primary care setting. Nurse Practitioner, 25(12), 40-42, 51, 55-58.

Norton, K., & Hinshelwood, R.D. (1996). Severe personality disorder: Treatment issues and selection for inpatient psychotherapy. British Journal of Psychiatry, 168(6), 723-731.

Offringa, G.A., & Goff, D. (1995). Dissociative disorder, psychosis, or both? Harvard Review of Psychiatry, 3(4), 222-226.

Ogrodniczuk, J.S., & Piper, W.E. (2001). Day treatment for personality disorders: A review of research findings. Harvard Review of Psychiatry, 9(3), 105-117.

Oldham, J.M., & Skodol, A.E. (1992). Personality disorders and mood disorders. American Psychiatric Press Review of Psychiatry, 11, 418-435.

Palmer, R.L., Birchall, H., Damani, S., Gatward, N., McGrain, L., & Parker, L. (2003). A dialectical behavior therapy program for people with an eating disorder and borderline personality disorder--Description and outcome. International Journal of Eating Disorders, 33(3), 281-286.

Paris, J. (2002). Chronic suicidality among patients with borderline personality disorder. Psychiatric Services, 53(6), 738-742.

Paris, J. (1997). Antisocial and borderline personality disorders: Two separate diagnoses or two aspects of the same psychopathology? Comprehensive Psychiatry, 38(4), 237-242.

Paris, J. (1997). Childhood trauma as an etiological factor in the personality disorders. Journal of Personality Disorders, 11(1), 34-49.

Parker L. (2001). Dialectical behavioural therapy: A working perspective. Nursing Times, 97(4), 38-39.

Pinkofsky, H.B. (1997). Mnemonics for DSM-IV personality disorders. Psychiatric Services, 48(9), 1197-1198.

Plakun, E.M. (1996). Treatment of personality disorders in an era of limited resources. Psychiatric Services, 47(2), 128-130.

Pontius, A.A. (2001). Two bankrobbers with "antisocial" and "schizoid/avoidant" personality disorders, comorbid with partial seizures: Temporal lobe epilepsy and limbic psychotic trigger reaction, respectively. Journal of Developmental & Physical Disabilities, 13(2), 191-197.

Posternak, M.A, & Zimmerman, M. (2002). Anger and aggression in psychiatric outpatients. Journal of Clinical Psychiatry, 63(8), 665-672.

Reisch, T., Thommen, M., Tschacher, W., & Hirsbrunner, H.P. (2001). Outcomes of a cognitive-behavioral day treatment program for a heterogeneous patient group. Psychiatric Services, 52(7), 970-972.

Rey, J.M. (1996). Antecedents of personality disorders in young adults. Psychiatric Times, 13(2); see http://www.mhsource.com/pt/p960237.html.

Rice, A.H. (2003). Interpersonal problems of persons with personality disorders and group outcomes. International Journal of Group Psychotherapy, 53(2), 155-175.

Rizvi, S.L., & Linehan, M.M. (2001). Dialectical behavior therapy for personality disorders. Current Psychiatry Reports, 3(1), 64-69.

Rosie, J.S. (1998). Services for patients with personality disorder. Canadian Journal of Psychiatry, 43(9), 955-956.

Rutan, J.S., & Rice, C.A. (2000). Personality disorders: Group psychotherapy as a treatment of choice. Journal of Psychotherapy in Independent Practice, 1(2), 3-11.

Rutter, D., & Tyrer, P. (2003). The value of therapeutic communities in the treatment of personality disorder: A suitable place for treatment? Journal of Psychiatric Practice, 9(4), 291-302.

Salekin, R.T. (2002). Psychopathy and therapeutic pessimism. Clinical lore or clinical reality? Clinical Psychology Review, 22(1), 79-112.

Sansone, R.A., Fine, M.A., & Sansone, L.A. (1994). An integrated psychotherapy approach to the management of self-destructive behavior in eating disorder patients with borderline personality disorder. Eating Disorders: The Journal of Treatment and Prevention, 2(3), 251-260.

Saper, J.R., & Lake, A.E. 3rd. (2002). Borderline personality disorder and the chronic headache patient: Review and management recommendations. Headache, 42(7), 663-674.

Sarol-Kulka, A. (2001). Group dynamics in psychotherapy of patients with personality disorders. Archives of Psychiatry & Psychotherapy, 3(1), 31-41.

Saverimuttu, A., & Lowe, T.(2000). Aggressive incidents on a psychiatric intensive care unit. Nursing Standards, 14(35), 33-36.

Shea, S.C. (1998). The chronological assessment of suicide events: A practical interviewing strategy for the elicitation of suicidal ideation. Journal of Clinical Psychiatry, 59(suppl 20), 58-72.

Sher, K.J., & Trull, T.J. (2002). Substance use disorder and personality disorder. Current Psychiatry Reports, 4(1), 25-29. Review.

Shahar, G., Blatt, S.J., Zuroff, D.C., & Pilkonis P.A. (2003). Role of perfectionism and personality disorder features in response to brief treatment for depression. Journal of Consulting and Clinical Psychology, 71(3), 629-633.

Sherman, M.E., Burns, K., Ignelzi, J., Raia J., Lofton, V., Toland, D., Stinson, B., Tilley, J.L., & Coon, T. (2001). Firearms risk management in psychiatric care. Psychiatric Services, 52(8), 1057-1061.

Skodol, A.E., Gunderson, J.G., Pfohl, B., Widiger, T.A., Livesley, W.J., & Siever L.J. (2002). The borderline diagnosis I: Psychopathology, comorbidity, and personality structure. Biological Psychiatry, 51(12), 936-950.

Silk, K.R., & Yager, J. (2003). Suggested guidelines for e-mail communication in psychiatric practice. Journal of Clinical Psychiatry, 64(7), 799-806.

Skodol, A.E., Siever, L.J., Livesley, W.J., Gunderson, J.G., Pfohl, B., & Widiger, T.A. (2002). The borderline diagnosis II: Biology, genetics, and clinical course. Biological Psychiatry, 51(12), 951-963.

Smith, G.W., Ruiz-Sancho, A., & Gunderson, J.G. (2001). An intensive outpatient program for patients with borderline personality disorder. Psychiatric Services, 52(4), 532-533.

Soloff, P.H., Lis, J.A., Kelly, T., Cornelius, J., & Ulrich, R. (1994). Risk factors for suicidal behavior in borderline personality disorder. American Journal of Psychiatry, 151(9), 1316-1323.

Sperry, L. (2002). From psychopathology to transformation: Retrieving the developmental focus in psychotherapy. Journal of Individual Psychology, 58(4), 398-421.

Stein, M.B., Chavira, D.A., & Jang, K.L. (2001). Bringing up bashful baby. Developmental pathways to social phobia. The Psychiatric Clinics of North America, 24(4), 661-675.

Stein, D.J., Hollander, E., & Skodol, A.E. (1993). Anxiety disorders and personality disorders: A review. Journal of Personality Disorders, 7(2), 87-104.

Stevenson, J., Meares, R., Comerford, A. (2003). Diminished impulsivity in older patients with borderline personality disorder. American Journal of Psychiatry, 160(1) 165-166.

Stewart, D., & Harmon, K. (2004). Mental health services responding to men and their anger. International Journal of Mental Health Nursing, 13(4), 249-254.

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The primary aim of this article is to describe modifications made to Dialectical Behavior Therapy (DBT) for a predominantly ethnic minority population of persons living with HIV/AIDS with substance-use diagnoses and borderline personality disorder (BPD) or three features of BPD plus suicidality (i.e., the triply diagnosed). Despite the myriad psychosocial needs of the triply diagnosed, there remains a dearth of treatments available that can adequately address the challenges presented by these individuals' dual diagnostic and HIV status. The key modifications we developed and describe in this article are (a) modification of Stage One, Target 2, behaviors to include HIV treatment adherence targets; (b) new and modified standard skills that address needs of the triply diagnosed client including methadone clinic-relevant skills and adherence skills; (c) expansion of the role of the therapist consultation group to include the DBT Therapist Path to HIV/AIDS Competence and HIV-related psychotherapy themes; and (d) use of a Consumer Advisory Board to provide consultation and feedback on treatment adaptations. A case study is presented that illustrates these modifications.

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The most salient characteristic of the psychopath is the propensity to engage in maladaptive and inappropriate behavior of all sorts, including antisocial and criminal actions. Consequently, there is considerable interest - particularly in the field of criminology - in determining what sorts of treatment interventions are likely to be effective in modifying the problematic behavioral tendencies of this difficult population. We suggest that interventions are most likely to meet with success if they are based on an accurate understanding of the cognitive deficits that underlie psychopaths' tendency to engage in maladaptive and illegal acts. Herein, we describe a theoretical framework for conceptualizing psychopaths' information processing deficits (in which the concepts of automatic information processing and implicit cognition play central roles), then discuss implications of this formulation for the design and implementation of treatment interventions.

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*In Session: Psychotherapy in Practice merged with the Journal of Clinical Psychology in 1/99.