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Neuropsychology of Borderline Personality Disorder and Implications for Treatment in a Cognitive-Behavioral Partial Hospital Program

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Neuropsychology of Borderline Personality Disorder and Implications for Treatment in a Cognitive-Behavioral Partial Hospital Program NEUROPSYCHOLOGY OF BORDERLINE PERSONALITY DISORDER AND IMPLICATIONS FOR TREATMENT IN A COGNITIVE-BEHAVIORAL PARTIAL HOSPITAL PROGRAM A dissertation presented by Catherine B. Mulrooney Submitted to The Department of Counseling and Applied Educational Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy In the field of Counseling Psychology Northeastern University Boston, Massachusetts September 2009 Mulrooney Dissertation – Neuropsychology of BPD, p. 2 Table of Contents Table of Contents ............................................................................................................................ 2 Acknowledgements ......................................................................................................................... 8 Abstract ........................................................................................................................................... 9 Chapter One (Introduction) ........................................................................................................... 10 Purpose of the Study ................................................................................................................. 10 Statement of the Problem .......................................................................................................... 10 Background of the Problem....................................................................................................... 13 Prevalence. ............................................................................................................................. 13 Features. ................................................................................................................................. 13 Treatment concerns. ............................................................................................................... 14 Divergent Theoretical Perspectives on BPD ............................................................................. 16 Psychodynamic ...................................................................................................................... 16 Mentalization-based treatment. ............................................................................................. 17 Cognitive-behavioral therapy and dialectical behavior therapy. ........................................... 19 Feminist-multicultural-ecological therapy. ........................................................................... 21 Gender and sexual orientation ............................................................................................... 22 Trauma ................................................................................................................................... 23 Toward a Neuropsychological Conceptualization of BPD ....................................................... 25 Theoretical Implications and Rationale of the Study ................................................................ 28 Mulrooney Dissertation – Neuropsychology of BPD, p. 3 Research Questions ................................................................................................................... 30 Description of the Present Study ............................................................................................... 30 Significance of the Present Study.............................................................................................. 33 Research Design ........................................................................................................................ 33 Definition of Terms ................................................................................................................... 33 Chapter Summary ...................................................................................................................... 35 Chapter Two (Literature Review) ................................................................................................. 36 Borderline Personality Disorder: Morbidity and Co-Morbid Disorders ................................... 36 Morbidity ............................................................................................................................... 36 Co-morbidity ......................................................................................................................... 38 Gender Bias in BPD Criteria ..................................................................................................... 39 Common Treatments for BPD .................................................................................................. 41 Psychoanalytic treatment ....................................................................................................... 41 Mentalization-based treatment. ............................................................................................. 43 Cognitive-behavioral therapy ................................................................................................ 44 Dialectical behavior therapy. ................................................................................................. 45 Feminist treatment ................................................................................................................. 46 Neuropsychology and Mental Health ........................................................................................ 46 Neuropsychology and treatment outcome. ............................................................................ 47 IQ and social functioning ...................................................................................................... 49 Mulrooney Dissertation – Neuropsychology of BPD, p. 4 Neuropsychology and BPD ....................................................................................................... 51 IQ and BPD ........................................................................................................................... 52 BPD and Overall Neuropsychological Functioning .................................................................. 54 Executive functions. .............................................................................................................. 54 Nonverbal cognition .............................................................................................................. 56 Implications of neuropsychological data ............................................................................... 57 Treatment implications .......................................................................................................... 59 Summary and Conclusions ........................................................................................................ 60 Chapter Three (Methodology) ...................................................................................................... 62 Purpose of the Study ................................................................................................................. 62 Participants ................................................................................................................................ 62 Sample population. ................................................................................................................ 62 Primary investigator .............................................................................................................. 63 Other investigators ................................................................................................................. 63 Other partial hospital staff ..................................................................................................... 64 Setting........................................................................................................................................ 64 Measures.................................................................................................................................... 67 Larger study measures ........................................................................................................... 67 BASIS-24............................................................................................................................... 68 The Center for Epidemiological Studies Depression Scale ................................................... 69 Mulrooney Dissertation – Neuropsychology of BPD, p. 5 Global Assessment of Functioning (GAF) ............................................................................ 69 Measures Specific to the Present Study .................................................................................... 71 Structured Clinical Interview for DSM-IV-TR Axis II Disorders. ....................................... 71 The Wechsler Adult Intelligence Scale, Third Edition (WAIS-III) ...................................... 72 The Stroop Color-Word Test ................................................................................................. 74 Procedure ................................................................................................................................... 75 Recruitment and informed consent. .......................................................................................... 76 Data collection procedures.. ...................................................................................................... 76 Development of the database ................................................................................................
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