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To examine how clinicians navigate providing treatment to Borderline Personality Disorder (BPD) in the context of the DSM 5, deinstitutionalization, and the biomedical model.

We conducted 39 interviews with mental health providers in the United States in a two-year period preceding and following the release of the DSM 5. Using Constructivist Grounded Theory, we analyzed the data for themes that emerged.

Clinicians faced pressures from insurance companies, the DSM categories, and their professional training to focus on biomedical treatments. These treatments, which emphasized pharmaceuticals and short courses of care, were ill-suited to BPD, which has a strong evidence base recommending long-term therapeutic interventions. We term this contradiction a “biomedical mismatch” and use Gidden’s concept of structuration to better understand how clinicians navigate the system of care. Providers ranged in their responses to the mismatch: some championed biomedicine, others were complicit, and a final group behaved as activists, challenging the paradigm. The sum of the strategies had downstream effects which included crisis reinstitutionalization and a discourse of untreatability. Ultimately, we discuss how social factors such as gender bias, stigma, and trauma are insufficiently represented in the biomedical model of care for BPD.

BPD fits poorly within the biomedical underpinnings of the current system. Accordingly, it illuminates the structuration of health care and where the rules of care break down. More precisely, deinstitutionalization was designed to remove patients from long courses of inpatient care. Many patients with BPD have failed to experience this outcome, with some patients now cycling through long courses of short-term crisis reinstitutionalization instead of having effective outpatient care over long periods. This unintended consequence of deinstitutionalization calls for a more biopsychosocial response to BPD.

There is limited research on the mental health of pregnant women in prison in England, mother and baby unit (MBU) applications and associated factors. Eighty-five pregnant women were interviewed in eight different prisons in England, UK. Schedules for the Clinical Assessment of Neuropsychiatry (SCAN) and Edinburgh Postnatal Depression Scale (EPDS) were used to assess mental health; Severity of Dependence Questionnaire (SOD-Q) for drug misuse; Alcohol Use Identification Test (AUDIT) for hazardous drinking and the Structured Clinical Interview for DSM-IV (SCID-II) to identify personality disorder. About 51% of participants had depression and 57% had anxiety. Those with prior social services involvement, diagnosis of personality disorder or history of suicidality were less likely to be admitted to MBUs. The high levels of depression and anxiety can have negative impacts on both the mother and her unborn child. Factors which influence MBU admission suggest those who might benefit most from MBU placement are least likely to be admitted. Other countries offer feasible alternatives to imprisonment for pregnant women and mothers which could be implemented in England.

Stress and the military go hand-in-hand, particularly in combat environments. While some personality traits or types weaken relationships between stress and performance, others, such as psychopathy, may strengthen them. In the present chapter, we consider the ramifications of individuals with high levels of psychopathy or psychopathic tendencies in the military with regard to both their own stress and performance and that of those around them. We discuss different reactions to psychological and physical stress, as well as the implications of psychopathic tendencies as they relate to current military issues, including gender, leadership, teamwork, turnover, post-traumatic stress disorder, and suicide. By juxtaposing relevant research findings on stress and psychopathy, we conclude that psychopathic tendencies should have neither uniformly negative nor positive effects on stress and performance in the military. Rather, effects on such individuals and the peripheral others with whom they interact will likely vary greatly depending on numerous factors.

This chapter documents how the shift in psychiatric representation from the “morally insane” perpetrator of the 19th century to the modern psychopath or person with anti-social personality disorder involves a recasting of the offender from someone afflicted with an illness whose criminal misconduct is merely a symptom of their disorder to someone whose criminal misconduct is perceived as an expression of their true character. Drawing upon recent case law, the article then shows how prosecutors deploy this modern psychiatric reconfiguring during the penalty phase of the US capital trial to persuade jurors to decide in favor of death over life without parole. Central to the building of this narrative is the reframing of the offenders’ silences as well as what are taken as their unconvincing attempts to show remorse as evidence of a pathology whose primary manifestation is the incapacity to feel or experience moral emotions. Applying but also modifying Harold Garfinkel's work on degradation ceremonies, the chapter shows how the pathologizing of the offender's lack of remorse involves a rite of passage in which he or she is symbolically demoted from someone worthy of life in spite of their grievous crime to someone for whom death is the only appropriate penalty.

Purpose – This chapter explores the changing definition of bipolar disorder, examining how debates within psychiatry actually construct the definition of mental illness, thereby creating the appearance of an emerging epidemic with increasing prevalence.

Method – I review the recent psychiatric and epidemiological research to reveal that the intellectual and scientific debates that occur in the psychological laboratory and in survey research are in fact falsely increasing the figures that show that an epidemic of bipolar is emerging.

Findings – For centuries, bipolar disorder was equated with severe psychosis and had a prevalence rate between 0.4% and 1.6%. As spectrum and subthreshold conceptions of bipolar disorder become established in official psychiatric diagnostic manuals, however, estimates of the prevalence of bipolar spectrum disorders have risen to almost 25%. I demonstrate that nearly all of this increase is a result of changes in the scientific and intellectual definition of bipolar disorders among psychiatric professionals, and that rates of symptoms are not in fact increasing.

Contribution to field – The arbitrariness of diagnostic thresholds naturally leads researchers to argue for lower thresholds. This allows more individuals who were previously considered psychiatrically normal to be reclassified as psychiatrically disordered. Lowering diagnostic thresholds increases the risk of confusing normal elation or sadness with disordered states, increasing the potential of false-positive diagnoses and the false impression of rising rates of disorder.

The NCS was based on multistage area probability sample of people age 15–54 in the non-institutionalized civilian population of the coterminous U.S., with a supplemental sample of students living in campus group housing (Kessler et al., 1994). The survey was carried out face-to-face in the homes of respondents by professional interviewers employed by the Survey Research Center (SRC) at the University of Michigan. The survey was carried out between September 1990 and February 1992. The response rate was 82.6%, with a total of 8,098 respondents participating in the survey. A supplemental non-response survey was carried out to adjust for non-response bias, with a random sample of initial non-respondents offered a financial incentive to complete a short form of the diagnostic interview. A non-response adjustment weight was constructed for the main survey data to compensate for elevated rates of disorders found among the initial non-respondents in this non-response survey. Significance tests were made using design-based methods because of this weighting and clustering of the data (Kish & Frankel, 1970; Koch & Lemeshow, 1972; Woodruff & Causey, 1976). More details about design and weighting procedures are reported elsewhere (Kessler, Little et al., 1995).

Purpose – Over the last years, in the United States there has been significant increase in the consumption of pharmaceuticals for the treatment of mental disorders. More specifically, the number of clinical diagnosis of bipolar disorders in young people has increased by 40 times over the last 10 years. The purpose of this chapter is to analyse the growth of bipolar disorder diagnosis using a sociological frame.

Methodology/approach – The methodology is based on the concepts proposed by the ‘conflictualist’ perspective of medical sociology. Medicalization, that is, the extension of medical categories in everyday life, is the main concept on which the chapter is constructed. The ‘syndromization’ of the Diagnostic and Statistical Manual of Mental Disorders lowers the threshold above which someone may be diagnosed with bipolarism. Moreover, advertisements push people to seek for pharmaceutical treatment for conditions of ‘normal’ sadness.

Findings – This work shows the importance of the analysis of ‘medical’ phenomena by approaches taken from social sciences. Bipolar disorder can be a terrible and painful disease, but it seems that there is the possibility that it is over-diagnosed.

Contribution to the field – In this epidemics of diagnosis of bipolar disorder it is central to integrate the medical perspective with other dimensions: the classification of mental disease, the advertisement for drugs and the cultural aspects of a given society.

Research in industrial and organizational psychology demonstrates that the regulation of negative emotions in response to both organizational stressors and interpersonal workplace interactions can result in functional and dysfunctional outcomes (Côté, 2005; Diefendorff, Richard, & Yang, 2008). Research on the regulation of negative emotions has additionally been conducted in social psychology, developmental psychology, neuropsychology, health psychology, and clinical psychology. A close reading of this broader literature, however, reveals that the conceptualization and use of the term “emotion regulation” varies within each research field as well as across these fields. The main focus of our chapter is to make sense of the term “emotion regulation” in the workplace by considering its use across a broad range of psychology disciplines. We then develop an overarching theoretical framework using disambiguating terminology to highlight what we argue are the important constructs involved in the process of intrapersonal emotion generation, emotional experience regulation, and emotional expression regulation in the workplace (e.g., emotional intelligence, emotion regulation strategies, emotion expression displays). We anticipate this chapter will enable researchers and industrial and organizational psychologists to identify the conditions under which functional regulation outcomes are more likely to occur and then build interventions around these findings.