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The aim of this study is to explore the dual-experiences of AN recovered service providers. Prognoses for anorexia nervosa (AN) and anorexia nervosa-like (AN-like) presenting patients remain poor, and notably, no current treatment approach is reliably successful. Past research into AN has focused on singular experiences, those of either AN patients or those of practitioners providing treatment, but has yet to explore the experiences of recovered AN service users now working as AN service providers.

In this study, four UK-based female participants shared their dual experiences of treatment for AN or AN-like presentations through individual semi-structured interviews. Data collection and analysis were conducted in accordance with an Interpretative Phenomenological Analysis methodology.

Analysis revealed four primary themes, including barriers to accessing services; the impact of treating professionals’ approaches; displacement of responsibility for treating AN; and the value of dual-experience of AN.

This study focuses on AN and AN-like presentations and does not address the other eating disorders. Additionally, only female-identifying individuals volunteered their participation. As such, this study is notably lacking the voices of individuals of other genders.

Participant narratives suggest that improvements in the treatment of AN lie in improving professionals’ understanding of – and compassion towards – this patient group to optimise the power of the therapeutic relationship across all AN-treating professions.

Participants revealed a pervasive misunderstanding of AN among treating professionals that is hindering patients’ treatment and suggested that lived experience can be an asset in a professional context.

Individuals with dual experiences of AN can provide a unique and reflective insight into experiences of treatment through their combined personal and professional expertise and elucidate the experiences that both helped and hindered their own recovery.

The UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder.

A scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable.

Ten papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients.

The shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective.

Borderline personality disorder (BPD) is a debilitating illness characterised by a pervasive pattern of emotional instability, interpersonal difficulties and impulsive behaviour in association with repeated self-injury and chronic suicidal ideation. People diagnosed with BPD also have high rates of co-occurring psychopathology, including disorders associated with disturbed impulse control, such as substance use disorder (SUD) and disordered eating behaviours. The co-occurrence of BPD and impulse control disorders contributes to the severity and complexity of clinical presentations and negatively impacts the course of treatment and recovery. This study qualitatively documents aspects of the lived experience and recovery journeys of people diagnosed with BPD and co-occurring SUD and/or disordered eating. This study aims to identify similarities with respect to themes reported at different stages of the recovery process, as well as highlight important factors that may hinder and/or foster recovery.

In-person, in-depth, semi-structured interviews were conducted with 12 specialist service consumers within a clinical setting. Ten women and two men (22–58 years; mean: 35.5 years) were recruited. Interview transcripts were analysed using thematic analysis principles.

As expected, participants with co-occurring disorders experienced severe forms of psychopathology. The lived experience descriptions aligned with the proposition that people with BPD engage in impulsive behaviours as a response to extreme emotional states. Key emergent themes and sub-themes relating to recovery comprised three domains: factors hindering adaptive change; factors assisting adaptive change and factors that constitute change. An inability to regulate negative affect appears to be an important underlying mechanism that links the three disorders.

This study highlights the potential shortcomings in the traditional approach of treating co-occurring disorders of BPD, SUD and eating disorders as separate diagnoses. The current findings strongly support the adoption of an integrative approach to treating complex mental health issues while concurrently emphasising social connection, support and general health and lifestyle changes.

The findings of this study contribute to the burgeoning BPD recovery literature. A feature of the current study was its use of in-depth face-to-face interviews, which provided rich, many layered, detailed and nuanced data, which is a major goal of qualitative research (Fusch and Ness, 2015). Furthermore, the interviews were conducted within a safe clinical setting with engagement facilitated by a clinically trained professional. There was also a genuine willingness among participants to share their stories in the belief that doing so would inform effective future clinical practice. Their willingness and engagement as participants may reflect their progress along the path to recovery in comparison to others with similar diagnoses. Finally, most of the interviewees were engaging in dialectical behavioural therapy (DBT)-style therapies; two were receiving mentalisation-based therapy treatment, and most had previously engaged in cognitive behavioural therapy or acceptance and commitment therapy-based approaches. The predominance of DBT-style therapy may have influenced the ways that themes were articulated. Future studies could supplement this area of research by interviewing participants receiving therapeutic interventions other than DBT for the treatment of BPD and heightened impulsivity.

This discussion paper aims to further explore narcissistic vulnerability as a psychological concept in relation to stalking, adding to the literature base by resurrecting this focus and exploring practical implications of this association through proposing a schema therapy (ST) approach.

Stalking results from an interaction of circumstances and a vulnerable personality. Understanding the psychology of those who stalk, before and during stalking episodes, is pivotal in helping the person stalking to desist and thus protect victims. Knowing how to most effectively intervene at the earliest opportunity with those stalking is an area receiving renewed attention. Not least due to the improved identification of stalking, but also the continued absence of empirical evidence on effective intervention approaches. This paper sets out to explore the utility of ST with stalking cases.

Recent research undertaken by Wheatley et al. (2020) with men who had stalked and were detained in prison within the UK highlighted narcissistic vulnerability as a key feature in their personalities. The original study provided support for the linked conceptualisations of narcissistic vulnerability, preoccupied attachment styles and the phenomenon of stalking. This paper extended discussions to explore the utility of ST to address narcissistic vulnerability in stalking cases.

This is an original discussion paper combining research with stalking cases, practitioner specialism, psychological theory and existing empirical literature to argue for the value of ST for addressing stalking.

This paper aims to examine how individuals’ need for distinction moderates the effect of perceived harm to others as a result of preferential treatment on customers’ attitudes towards the service provider.

Two experiments test the hypothesis that when a customer receives preferential treatment, the effect of perceived harm to others on the customer’s attitudes towards the service provider is moderated by their need for distinction and mediated by negative moral emotions, such that mediation occurs for customers with a lower (but not higher) need for distinction.

When customers have a lower need for distinction, they scan the environment to seek information about others when judging their own experience. In contrast, customers with a higher need for distinction tend to disregard others’ opinions and feelings, focusing solely on the benefits they receive from the service provider and avoiding moral emotions. Our results show that customers with a higher need for distinction tend to evaluate the service provider more favourably than those with a lower need for distinction in scenarios where the benefit given to an advantage customer imposes a disadvantage on other customers.

To the best of author’s knowledge, this research is the first to examine the interaction between perceived harm to others and one’s need for distinction as drivers of customers’ response to preferential treatment. The authors are the first to show that negative moral emotions may arise for customers with a lower need for distinction but not for those with a higher need for distinction.

This study aims to explore the rise of virtual specialty care startups and understand how the ventures leverage digital services to create a new market space. Given the high level of competition in an established industry like health care, the authors investigate the business models and competitive strategies of leading virtual specialty care startups with unicorn status (i.e. emerging, current and exited unicorns).

The authors performed an analysis of Crunchbase data to examine whether rising virtual care ventures target specialty care. They focused on companies from the USA, Europe and Asia-Pacific. The identified virtual specialty care ventures were investigated in-depth via a multiple case study. By reviewing corporate websites, Crunchbase data and media coverage, the authors analyzed the ventures’ business models and competitive strategies.

This study demonstrates that even in established and highly competitive markets such as health care, managers and entrepreneurs can still leverage digital services to unlock new market spaces. The data analysis reveals that virtual care startups target the field of specialty care. They create a new market space by focusing on fast access to services, personalization, measurable outcomes and affordability. The majority of investigated companies pursues a platform-based business model approach.

In the context of an established industry like health care, this study gives insights into a new generation of virtual specialty care ventures. By investigating the ventures’ business models and competitive strategies, the authors advance a young field of research.

Psychotherapy is often used to treat dysfunctional inter-personal relationships, but it is rarely used to treat dysfunctional B2B relationships. Yet many of the variables found in inter-personal relationships are also found in B2B relationships and both types of relationships have similar fail rates. The authors take a multi-disciplinary approach by adapting an instrument from marriage therapy into a new measure called the Business Relationship Health Index (BRHI). In the process we re-evaluate the drivers of B2B relationships.

The authors apply the Global Assessment of Relational Functioning (GARF) psychiatric system to B2B relationships. The GARF instrument incorporates three components: interaction/problem solving, organization/structure and emotional climate. Using US panel data of 500 B2B relationships based in the USA, the authors use partial least squares analysis and develop a structural equation model to test the validity and reliability of the BRHI with some well-known relationship measures including, satisfaction, trust, commitment and performance.

The findings support a strong link between the BRHI (emotion, interaction and organization) and relationship performance. The proposed measure shows a strong link between BRHI and relationship performance (R² = 0.54).

The GARF instrument has never been applied to a B2B context. BRHI is a holistic instrument used for assessing the specific relational characteristics of B2B relationships. The BRHI can benefit relationship stakeholders when used as a diagnostic tool to prioritize B2B investment strategies. Managers can use BRHI to determine the extent to which the relationship is healthy or needs repair, re-evaluation, re-commitment, or repositioning.

This chapter first analyzes how the data-cleaning process affects the share of missing values in the extracted European and North American datasets. It then moves on to examine how three different approaches to treat the issue of missing values, Complete Case, Multiple Imputation Chained Equations (MICE), and K-Nearest Neighbor (KNN) imputations affect the number of firms and their average lifespan in the datasets compared to the original sample and assessed across different SIC industry divisions. This is extended to consider implied effects on the distribution of a key performance indicator, return on assets (ROA), calculating skewness and kurtosis measures for each of the treatment methods and across industry contexts. This consistently shows highly negatively skewed distributions with high positive excess kurtosis across all the industries where the KNN imputation treatment creates results with distribution characteristics that are closest to the original untreated data. We further analyze the persistency of the (extreme) left-skewed tails measured in terms of the share of outliers and extreme outliers, which shows consistent and rather high percentages of outliers around 15% of the full sample and extreme outliers around 7.5% indicating pervasive skewness in the data. Of the three alternative approaches to deal with missing values, the KNN imputation treatment is found to be the method that generates final datasets that most closely resemble the original data even though the Complete Case approach remains the norm in mainstream studies. One consequence of this is that most empirical studies are likely to underestimate the prevalence of extreme negative performance outcomes.

Breast cancer is a global public health dilemma and the most prevalent cancer in the world. Effective treatment plans improve patient survival rates and well-being. The five-year survival rate is often used to develop treatment selection and survival prediction models. However, unlike other types of cancer, breast cancer patients can have long survival rates. Therefore, the authors propose a novel two-level framework to provide clinical decision support for treatment selection contingent on survival prediction.

The first level classifies patients into different survival periods using machine learning algorithms. The second level has two models with different survival rates (five-year and ten-year). Thus, based on the classification results of the first level, the authors employed Bayesian networks (BNs) to infer the effect of treatment on survival in the second level.

The authors validated the proposed approach with electronic health record data from the TriNetX Research Network. For the first level, the authors obtained 85% accuracy in survival classification. For the second level, the authors found that the topology of BNs using Causal Minimum Message Length had the highest accuracy and area under the ROC curve for both models. Notably, treatment selection substantially impacted survival rates, implying the two-level approach better aided clinical decision support on treatment selection.

The authors have developed a reference tool for medical practitioners that supports treatment decisions and patient education to identify patient treatment preferences and to enhance patient healthcare.

Evidence is lacking as to the superiority of dual-focused versus single-focused approaches in treating depression and alcohol use comorbidity. Different people may also value the different features of treatment options differently, necessitating a decision-support tool. This study aims to test the acceptability, feasibility, safety and potential usefulness of the Alcohol and Depression Decision-Aid for Psychological Treatments (ADDAPT).

ADDAPT was developed according to International Patient Decision-Aid Standards and in consultation with potential end users. Adults with depression and alcohol use comorbidity, who were considering/recently considered psychological treatments, were recruited via online advertisements. After clicking on the study URL, participants accessed the ADDAPT e-book and completed validated and purpose-designed questionnaires.

Of the 24 participants, most would recommend ADDAPT to others (79.2% agree) and endorsed it as easy-to-use (75%), useful in decision-making (79.2%), presenting balanced (87.5%), up-to-date (91.7%), easy-to-understand (79.2%) and trustworthy information (83.3%), which did not provoke anxiety (i.e. safety; 75%). Post-use, participants felt well prepared to decide on treatment (M = 3.48/5) and demonstrated good treatment knowledge (M = 65.83%). All but one participant indicated a treatment choice supported by best available evidence, and decisional conflict scores except for the uncertainty subscale were below the threshold for decisional delay (all M < 37.5/100).

ADDAPT is the first decision-aid of its kind, with pilot findings supporting its acceptability, feasibility, safety and potential usefulness for improving decision-making quality among people considering psychological treatment options for depression and alcohol use comorbidity.