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1 – 6 of 6Madeleine Allman, Sophie Kerr, Carmelo Ismael Roldan, Geri Maria Harris and Gerald E. Harris
Autism spectrum disorder (ASD) and borderline personality disorder (BPD) are complex disorders characterized by pervasive symptoms of rigidity, emotion dysregulation and social…
Abstract
Purpose
Autism spectrum disorder (ASD) and borderline personality disorder (BPD) are complex disorders characterized by pervasive symptoms of rigidity, emotion dysregulation and social cognitive difficulties. Comorbid ASD and BPD are recognized emerging clinical problem that may be challenging to treat.
Design/methodology/approach
The authors present a case study of a young person in the authors’ assessment clinic diagnosed with BPD and ASD who had received standard dialectical behavior therapy (DBT) with modest effects. The authors provide ASD-informed recommendations for continued DBT treatment.
Findings
The de-identified patient described in this case report met full criteria for ASD and BPD. The patient’s cognitive, behavioral, social and personality functioning are described in detail.
Practical implications
Other practitioners seeking to treat this complex comorbidity may make use of the authors’ treatment recommendations for their patients. The authors underscore the importance of individualized treatment planning and hope the authors’ exemplar will be useful to others.
Originality/value
Several evidence-based treatments exist for ASD and BPD symptom reduction. However, to the best of the authors’ knowledge, no current treatments exist for comorbid ASD and BPD to target emotion dysregulation in individuals with restricted and repetitive interests and behaviors and disturbances in social and communication domains.
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Matthew David Phillips, Rhian Parham, Katrina Hunt and Jake Camp
Autism spectrum conditions (ASC) and borderline personality disorder (BPD) have overlapping symptom profiles. Dialectical behaviour therapy (DBT) is an established treatment for…
Abstract
Purpose
Autism spectrum conditions (ASC) and borderline personality disorder (BPD) have overlapping symptom profiles. Dialectical behaviour therapy (DBT) is an established treatment for self-harm and BPD, but little research has investigated the outcomes of DBT for ASC populations. This exploratory service evaluation aims to investigate the outcomes of a comprehensive DBT programme for adolescents with a diagnosis of emerging BPD and a co-occurring ASC diagnosis as compared to those without an ASC diagnosis.
Design/methodology/approach
Differences from the start to end of treatment in the frequency of self-harming behaviours, BPD symptoms, emotion dysregulation, depression, anxiety, the number of A&E attendances and inpatient bed days, education and work status, and treatment non-completion rates were analysed for those with an ASC diagnosis, and compared between those with an ASC diagnosis and those without.
Findings
Significant medium to large reductions in self-harming behaviours, BPD symptoms, emotion dysregulation and inpatient bed days were found for those with an ASC diagnosis by the end of treatment. There were no significant differences between those with an ASC and those without in any outcome or in non-completion rates. These findings indicate that DBT may be a useful treatment model for those with an ASC diagnosis, though all results are preliminary and require replication.
Originality/value
To the best of the authors’ knowledge, this is the first study to report the outcomes of a comprehensive DBT programme for adolescents with an ASC diagnosis, and to compare the changes in outcomes between those with a diagnosis and those without.
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Arvid Nikolai Kildahl, Kristin Storvik, Elisabeth Christina Wächter, Tom Jensen, Arvid Ro and Inger Breistein Haugen
Distinguishing between autism characteristics and trauma-related symptoms may be clinically challenging, particularly in individuals who have experienced early traumatisation…
Abstract
Purpose
Distinguishing between autism characteristics and trauma-related symptoms may be clinically challenging, particularly in individuals who have experienced early traumatisation. Previous studies have described a risk that trauma-related symptoms are misinterpreted and/or misattributed to autism. This study aims to describe and explore assessment strategies to distinguish autism and early traumatisation in the case of a young woman with mild intellectual disability.
Design/methodology/approach
A clinical case study outlining assessment strategies, diagnostic decision-making and initial intervention.
Findings
A multi-informant interdisciplinary assessment using multiple assessment tools, together with a comprehensive review of records from previous assessments and contacts with various services, was helpful in distinguishing between autism and trauma. This included specific assessment tools for autism and trauma. Autism characteristics and trauma-related symptoms appeared to interact, not merely co-occur.
Originality/value
The current case demonstrates that diagnostic overshadowing may occur for autism in the context of early trauma. The case further highlights the importance of not ascribing trauma-related symptoms to autism, as service provision and treatment need to take account of both. Overlooking autism in individuals who have experienced early traumatisation may result in a risk that intervention and care are not appropriately adapted, which may involve a risk of exacerbating trauma symptoms.
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Niamh O’Leary, Christian Ryan and Philip Moore
Mentalization-based treatment (MBT) is a psychotherapeutic approach that aims to increase mentalizing capacity. The purpose of this meta-ethnography was to synthesize the…
Abstract
Purpose
Mentalization-based treatment (MBT) is a psychotherapeutic approach that aims to increase mentalizing capacity. The purpose of this meta-ethnography was to synthesize the available qualitative literature on MBT to allow for a more thorough understanding of the lived experience of those who have undergone this therapy.
Design/methodology/approach
A systematic search of seven databases was carried out. The Critical Appraisal Skills Programme was used to appraise the papers suitable for inclusion. The data were synthesized using a meta-ethnographic approach in which the second-order constructs from each paper were translated and reinterpreted creating a line of argument synthesis.
Findings
A total of 11 studies were included in the meta-ethnography. Three overarching themes were identified within the included papers which outlined that participant experience of MBT consisted of three different developmental stages. Navigating the therapeutic process describes the participant’s experience of the therapeutic process of MBT. The processes of change in MBT outlined participant reports of mechanisms of change experienced in MBT. Mentalizing self and others described the experience of generalizing new knowledge and skills to the world outside of therapy and unveiled the impact that engaging in MBT had on participants.
Originality/value
This meta-ethnography offers new insights into how clients experience MBT as a therapeutic process and offers suggestions for implementation in clinical practice as well as areas of focus for research of this therapeutic approach.
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Freya Rumball, Rachel Parker, Ailbhe Elizabeth Madigan, Francesca Happe and Debbie Spain
Autistic individuals are at increased risk of trauma exposure and post-traumatic stress disorder (PTSD). Diagnostic overshadowing, however, often results in PTSD symptoms being…
Abstract
Purpose
Autistic individuals are at increased risk of trauma exposure and post-traumatic stress disorder (PTSD). Diagnostic overshadowing, however, often results in PTSD symptoms being mislabelled as autistic traits. This study aims to develop professional consensus on the identification and assessment of co-occurring PTSD in autistic adults.
Design/methodology/approach
An online modified Delphi design was used to gather professionals’ perspectives on key aspects of the identification and assessment of PTSD in autistic adults. Data were gathered qualitatively in Round 1 and then synthesised using content analysis into a list of statements that were rated in Round 2. Statements reaching 60–79% consensus and additional suggestions were sent out for rating in Round 3. Consensus for the final statement list was set at 80% agreement.
Findings
Overall, 108 statements reached consensus. These form the basis of professional-informed recommendations to facilitate the identification and assessment of PTSD symptoms in autistic adults.
Practical implications
The final Delphi statements provide a framework to assist with the assessment and recognition of traumatic stress reactions in autistic adults presenting to mental health, diagnostic or social services.
Originality/value
To the best of the authors’ knowledge, this is the first study to explore the presentation and identification of PTSD in autistic adults (with and without intellectual disability), using a bottom-up approach informed by professional consensus.
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Michael Haslam and Keir Harding
This discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially…
Abstract
Purpose
This discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially where the diagnostic label of personality disorder intersects with risk.
Design/methodology/approach
Key concepts from Orwell’s 1984 are studied for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices arise from dichotomous thinking and externalised fears.
Findings
Drawing upon Orwellian themes of power, social control and digital surveillance from 1984, the authors highlight the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges.
Research limitations/implications
To transcend damaging dichotomies and reduce restrictive practices in inpatient settings, the authors make the argument for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care.
Originality/value
The authors use Orwell’s novel to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings and to question whose interests’ these restrictive practices serve.
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