Borderline Personality Disorder (BPD) is a severe psychiatric health problem with a reputation of being difficult to deal with and to treat. Significant Others (SOs) of patients with BPD show higher levels of psychological distress compared with the general population. Strengthening the coping strategies of SOs has been shown to play an important role in the recovery of the person with psychiatric health problems. Research around SOs of persons with BPD is, to our knowledge, scarce, especially qualitative research exploring their experiences.

We believe that if the personnel working in health care and psychiatric care are able to better understand SOs experiences and life situation, it could be an important step toward improved care.

The aim of this study was to describe SOs experiences of living close to a person with BPD and their experience of encounter with psychiatric care.

Data were collected by free-text questionnaires and group interviews and were analyzed by qualitative content analysis.

The results revealed four categories: a life tiptoeing; powerlessness, guilt, and lifelong grief; feeling left out and abandoned; and lost trust. The first two categories describe the experience of living close to a person with BPD, and the last two categories describe encounter with psychiatric care.

The authors have not supplied their declaration of competing interest.

Borderline personality disorder begins in adolescence, however, its diagnosis is subject to some controversy and tends to be underdiagnosed. Stigma associated with its diagnosis, comorbidity with other axis I disorders or the changeable sense of identity during adolescence are some of the elements that obscure the diagnosis. Increasingly, recent studies have shown the utility of prevention programs as well as instituting early intervention in adolescents, with very hopeful outcomes.

The aim of this study is to review the benefits derived from early prevention and intervention programs in adolescents with borderline symptoms from a cognitive analytic approach.

A systematic review for scientific articles extracted from research databases including Dialnet, EBSCO, Pubmed, Unika and Scholar Google was conducted. Other high-impact studies in the field were also included.

Evidence reported by reviewed articles supports Cognitive analytical therapy as one of the most successful approaches, the same as Mentalization based therapy, in the treatment of Borderline personality disorder. From this approach, prevention and early intervention have shown their effectiveness in reducing borderline symptoms and risk factors besides they contribute to interpersonal functioning improvement.

Prevention and early intervention constitute the main pillars to prevent the potential development of Borderline personality disorder or its evolution in more complex and irreversible forms. But this intervention must be carried not only in young already diagnosed, but also in those who are on the diagnostic threshold, presenting risk factors for further development.

The authors have not supplied their declaration of competing interest.

Personality disorders are chronic affectation of mood, impulsivity, aggression and anxiety. It is thought to have biological factors related to the development of personality disorders.

To evaluate and compare the efficacy of injectable paliperidone in actual clinical practice of patients diagnosed with Personality Disorder, compared to other treatments.

We conducted a descriptive, restrospective and observational study from January 2012 to June 2015 including all the patients who are treated with paliperidone palmitate extended-release injectable suspension with a diagnosis of Personality Disorder according to DSM 5. We included patients with at least 12 months of treatment and the results were compared with respect to the 12 months prior to taking said drug. Variables studied: medical diagnosis, hospital admissions, average length of stay, total number of emergency visits or other devices, maintenance doses.

We recruited 14 patients (7 women and 7 men) with a mean age of 36.2. 64.29% of patients had borderline personality disorder; 21.43% unspecified personality disorder. The mean dose of maintenance treatment is 105.357. Before the treatment, the quantity of total number of hospital admission are 1.14 versus 0.429 after treatment. The number of stay is also decreased from 13.7 to 3.5; like emergency room visits or to other devices. 78.57% of patients continue to psychopharmacological treatment. Fifty percent of patients undergoing treatment with another antipsychotic (P < 0.05).

The present results show that paliperidone palmitate can be an effective way to control the most characteristic symptoms of Personality Disorders, and reducing emergency visits, hospitalisations and other devices.

The authors have not supplied their declaration of competing interest.

The personality disorders are defined according to the DSM-5 like “an enduring maladaptive patterns of behavior, cognition and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's cultures. These patterns develop in adolescence and the beginning of adulthood, and are associated with significant distress or disability”. The personality disorders can be a risk factor for different processes of the psychiatric pathology like suicide. The personality disorders are classified in 3 groups according to the DSM-5:

– cluster A (strange subjects): paranoid, schizoid and schizotypal;

– cluster B (immature subjects): antisocial, bordeline, histrionic and narcissistic;

– cluster C (frightened subjects): avoidant, dependent and obsessive-compulsive.

To describe the influence of personality disorders in suicide attempts.

Exhibition of clinical cases.

In this case report, we exhibit three clinical cases of suicide attempts which correspond to a type of personality disorder belonging to each of the three big groups of the DSM-5 classification, specifically the paranoid disorder of the cluster A, the disorder borderline of cluster B and the obsessive compulsive of cluster C.

The personality disorders have a clear relation with the suicide attempts, increasing this influence in some of them, especially the borderline personality disorder.

The authors have not supplied their declaration of competing interest.

Mental illness develops and is inseparable from the sociocultural context. The Disturbances may exhibit different symptoms in different cultures. In personality disorders, there is a pathological expansion of normal traits that often demonstrate a sociocultural change. The quality of life of these patients can improve with certain treatments, which appears to be relevant to be achieved.

Search on Pubmed and Medline for original research or review articles published in English or Portuguese in the last 10 years. It used a combination of terms: “personality”, “treatment”, “personality disorder”, “borderline”, “antissocial”, “pharmacotherapy”, and other named personality disorders.

Search the evidence base and the new perspectives for the effective treatment of personality disorders.

The same personality traits may be adaptive or non-adaptive in different contexts. So, without changing these characteristics, patients can learn to use them more effectively. In other words, although the therapy did not change the personality traits, it can be modified in the way they affect the behavioral expression.

Psychological or psychosocial intervention is recommended as the primary treatment for borderline personality disorder and pharmacotherapy is only advised as an adjunctive treatment. The amount of research about the underlying, abnormal, psychological or biological processes leading to the manifestation of a disordered personality is increasing, which could lead to more effective interventions.

The authors have not supplied their declaration of competing interest.

Histrionic Personality Disorder is one of the most common personality disorders diagnosed in Psychiatry. This disorder has been known to be present in more than 40% of patients. There is also a high tendency for those diagnosed with this disorder to be female.

The case is to show all the difficulties caused by this pathology, differencial diagnosis with other personality disorders, groups of characteristics from different clusters and also, complications produced in daily routine.

The purpose is to study a clinical case of a 27-year-old woman, with a degree in journalism, who began with a depressive episode after a failed relationship. After being diagnosed of infertility, she debuted with dissociative episodes and somatization symptoms. After that, she suffered several depressive episodes. At the moment, all the clinical symptoms support the diagnosis of histrionic personality disorder.

Histrionic Personality Disorder can be found in the cluster B group of personality disorders. They often present in an overly dramatic, erratic or emotional manner. They may fulfil their need for attention through speech and behaviour that draws one's focus of attention toward themselves, and also demanding and manipulative in interpersonal relationships. There are high comorbidity rates in those who suffer from HPD with other diagnoses.

Histrionic Personality Disorder appears to be one of the least threatening diagnosis among personality disorders as those affected are high functioning and do not seek relief for the disorder itself. There is also very little research on HPD which makes treatment options limitless.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

To review the current knowledge about Diogenes symptoms and organic personality disorder through systematic review of the literature and the analysis of a case.

Case report. Review. Literature sources were obtained through electronic search in PubMed.gov database of 10 last years.

Background: Diogenes syndrome is a behavioral disorder characterized by severe self-neglect, hoarding, domestic dirt, and lack of shame regarding one's living state. Patients may present due to a range of reasons, few studies has been described hoarding symptoms secondary to brain injury. Early management could reduce their high-mortality condition.

We present a case of a 67-year-old Caucasian female known with a organic personality disorder secondary to a head trauma with obsessive hoarding symptoms. After being hospitalizated, we were authorized to explore her personal items trough photographs. Her handbag and her house were filled with rubbish and rotting food. Our patient had no insight into any self-hygiene or public health problems.

Information of the characteristics of Diogenes syndrome can help in earlier recognition of such persons, in order to decrease their morbidity and mortality.

The authors have not supplied their declaration of competing interest.

As it has been for the last 30 years, male borderline personality are still misdiagnosed and herded into substance treatment, anger management and prison. Gender matters from the failure of clinicians to identify it in men to the failure of researchers to study how it affects men differently and the treatment implications of those dissimilarities.

The authors propose a retrospective study investigating all patients hospitalized with Borderline Personality Disorder diagnosis from 2000 to 2015 in Baixo Vouga Hospitalar Center.

From an average of 500 patients admitted per year, in the considered period, the number of men with this psychiatric diagnosis was irrelevant.

Taking into account the results, it is important recognise some gender differences in borderline personality disorder with respect to specific types of self-harm behavior, such as self-cutting or levels of psychological distress at clinical presentation in order to prevent clinical disgnosis failure.

The authors have not supplied their declaration of competing interest.

According to time perspective (TP), theory behaviour is influenced by the individual's perception of his/her past, present and future. Boyd and Zimbardo postulate that a healthy balance between orientation to the past, present and future exists.

Investigation of TP in the context of psychopathology.

To investigate and compare TP in Obsessive Compulsive (OCD) and Borderline Personality Disorder (BPD).

Twenty-eight OCD and 28 BPD patients (36% of men), matched for age and education, completed the Greek version of the Zimbardo Time Perspective Inventory (ZTPI); a 56-item self-administered questionnaire measuring individuals’ orientations to the past, present, and future. ZTPI consists of five factors: Past Negative (PN), Past Positive (PP), Present Hedonistic (PH), Present Fatalistic (PF) and Future (F).

BPD patients scored significantly higher in PH and PF and significantly lower in PP factors than OCD patients. No significant gender differences emerged for either group. In the BPD group, age correlated significantly negatively with PH, while education correlated positively with F.

The study's findings suggest that BPD patients have a hedonistic orientation towards time and life and a helpless/hopeless attitude towards the future to a significantly greater degree than OCD patients, whereas OCD patients seem to have a more positive and nostalgic attitude towards the past than BPD patients. Further research would provide additional information concerning the role of TP in OCD and BPD patients.

The authors have not supplied their declaration of competing interest.

Personality disorders designate a series of personality traits involving a behavioural pattern characterized by the recurrent violation of social norms, the importance of medico-legal implications associated to personality disorders being incontestable.

This study aims to obtain a clear image regarding the particularities of violent behaviour, and also the mechanisms of anger in personality disorders, in relation with the legal implications of those reactions.

The present study is a synthesis of recent literature (2012-2014) regarding the role of anger in violent behaviour with legal implications, in personality disorders. The research was made on PubMed, by the following keywords: personality disorder; violence in personality disorders; anger.

The core element that determines violent behaviour is anger. The physical effects of anger include increased heart rate and blood pressure, as well as an increase in the level of epinephrine and norepinephrine. Therefore, anger can be considered an integrant part of the response to a potential aggression or a potentially dangerous environment. Several general circumstances can activate anger. A strong example in supporting this theory is the bidirectional relation between anger within personality disorders and the use of alcohol and psychoactive substances. The individual gets extra stimulation, including through their psychopharmacological properties, thus exacerbating anger.

In conclusion, it is necessary to conduct future studies focusing on the underlying causes of violence in personality disorders, as well as on the warning signs of potential violent acts, considering that personality disorders alone often cannot explain criminality.

The authors have not supplied their declaration of competing interest.

According to previous researches, the risk of addictions and self-harm or suicidal behaviours seems to be higher in patients with personality disorders (PD) than in general population.

To prove that patients with the diagnosis of PD are in the group of risk of addictions, self-harm behaviours and suicidal attempts.

Analysis the occurrence of addictions, autoagressive behaviours and suicidal attempts in patients with PD.

Retrospective analysis of 123 patients diagnosed with PD and hospitalized over the years 2012-2015 in the Department of psychiatry and psychotherapy, medical university of Silesia, Katowice. Statistic analysis of variables and comparing with previous studies.

Three quaters of hospitalized patients were females.

Average age in analysed population was about 48.5 years old.

The frequency of suicidal attempts history was 38% among these patients.

Most popular method of suicidal attempts was drugs overuse.

Nineteen percent of PD patients has revealed self-harm behaviours history.

PD's population have 46% risk of addictions.

Hospitalized patients with personality disorders are in the group of risk of addictions, self-harming behaviours and suicidal attempts.

Care should be taken with patients revealing any risk of autoregressive behaviours and they should be advised accordingly. Preventive actions should be taken with these patients when any life-threatening behaviours suspecting.

The authors have not supplied their declaration of competing interest.

Personality disorders (PD) are weight group of conditions. As possible causes of PD, literatures indicates being victim/witness of domestic violent. There is valid suspicion that PDs may have influence on marital status, education level and professional activity.

Studying the PD influence on patients quality of life concerning both personal and professional areas of life.

Analysis of the exposition to the violence in relation to PD diagnosis. Evaluation of the education level and professional activity in studied group, furthermore marital status.

Retrospective analysis of 123 patients diagnosed with PD hospitalized over the years 2012-2015 in the Department of psychiatry and psychotherapy, medical university of Silesia hospital. Statistic analysis of variables and comparing with previous researches.

Three quarters of hospitalized patients were females.

Average age was about 50 years old.

Proximal martial status: 40% single, 60% formalized relationship (about 20% were divorced).

Among participants, 50% were employed, and 80% have completed at least 12 years of education.

About 40% had been victim/witness of domestic violence.

The patients with PD had often experienced the domestic violence in childhood. Higher risk of impaired personality development with patients, who had been violence victim or witness is possible and they need to be advised accordingly. Research did not reveal PDs’ influence on the education level. To define correlation between employment or marital status and PD further researches are needed.

The authors have not supplied their declaration of competing interest.

The vulnerability model is prevalent in the current Theory of Psychiatry. Systematic reflection after reviewing the historical proposition of this model can enrich its contents.

Complete and deepen the meaning of the concept “vulnerability” in Psychiatry.

Review historical approaches to the concept of vulnerability in Psychopathology. The study starts with Zubin & Spring and reaches contemporary approaches especially in the writings of Giovanni Stanghellini.

Seek sources to deepen its meaning looking back to Karl Jaspers and Ludwig Binswanger's classical Psychiatry. They offer psychopathological notions that can be used to enrich a model of vulnerability.

This is research in the context of Theory of Psychiatry, its method implies a historical literature review and a systematic philosophical reflection.

Vulnerability is still revealed to be the best concept to organize a model of mental illness. This study proposes to avoid any simple identification of vulnerability with statistical or genetic risk. Vulnerability in psychopathology should always be confronted with the horizon of human subjectivity. To keep in view this horizon – a limit impossible to grasp – is indispensable for clinicians and researchers if they want to understand patients who suffer mental illness. This process is helpful to avoid any reductionism about the image of mental illness and about the human being who suffers that illness.

“Vulnerability” is shown as a concept that needs to be thought over thoroughly and to be present in psychopathology to overcome reductionism and to understand the very possibility of psychiatric illness.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

As a general problem in nosology, the moment when one becomes ill may be hard to define. In Psychiatry, the boundaries of disease may be more difficult to establish. In the last decade, we’ve been observing a growing interest in early diagnosis in this field, and the concept of “transition” to a mental illness became an important topic of discussion with implications in clinical practice.

To review different author's models of evolution of symptoms and transition to mental illness and discuss their advantages and limitations in the actual context of Psychiatry research and clinical practice.

To increase understanding on the different paradigms of becoming ill and their relevance to present and future psychiatric practice.

Non-systematic review of literature devoted to the creation of models that describe the establishment of a mental disorder.

One of the first accounts of becoming mentally ill was developed by K. Jaspers within a phenomenological life-history analysis. Nonetheless, a cross-sectional approach to diagnosis has dominated Psychiatry for most of the time. With the advent of early intervention studies, longitudinal models of disease have been emphasized. The concept of a transition to disease was then operationalized but also highly criticized. Recently, McGorry proposed a staging model for psychiatric disorders in continuum with the non-clinical population. Finally, a dynamic systems approach to diagnosis in Psychiatry will be discussed.

Driven by research in early phases of mental illnesses, current models of disease propose a longitudinal approach that emphasizes the complex and non-linear course of symptom clusters.

The authors have not supplied their declaration of competing interest.

Justice is one of the fundamental concepts of right ordering of human relationships. Justice is a regulative idea for the arrangement of society preceding the law and already seen in animals; the sense of justice is observed as early as in young children. The ability to altruistic behavior, sense of fairness, reciprocity and mutual help are probably genetically determined as a disposition, which may further develop or be deformed by education. Although justice issues are common in psychotherapy, they may not be reflected and processed in the course of therapy.

Review of psychotherapeutic text and reflection of experiences of the authors.

In psychotherapy, justice issues appear directly in what the client says (mostly about injustice), but more frequently, the issues are implicitly contained in complaints and stories against a background of conflicts and problems. They may be related to the client's story, his or her problems with other people, and the therapeutic process itself, including client's selection of therapy, therapeutic relationship, and therapeutic change strategies. Problems with justice between the therapist and the client may be revealed by honest therapist self-reflection or high-quality supervision.

Although justice issues are common in psychotherapy, they may not be reflected and processed in therapy. By increasing receptiveness to the issue of justice, the therapist may improve the therapeutic process.

The authors have not supplied their declaration of competing interest.

Phenomenology is a term borrowed from philosophy which refers to the study of the structures of experience and consciousness. Founded as a school by Edmund Husserl in the early 20th century, it was later expanded and modified by many others, including Martin Heidegger, to include the analysis of existence and hermeneutics.

To explain the clinic phenomenology of ADHD based on the historical bibliography regarding this term, making references to the heterogeneity of its phenomenological presentation depending on social context, age and gender.

To go over the historical considerations of phenomenology and its evolution, as well as its clinical applications, in order to use this knowledge in a clinical context based on the observation of different cases in clinical practice.

We try to apply the phenomenological method as first inaugurated by Karl Jaspers’ General Psychopathology (1913) to analyse the different clinical phenomena that can be observed in patients diagnosed with ADHD.

We think that watching the psychiatric conditions, in this case ADHD, through the phenomenological lens can lead to a better understanding of the heterogeneity of their appearance in the clinical practice.

The authors have not supplied their declaration of competing interest.

The private language argument was introduced by Ludwig Wittengstein in his Philosophical Investigations (1953). For Wittengstein, language is a rule-governed activity and a language in principle unintelligible to anyone but its originating user is impossible, as even the originator would fail to establish meanings for its putative signs. The private language argument is of paramount significance in modern debates about the nature of language and mind and continues to be disputed. Language disorder has been described since the first accounts of Schizophrenia. Multiple studies have reported anomalies at multiple levels of language processing, from lexical and syntactic particularities to the discourse field, as well as structural and functional abnormalities in brain regions that are involved with language perception and processing.

We aim to critically assess the Wittengstein's argument in the light of recent developments in neuroscience of language.

We conclude that in some patients diagnosed with schizophrenia, presenting a significant language impairment, one can infer a dysfunctional process, in which the language becomes progressively more private and the meaning of utterances harder to ascertain in the realm of interpersonal communication. The privatization of language might contribute to the social cognition deficits and the so-called negative symptomatology of these patients.

The authors have not supplied their declaration of competing interest.

The question what mental disorders are lies at the heart of the philosophy of psychiatry. In search of a valid taxonomy of mental disorders, it is a question that needs a proper answer. In recent work, Kenneth Kendler et al. (2011) have put forward the “mechanistic property cluster” (MPC) model of mental disorder. On this view, mental disorders are mechanistically mediated clusters of multi-level (bio-psycho-social) properties. Kendler et al. present the MPC-model as a non-reductionist form of realism – realist because it tries to account for mental disorders in terms of the causal structure of the natural world, non-reductionist because it views mental disorders as clusters of multi-level properties. For the project of psychiatric nosology, such non-reductionist realism would be a great step forward and indeed preferable to pragmatist and constructionist models of mental disorder.

To critically assess the MPC-model in light of arguments against realism about mental disorders presented in the philosophical literature.

To achieve a proper understanding of the ontology of mental disorders that can inform future psychiatric nosology.

Literature study and conceptual analysis.

Despite appearances, the MPC-view fails to take into account the various (societal, practical, scientific) values that determine the delineation of mental disorders. It ultimately faces philosophical problems similar to those of more reductionist forms of realism.

The MPC-model fails as a realist model of mental disorders. Its non-reductionism, however, is an important contribution to theories of explanation in psychiatry.

The authors have not supplied their declaration of competing interest.