isspd xiv proposed symposia

 ISSPD XIV PROPOSED SYMPOSIA A computational psychiatry approach to studying personality disorders In this symposium the new and emerging field of Computational Psychiatry (CP) will be introduced. The potential that computational approaches can offer to an understanding of interpersonal difficulties and to a developmental framework based upon an interplay between epistemic trust and evolving mentalizing capacities of will be outlined. We will give both a conceptual account of CP and present preliminary findings from a large scale study in Read Montague's lab at UCL and Virginia Tech investigating model-­‐
based impairments in two-­‐party interactions in patients with BPD. Attendees will learn about: -­‐ What Computational Psychiatry is -­‐ How current nomenclature of personality disorders can be challenged with CP notions and empirical tools -­‐ How early experiences might be organized via generative models of self and other according to the notion of a Bayesian Infant -­‐ first empirical findings characterizing mentalizing deficits in patients with BPD using computational modeling and neuroimaging Chair: Tobias Nolte Speakers: Peter Fonagy; Tobias Nolte A conversation about psychotherapy with Borderline Personality Disorder from perspectives across the professional lifespan What are the obstacles and mechanisms related to integrating psychotherapy in psychiatric practice? What are the factors that lead to change and growth for the BPD patient? What is required of the clinical setting to facilitate the optimization of a BPD therapy program? What is required of the patients to optimize their change and growth? How do therapists and programs handle the spectrum of theories and procedures, fads and fashions, that is continually expanding? This symposium will focus on the process of psychotherapy when working with patients diagnosed with Borderline Personality Disorder (BPD). The presenters will raise questions and encourage conversation relevant to four main topics, namely: 1) The myths and realities of treating BPD, 2) How to grow personally and professionally as a junior therapist working with BPD, 3) How to integrate psychotherapy into psychiatry practice, and 4) Team process in the treatment of BPD. The goal of this symposium is to share our experience and thoughts in order to stimulate reflection. The intention is for our conversation to encourage the development of new ideas and perspectives relevant to the treatment of BPD. Chair: Rosemarie Soucy Speakers: Rosemarie Soucy; Sally Butterworth; Tonje Persson; Allen Surkis Adherence and competence in mentalization-­‐based treatment (MBT) Treatment integrity is crucial to modern psychotherapies and it is paramount to measure it in a valid and reliable way. Claims about efficacy of specified psychotherapies are at least speculative if measures of treatment integrity is lacking. Mentalization-­‐based treatment (MBT) is rapidly gaining international recognition due to its treatment effect for adolescents and adults with borderline personality disorder (PD). However, long term progress in MBT will also depend on measurements of adherence and competence. This symposium presents studies and data that will facilitate such developments. The MBT adherence and competence scale (MBT-­‐ACS) was developed by Karterud and coworkers (2013). It is the main tool for the Norwegian Quality Laboratory for MBT. Clinical psychologist Kjetil Bremer will describe the tasks and work of this laboratory which is sponsored by Norwegian health authorities. The MBT lab started its services by rating individual MBT sessions. Clinical psychologist Espen Folmo will present data from the first reliability study of the adherence and competence scale for MBT group therapy. Sebastian Simonsen, PhD, will thereafter describe experiences from a Danish training project in training raters for assessment of MBT adherence and competence. Finally, Sigmund Karterud, MD, PhD, presents data from a detailed study of four MBT sessions of different quality: What qualifies as very good versus poor mentalization-­‐based treatment (MBT)? Chair: Sigmund Karterud Speakers: Kjetil Bremer; Espen Folmo; Sebastian Simonsen; Sigmund Karterud Advances in understanding social cognition and social behavior in borderline personality Social cognition and social behavior are central to the pathology and treatment of those with borderline characteristics. In this panel three laboratory investigations of social cognition in subjects with varying degrees of borderline pathology will be described, followed by an examination of aspects of interpersonal relatedness in daily life among individual with borderline features. A last presentation uses network analysis to model the relationships between the symptoms and personality traits in BPD. In the first presentation (E. Fertuck), facial identities that vary on trustworthiness morphology are appraised before and after social trait learning. In the second presentation (C. DePanfilis and colleagues) use the construct of effortful control to understand varying emotion recognition capacities in BPD subjects. E. Preti and colleagues use static and dynamic emotion recognition tasks under uni-­‐ and cross modal conditions to investigate interaction between BPD traits and context. K. Meehan and colleagues use experience samples of daily interpersonal interactions to explore impact of rejection sensitivity and borderline features. Finally, J. Richetin and colleagues utilize network analysis to examine patterns of BPD symptoms and traits. Chair: John Clarkin Speakers: E. Fertuck; C. DePanfilis; E. Preti; K. Meehan; J. Richetin An international perspective on DSM-­‐5 personality dimensions The personality dimensions described in the Alternative Model of Personality Disorders (AMPD) from the DSM-­‐5 are attracting substantial interest around the world. The major aim of this symposium is to highlight the international nature and overall breadth of this interest. Participants in this symposium come from around the world, and are united by their interest in furthering research on the clinical utility of novel dimensional approaches to personality disorder. Dr. Erik Simonsen from Denmark will introduce the symposium, highlighting how his own work connects with the DSM-­‐5 dimensional model. Next, Bo Bach will provide a presentation on work from Denmark (involving Bo Bach, Sune Bo, and Dr. Simonsen) focused on the clinical utility of DSM-­‐5 personality dimensions. Next, Dr. Andrea Fossati from Italy will describe his extensive program of research on the validity of DSM-­‐5 personality dimensions. Dr. Fossati’s group has amassed substantial evidence for the validity of DSM-­‐5 dimensions in predicting numerous clinically relevant phenomena (including, e.g., self harm, pathological gambling, and Borderline Personality Disorder). Following Dr. Fossati, Dr. Johannes Zimmerman from Germany will present novel research on ambulatory assessment of cognition, emotion, and behavior, and the ways in which these phenomena are linked to DSM-­‐5 personality dimensions in daily life. Finally, Dr. Robert Krueger from the USA will summarize the major themes of the symposium, as well as provide an update on his own research on genomic and neural underpinnings of DSM-­‐5 personality dimensions. Chair: Robert Krueger Speakers: Bo Bach; Andrea Fossati; Johannes Zimmerman Discussant: Erik Simonsen Antisocial personality disorder across the life span: Treatment implications Antisocial personality disorder is a broad diagnostic umbrella containing different subgroups of individuals with different aetiologies and developmental pathways and corresponding different responses to treatment. The presence of callous and unemotional traits in childhood and their development into psychopathy has received much interest in ASPD; the role of anxiety in motivating more impulsive violent and antisocial behaviour has been relatively neglected but characterises a large proportion of individuals with ASPD who are potentially more responsive to treatment. An attachment framework is helpful to conceptualise and differentiate these different developmental trajectories. This symposium describes recent developments and research findings in the treatment of individuals with ASPD of different ages within the Criminal Justice System in the UK. All of the presenters are working within the UK Government’s Offender Personality Disorder Pathway Strategy, which is informed by attachment theory and whose ‘pathway’ approach both reflects and aims to alter the lifespan trajectory of offenders with PD. Dr Yakeley will summarise the empirical data indicating the attachment disruptions in the development of ASPD with and without psychopathy and present preliminary findings in the treatment of ASPD with MBT (a treatment based on attachment theory). Dr Motz will present her findings in the treatment of women with antisocial personality disorder focusing on parenting and the generational transmission of attachment pathology. Dr Taylor will present her findings of how the aging process affects the treatment and management of offenders with personality disorder within the forensic system. Chair: Jessica Yakeley Speakers: Jessica Yakeley; Anna Motz; Celia Taylor Assessment of maladaptive personality functioning in adolescents The diagnostic approach to personality disorders (PD) is in transition. First, the dimensional severity approach is regarded as superior to the traditional categorical approach that has numerous problems concerning the validity of the diagnoses. Second, the prototype approach to define and classify current PD is questioned fundamentally and a shift to basic personality functions defining the core of PD in general is in intense international discussion. Third, the life-­‐span approach promotes the inclusion of children and adolescents to overcome the artificial age limitation. The focus of this symposium is on different models to define basic personality functions in adolescents and to assess them with high psychometric standards. The first two talks describe the psychometric properties of an interview and a self-­‐report questionnaire to assess personality functioning in adolescents according to the descriptions given in the research section of DSM-­‐5. The third talk presents clinical data from an adolescent patient sample with personality disorders using the self-­‐report questionnaire AIDA to assess the personality function “identity”. Chair: Klaus Schmeck Speakers: Joost Hutsebaut, Dineke Feenstra, Hilde de Saeger and Jan Henk Kamphuis; Kirstin Goth, Christian Schrobildgen, Marc Birkhoelzer, Susanne Schlueter-­‐Mueller, Klaus Schmeck; K. Schmeck, R. Zimmermann, M. Birkhölzer, C. Schrobildgen, S. Schlüter-­‐Müller, K. Goth Borderline Personality Disorder in a community sample of men: Clinical features, comparisons with men with antisocial personality disorder, and childhood antecedents What are the features of men with BPD identified in a community sample? Do they also present Antisocial Personality Disorder (ASPD)? How do those with BPD and ASPD differ in adulthood and in childhood? The symposium will report findings from a study of a community sample of middle-­‐aged who have been followed since age 6. The first presentation by Joel Paris, McGill University, will present the prevalence of BPD identified in this sample and the clinical characteristics of the men who developed BPD. These characteristics will be compared to those reported from clinical samples of men with BPD. Reasons for the differences in the community and clinical samples of men with BPD will be discussed. Nathan Kolla, University of Toronto, will present a study of the men with BPD, those with ASPD, those with both BPD and ASPD, and men with no personality disorders. Surprisingly, most of the men with BPD also met diagnostic criteria for APSD. Further, the results reveal dramatic similarities and differences in the two groups. Sheilagh Hodgins, Université de Montréal, will present a study of the childhood antecedents of those with BPD and those with ASPD. Classroom teachers rated participants' behaviour at age 6, 10, and 12. Many of the problems shown by the men with ASPD as children, were also exhibited by the boys who developed BPD. A final discussion will focus on the characteristics that distinguish BPD and ASPD in males at different developmental stages. Chair: Sheilagh Hodgins Speakers: Joel Paris; Nathan Kolla; Sheilagh Hodgins Borderline personality disorder in the here-­‐and-­‐now: Elucidating patterns of variability and behavior through ecological momentary assessment Borderline personality disorder (BPD), a highly prevalent and debilitating disorder, is characterized by intense fluctuation of symptoms, including affect, identity disturbance, and parasuicidal behavior. Much of the literature has relied on retrospective assessment of BPD features (e.g., clinical interviews) as well as examining symptoms and their correlates through a “between-­‐subjects” lens, identifying whole-­‐group differences across BPD and non-­‐BPD populations. However, given the variable nature of BPD symptoms, as well as the importance of identifying and preventing life-­‐threatening behaviors such as self-­‐injury, novel methodologies are necessary. Ecological momentary assessment (EMA), consisting of daily, repeated assessment of symptoms and behaviors, provides both a granular and generalizable avenue to understanding BPD symptomatology, and multilevel analytic techniques allow a parsing of overall group differences from more ideographic “within-­‐subjects” dissimilarities. The three talks comprising this symposium utilize data from a 21-­‐day EMA study of individuals with BPD and anxiety-­‐disordered controls and use multilevel or person-­‐specific approaches to analyze these data. The first applies survival analysis to identify patterns of risk for urges to engage in suicidal/parasuicidal behaviors. The second elaborates upon these findings by proposing predictors of self-­‐injurious urges, a crucial step towards understanding patterns of risky behavior. The third and final talk provides a pointed and timely critique of between-­‐groups analyses by presenting the advantages of a person-­‐specific approach to both quantitative and qualitative analysis of BPD symptoms. Together, this symposium simultaneously generates new material for treatment applications and research ventures in BPD and calls for a broadening of methodological and analytic frameworks. Chair: Kenneth N. Levy Speakers: Benjamin N. Johnson; J. Wesley Scala; William D. Ellison Discussant: Timothy J. Trull Clinical services and individual psychotherapies for early intervention in adolescent personality disorder Despite longstanding general agreement that personality disorders have their roots in childhood and adolescence, diagnosing borderline personality disorder (BPD) prior to age 18 years has been controversial. To date, there is increasing evidence in support of both diagnosing and treating BPD in adolescence. Thus, national treatment guidelines, Section 3 of the new DSM-­‐5, and the proposed ICD-­‐11 personality disorder classification have all recently confirmed the legitimacy of the BPD diagnosis in adolescents. There are evidence-­‐based and effective interventions for BPD in adulthood. Given these recent developments, adolescence can now be considered a critical period for early intervention of emerging BPD, and the field of child and adolescent psychiatry is in need to develop effective interventions that are specifically tailored to the developmental period of adolescence. This symposium will present current service models and specialized psychotherapeutic approaches (including Cognitive-­‐Analytic Therapy, Dialectical-­‐Behavior Therapy, Mentalization-­‐Based Therapy and Adolescent Identity Treatment) available for early intervention of adolescent BPD. Chairs: Michael Kaess and Andrew Chanen Speakers: Andrew Chanen; Michael Kaess; Joost Hutsebaut; Klaus Schmeck Collaborating for change: What families need to learn to participate in effective BPD skills training For two decades, TARA for Borderline Personality Disorder, an advocacy and education organization, has provided a principle-­‐based family program integrating DBT, Mentalization (MBT) and neurobiology into a psychoeducational format. This intensive program designed to teach and reinforce loved one’s ability to cope focuses on what families actually need to learn so as to contribute to recovery. As people with BPD either refuse treatment or quit 70% of the time, families are left on the front lines, providing support and care for difficult, often life-­‐threatening behaviors without knowledge of how to deescalate dysregulated behaviors, avoid triggers, unnecessary hospitalizations, or repair damaged relationships. They often do the wrong thing for the right reason. With informed psychoeducational training, family members can become therapeutic allies, adjuncts to treatment, and can potentially improve outcomes. Currently, psychoeducation programs do not take the approach of training family members to become part of the solution; potential partners in teaching and reinforcing effective coping skills. Key components of the TARA Method curriculum include reconceptualization of BPD etiology and symptoms, underlying neurobiology, explanation of evidence based treatments, communication and problem solving skills, tools to navigate stressors and social support. It includes validation techniques and problem solving skills based on EBT treatments. TARA Method teaches family members to avoid or decrease volatile incidents, reduce their intensity and frequency, reinforces therapeutic goals, and repairs and improves trust and overall interpersonal relationships. Chair: Valerie Porr Speakers: Regina Piscitelli; Lisa Rosenberg; Valerie Porr Comparatif de trois thérapies reconnues efficaces pour les troubles de la personnalité limite. (symposium en français / symposium in french) La thérapie comportementale dialectique (TCD), la thérapie centrée sur les schémas (TCS), et le traitement basé sur la mentalisation (TBM) sont trois modèles de thérapies manualisés et démontrés efficaces pour le traitement des personnes ayant un trouble de la personnalité limite. Généralement présenté en anglais, le présent symposium permettra à un auditoire francophone d’observer trois cliniciens expérimentés intervenir successivement dans chacune de ces trois approches (TCD, TCS et TBM). Les cliniciens fourniront d’abord un bref descriptif des assises et des modalités de leur traitement respectif, suivi d’une démonstration clinique auprès d’un même patient. La mise en situation portera sur la façon d’intervenir lorsqu’il y a présence de conduites automutilatoires. Suite aux présentations, une discussion s’en suivra quant aux similitudes, aux distinctions et aux possibilités d’intégration des différentes modalités. Chair: Pierre David (Programme des troubles relationels et de la personnalité, Institut universitaire en santé mentale de Montréal et département de psychiatrie de l'Université de Montréal) Discussant: Conrad Lecomte (Professeur aux Universités de Montréal, de Sherbrooke, du Québec à Montréal, et à l'Université de Paris) Thérapeute TCD : Hélène Poitras (ergothérapeute, psychothérapeute, clinique ambulatoire des troubles affectifs du Centre Hospitalier Universitaire de Montréal) Thérapeute TCS : Martin Roy (psychologue, clinique Saine, Montréal) Thérapeute TBM : Frédéric Pérusse (Psychologue, Programme des troubles relationels et de la personnalité, Institut universitaire en santé mentale de Montréal) Effective mechanisms of (implementation of) Dialectical Behavior Therapy Dialectical Behavior Therapy is the BPD treatment model for BPD with the largest number of evidence-­‐
based published research of effectiveness (13 RCTs vs. 2 RCTs of next cab off the rank). These studies have shown the efficacy of DBT. In the presentation, four themes about DBT will be presented. First we will discuss in detail the mechanisms of change in DBT. Secondly, we will show results of a study in which a short-­‐term inpatient DBT program was compared with standard outpatient DBT, using a randomized design. This study was undertaken because some BPD patients are not sufficiently engaged in outpatient treatment and/or experience periodic exacerbation of severe self-­‐injurious behavior making hospitalization necessary. We will discuss the dilemma of hospitalization, how patients can be motivated to participate, how we enforced consultation to the client in an inpatient setting and the added value of short-­‐term inpatient DBT in a treatment trajectory. Thirdly, we will discuss the mechanisms that make DBT teams survive organizational changes that occur so often nowadays due to financial cut downs. Chair: L.M.C. van den Bosch, PhD Speakers: A.Fruzetti, PhD; R.Sinnaeve, MsC; L.M.C. van den Bosch, PhD Elements for an integrated modular treatment of personality disorders Personality disorders are complex entities and treatment needs to address the many aspects of pathology to exist in order to display full effectiveness. A modular approach based on principles of change coming from what we currently know about effective ingredients of change can help clinicians deliver comprehensive treatments with the promise of addressing the patients many needs. In this symposium the authors focus on four key ingredients for an integrated treatment of personality disorders: drafting and negotiating a therapy contract; managing countetransference; treating emotional dysregulation; adopt behavioral activation-­‐based principles in order to break maladaptive routines and promote change. Chair: Giancarlo Dimaggio Speakers: John F. Clarkin; Paul S. Links, Deanna Mercer, Jon Novick; John Livesley; Giancarlo Dimaggio, Giampaolo Salvatore, Paul H. Lysaker, Paolo Ottavi and Raffaele Popolo Family interventions in Borderline Personality Disorder: Impact, effectiveness, and future directions Family Connections is a manualized skills training program for family members of individuals with borderline personality disorder (BPD), based on strategies used in dialectical behaviour therapy (DBT). Studies evaluating the Family Connections program have shown promising results related to the reduction of family members burden and improved relationships between family members and the identified patient (Hoffman & Fruzzetti, 2007; Hoffman, Fruzzetti, Buteau et al., 2005; Hoffman, Fruzzetti, & Buteau, 2007). The goal of this panel is to present data from three research groups investigating the impact and effectiveness of the Family Connections group in naturalistic settings, and to integrate these findings by identifying points of intersection and divergence, and the implications for future research. The first two papers present findings from a study that evaluated an adaptation of Family Connections for family members of youth with problems with emotion dysregulation. In the first paper, Tali Boritz will describe the modified Family Connections group and present data on the effectiveness of its application. The second paper by Karen Wang presents findings from a qualitative study exploring family members’ experiences of the modified Family Connections group. The third paper by Sophie Liljedahl and colleagues presents Family Connections (Familjeband) from two treatment centres in South Sweden, delivering the program to family members of adults receiving DBT either residentially or on an outpatient basis. Differences and similarities in outcomes between standard multi-­‐week Familjeband in comparison to a modified intensive version of the program are contrasted. Clinical implications and future research directions will be discussed. Chair: Tali Z. Boritz (Centre for Addiction and Mental Health/University of Toronto) Presenters: Tali Z. Boritz (Centre for Addiction and Mental Health/University of Toronto); Karen Wang (University of Toronto); Sophie Liljedahl (Lund University) Discussant: Alan Fruzetti (University of Nevada) Fifty shades of Borderline Personality Disorder in adolescence Borderline personality disorder (BPD) is a severe and complex disorder that typically starts in late adolescence/early adulthood. Regardless of the presence of a full-­‐fledged disorder, symptoms in adolescents such as suicidal behaviour, self-­‐injury, social dysfunction, identity disturbance, impulsivity and substance abuse, often reflect significant distress and dysfunction that require intervention. These symptoms are likely to be reduced through appropriate treatment, and services are most likely to be effective when tailored to the individual’s needs. However, providing the right mental health services according to severity of symptoms presented by adolescents with BPD is a challenge. Although these youths commonly seek help and are heavy users of health care, the diagnosis of BPD in this age group remains controversial. Even when an adolescent show symptoms such as frequent self-­‐injury, anger outburst and mood instability too often the diagnostic of BPD is not considered. In addition, these adolescents are often misdiagnosed or even dismissed as having adolescent turmoil or as having disruptive behaviour if they present with many externalizing symptoms. The aim of the symposium is to present research findings that explore BPD diagnosis in adolescents. The symposium will present: 1) a qualitative study on the diagnosis making process of BPD in adolescents receiving specialised mental health services; 2) a research on access to mental health services for adolescents with BPD features in youth protection services; 3) a chart review on service trajectories of adolescents with BPD in a specialized child psychiatry service in Montréal. Chair: Lyne Desrosiers (Université du Québec à Trois-­‐Rivières) Speakers: Christophe Huynh, Pascale Abadie,Tim Monday (Hôpital Rivière-­‐des-­‐Prairies); Lyne Desrosiers, Lise Laporte (Centre jeunesse de Montréal-­‐Institut universitaire, UQTR, CUSM); Pascale Abadie (Hôpital Rivière-­‐des-­‐Prairies) GPM I: Expanded applications and understanding about Good Psychiatric Management (GPM) Good Psychiatric Management for borderline personality disorder patients is meant to offer a basic model for their treatment. In this symposium Dr. McMain will review GPM-­‐related research underway or completed since her seminal study (McMain et al. AJP, 2009). Dr. Aguirre, who directs a residential service for adolescents with BPD, will describe GPM’s applications for this age group. Dr. Gunderson will describe the means by which clinicians gain competence in GPM, emphasizing efforts to introduce it into residency training programs. Finally, Dr. Unruh who has direct exposure to patients being treated with MBT, DBT, and TFP will discuss how and when these models can conflict or be complementary to GPM. Chair: John Gunderson Speakers: Blaise Aguirre, MD; John Gunderson, MD; Shelley McMain, PhD; Brandon Unruh, MD GPM II: Understanding specific elements and interventions within good psychiatric management Good Psychiatric Management (GPM) is an evidence-­‐based therapeutic approach to treating patients with borderline personality disorder (BPD). While there are a number of general approaches and techniques that are embedded in GPM that inform general mental health clinicians on this effective treatment that assists clinicians in avoiding common pitfalls of treatment for patients with BPD, one might be able to drill down/refine/expand upon some GPM principles to develop GPM treatment further. This symposium discusses four topics that may expand our understanding of and expertise in GPM treatment. “The Therapeutic Relationship in the Practice of Good Psychiatric Management for Borderline Personality Disorder” describes how GPM plays out within the therapeutic interpersonal relationship between patient and clinician, while two presentations, “The Use of Good Psychiatric Management for Borderline Personality Disorder as a Tool for Independent Community Mental Health Workers” and “The Use of GPM Management Principles in a Psychiatric Emergency Department” bring its principles and practices into additional clinical settings. Finally “The Prescribing of Psychotropic Medications While Adhering to the Principles of GPM”, describes how to incorporate a mainstay of general psychiatric treatment, the prescribing of psychotropic medication, into the practice of GPM. Taken as a group, these 4 presentations not only expand upon some of the principles of GPM, they also connect GPM to clinical practices and situations found in everyday general mental health treatment. Chair: Kenneth Silk Speakers: Ulrich Kramer; James Ross; Victor Hong; Kenneth Silk Helping persons with borderline personality disorder successfully participate in the work domain of life It has been documented that finding and maintaining a meaningful employment is an important aspect of recovery of persons living with mental illness (Davidson, 2003; Krupa, 2004; Larivière et al., 2015). For persons with borderline personality disorder (BPD), it has been shown that it is one of the most difficult occupation to accomplish (Larivière, 2010; Zanarini et al., 2012). However, the specific challenges they encounter are not clear and there is a need to guide vocational interventions for this clientele. This symposium will start with Marc Corbière, who will present a comprehensive study on the relative contribution of programmatic (n=24 supported employment programs), employment specialist (n=97) and individual (n=489) variables in determining the likelihood of obtaining competitive employment for people with a severe mental illness (Corbière et al., 2015). Then, Nadine Larivière will present a scoping study based on the literature review framework of Arskey and O’Malley (2005) on work functioning and BPD, discussing challenges faced to integrate and maintain employment, perceptions about work and how work is integrated in current interventions for persons with BPD. Finally, Kathy Dahl will present a qualitative multiple case study that identified factors that facilitated or hindered work participation from the perspectives of individuals with BPD (n = 9) and their service providers (n = 9) as well as solutions to improve work integration and job tenure (Dahl et al., 2015). The symposium will conclude with recommendations for clinicians and avenues for future research (Nadine Larivière). Chair: Nadine Larivière Speakers: Nadine Larivière; Marc Corbière; Kathy Dahl How to help social and health services understand and intervene effectively with personality disorder Patients with personality disorder often present serious social, medical and legal difficulties. They are well known to the youth protection services, to employment centers, to specialized services for substance use disorders and to the judicial system. Over the years, many specific treatment approaches have been developed in specialized personality disorder settings. However these patients are also getting services from many organisms that are not specialized in personality disorder. These organizations are mostly providing services for specific problems not related directly to personality disorder but still have to interact with these patients who often are complex to deal with, make poor alliances or are difficult to manage. Common examples include problems with limit setting, counter transference enactment and frequent resignation of staff. Over the years, faced with many pressing demands from different organizations, clinical teams in Montreal and in Quebec City have provided training, support, supervision and consultation to clinicians, team leaders and directors to address the many difficulties they are confronted with. During this symposium, we will be presenting three very different settings and the process put in place with specialized programs to address these issues. Presenters will focus on difficulties, errors that are sometimes made but also on success, trying to better outline the key elements of a successful collaboration. Chair: Pierre David Speakers: Jean-­‐François Cherrier; Simon Poirier; Mireille Langlois; Pierre David Impairments in social cognition and metacognitive capacities in borderline personality disorder: The specificity of disturbances and associations with therapy outcome Impairments in the ability to infer the mental state of oneself and others is suggested as a core aspect of borderline personality disorder (BPD) and a field receiving increasing research attention. Various concepts, like social cognition, theory of mind, metacognition, or mentilization are applied to capture such mindreading abilities, which are seen as developmental achievements, to a large degree rooted in early attachment experiences. It is assumed that disturbances in social cognition and metacognitive capacities are closely related to the emotional dysregulation in BPD and contribute to the interpersonal difficulties typical for patients with in this disorder. There is also incipient evidence that certain aspects of social cognitive impairments may be improved during psychotherapy. However, disturbances in the ability to read the minds of self and others are features of several disorders and the specificity of such impairments in patients with BPD remains uncertain. More knowledge of social cognition difficulties may contribute to a better understanding of BPD, and point to potential targets of treatment or mediators of change. Yet, social cognition represents complex phenomena and inferences about specific impairments require information based on advanced methods, such as complex experimental tasks, analysis of material from the psychotherapeutic dialogue, or specialized interviews. This symposium brings together presentations of studies using different research tools, focusing on the specificity of social cognition difficulties in BPD, the relationship between attachment styles, metacognition and severity of BPD, as well as the predictive value of metacognitive capacities regarding clinical outcome of a short-­‐term intervention. Chair: Theresa Wilberg Speakers: Carla Sharp and Salome Vanwoerden; Theresa Wilberg, Bjørnar Torske Antonsen, and Eivind Normann-­‐Eide; Giancarlo Dimaggio, Jared Outcalt, Raffaele Popolo, Kelly Buck, Kelly A. Chaudoin-­‐Patzold, Kyle L. Olesek, and Paul H. Lysaker; Pauline Maillard, Giancarlo Dimaggio, Yves de Roten, Jean-­‐Nicolas Despland, Ueli Kramer Implementing an evidence-­‐based early intervention program for BPD in youth The first wave of controlled treatment trials have demonstrated that Early Intervention for BPD (EIBPD) is possible and that meaningful improvements can be achieved for young people with high quality, structured interventions. The next priority is to demonstrate that EIBPD programs can be effectively translated and implemented into existing Child & Youth Mental Health Services, despite the variation in the structure and the way these services function. One of the most pertinent issues is that of model fidelity and establishing the essential EIBPD components. This symposium will comprise 3 papers describing an EIBPD program and the challenges encountered in attempting to implement this program in two different mental health settings. The first paper will describe the core features of The Helping Young People Early Service (HYPE) program, an evidence-­‐based EIBPD program that has been operating successfully since 2000 in Melbourne, Australia. The second paper will describe the process of working with another CYMHS in Melbourne to develop an early intervention approach to BPD. Some aspects of the EIBPD program have been taken up more successfully than others. The third paper will describe the process of implementation of the HYPE program in a Youth Mental Health Service in The Netherlands. The cultural, language and system differences will be reflected on and discussed. Even with enthusiasm and commitment to EIBPD, some important considerations have been identified, particularly how to balance the issues of model fidelity, collaboration, flexibility and innovation. The success of such service development initiatives rely on these being addressed satisfactorily. Chairs: Louise McCutcheon and Andrew Chanen Speakers: Emma Burke; Louise McCutcheon; Christel Hessels Innovations in research on emotional functioning in borderline personality disorder The past decade has seen a dramatic increase in research on emotional functioning in borderline personality disorder (BPD). This research has begun to clarify the role of emotions and emotion regulation in this disorder and its associated consequences. At the same time, this research has identified questions that remain unanswered and increased awareness of how much additional research needs to be done. This symposium will bring together leading researchers on emotion in BPD with the goal of highlighting both ground-­‐breaking research on emotional dysfunction in this disorder and the novel methodologies that may be most useful for capturing the complexity of emotional functioning in BPD. Specifically, Dr. Jennifer Cheavens will present laboratory and daily diary data on the use of acetaminophen to reduce socially-­‐driven emotional pain and increase prosocial behavior among individuals with BPD. Dr. M. Zachary Rosenthal will present on novel laboratory research examining emotional responding to either standardized or personally-­‐relevant emotionally-­‐evocative cues among individuals with and without BPD. Dr. Matthew Tull will describe cutting edge research on emotion regulation in BPD, identifying the impact of co-­‐occurring BPD on drug cravings, emotional arousal, and emotion regulation strategies in response to trauma cues in PTSD. Dr. Katherine Dixon-­‐Gordon will present data on the cognitive consequences of emotional dysfunction in BPD, focusing on the adverse effects of negative emotional contexts on reinforcement learning. Finally, Dr. Kim Gratz will present prospective data on the relevance of emotion dysregulation in BPD to one particularly understudied consequence of this disorder: physical health problems. Chair: Kim Gratz Speakers: Jennifer Cheavens; M. Zachary Rosenthal; Matthew Tull; Katherine Dixon-­‐Gordon; Kim Gratz Involving families in daily practice There is a potentially tremendous impact of personality disorders on family and relatives. Imagine the effects of ongoing and long-­‐term anxiety, aggression, withdrawal, suicidality, self-­‐harm, lost jobs and income, accusations and broken relationships. But families (parents!) feel isolated and blamed (‘neglect & abuse’). It is our job to see if we can help to ‘repare’ the past, to educate and train both patient and their relatives and to seriously involve them in the treatment proces. Each human being, especially the stigmatized and marginalized psychiatric patient, is better off in a safe and reliable environment. In the symposium all presenters show different ways and perspectives for involving families and other relatives in daily practice. They have the same goal: a better connection between professionals, patients and their relatives to improve life for both patients and their relatives Chair: Erwin van Meekeren Speakers: Erwin van Meekeren; John Gunderson; Perry Hoffman; Maria Elena Ridolfi Mechanisms and pathways of familial aggregation of personality disorders Growing evidence suggest a familial aggregation of personality disorders. However, the exact mechanisms of this intergenerational transmission remain unclear. This symposium aims to present recent research findings that explored potential mechanisms and pathways of familial aggregation of personality disorders. Findings on neurocognitive functioning will be presented comparing individuals with borderline personality disorder and their first-­‐degree relatives. A particular focus of the symposium will lie on the role of early adversity and a potential cycle of abuse that beside genetic predisposition may play a prominent role. In addition, results from a sibling study will give insights to the individual perception of childhood adversity and resulting psychopathology in individuals with borderline personality disorders compared to their siblings. Chair: Michael Kaess Speakers: Corinna Reichl (University of Heidelberg, Germany); Catherine Winsper (University of Warwick, United Kingdom); Anthony Ruocco (University of Toronto, Canada); Lise Laporte (McGill University, Montreal, Canada) Mentalization and adolescent narcissism, borderline personality features and psychopathic traits Mentalization and trauma have been identified as important potential risk factors for borderline personality disorders, but there are important gaps in our knowledge regarding their relationship with non-­‐suicidal self-­‐injury, narcissism and psychopathy, especially in adolescents. Little is also known regarding personality organization in adolescents. In this symposium findings from both a community study of 750 adolescents in Québec, as well as a study of 80 adolescents in forensic settings in Denmark, will be presented. The first study focuses on mentalization and trauma as predictors of borderline personality disorder features and narcissism, using a dimensional approach. The aim of this study is to examine similarities and differences in the predictors of borderline personality features, as well as features of grandiose and vulnerable narcissism. The second study focuses specifically on non suicidal self-­‐
injury in adolescents in the community, the overlap between self-­‐harm and borderline personality disorder, and the contribution of mentalization and borderline personality disorder features, relative to other predictors of self-­‐injury. The third study takes a different approach and examines personality of adolescents in the community from the perspective of personality organization and its association with personality disorder, adaptive functioning and mentalization. The fourth study focuses on mentalization and psychopathic traits, with mentalization measured with the RMET. Discussion will address the implications of the findings that deficits in mentalization, appear to be a risk factor associated with a range of personality disorders in adolescents. Chair: Karin Ensink Speakers: Karin Ensink, Mickey Kongeslev, Michaël Begin, Marko Biberdzic Narcissistic Personality Disorders: A dimensional approach in studies and treatment Patients with pathological narcissism or narcissistic personality disorder, NPD, present challenges in treatment, including negative therapeutic reactions and alliance disruptions. Research has indicated that neuropsychological underpinnings and attachment as well as range of regulatory personality functioning and external life circumstances affect their ability and motivation for alliance building and change. The proposed re-­‐conceptualization of the exclusively trait focused approach to personality disorders with integration of dimensional aspects of personality functioning in DSM 5 Section III opens new perspectives on conceptualizing and understanding the conditions and processes of change in NPD. Elisabeth Krusemark presents a study investigating whether both grandiose and vulnerable dimensions are characterized by general defensiveness marked by selective attention to evaluative stimuli, or can be distinguished by selective attention to positive and negative information, respectively. Igor Weinberg examines published reports of effective treatments of NPD patients. The Treatment Effectiveness Factors Scale (TEFS) is used to assess presence versus absence of treatment parameters and interventions in individual case-­‐studies identifying factors contributing to improvement. Diana Diamond explores the clinical implications of a study of attachment and mentalization in patients with severe narcissistic disorders. Specific emphasis is on how the attachment states of mind in this subgroup might affect the process and outcome in Transference Focused Psychotherapy (TFP). Elsa Ronningstam discusses aspects of self-­‐agency and self-­‐regulatory strategies in patients with NPD that either prevent or enable change in personality functioning. Specific focus is on motivation, sense of control, fluctuations in self-­‐esteem, interpersonal relational and reaction patterns, and perception of life circumstances Chair: Elsa Ronningstam Speakers: Elisabeth Krusemark; Igor Weinberg; Diana Diamond; Elsa Ronningstam Discussant: Steven Huprich Pain processing and borderline personality disorder Self-­‐injurious behavior is a common feature of borderline personality disorder (BPD). Eighty-­‐five percent of these patients injure themselves, mostly in order to release high levels of aversive inner tension. Individuals engaging in self-­‐injury commonly report less sensitivity to pain during self-­‐directed acts of injuring. There is a growing body of evidence that altered pain processing may play a role both in development and maintenance of self-­‐injury, particularly among individuals with BPD. In this symposium, the latest empirical data on pain processing in individuals with self-­‐injurious behavior and BPD will be presented. First, current evidence will be summarized in the presentation of a meta-­‐analysis. Subsequently, experimental studies on the potential neurobiological mechanisms of altered pain processing will be presented elucidating the role of the autonomic nervous system, the hypothalamus-­‐
pituitary-­‐adrenal axis, and the activation of important brain regions involved. Chair: Michael Kaess Speakers: Julian König (Ohio State University, US); Michael Kaess (University of Heidelberg, Germany); Paul Plener (University of Ulm, Germany); Ulf Baumgärtner (University of Heidelberg, Germany) PD-­‐SMI: Seriously mental Ill people with a personality disorder A significant part of people with personality disorders drop out of or do not profit from treatment. They receive care as usual (very variable in nature and quality) or no care at all. These people appear to have several comorbid disorders, substance dependancies, a low level of functioning and self mutilating and suicidal behaviors. In addition they are very ambivalent in seeking care and fulfil criteria,of Serious Mental Illness (SMI), We call them people with PD-­‐SMI. Since these patients have very bad quality of life, put a heavy burden on their families and are heavy users of medical services. Sometimes they are characterized as difficult. Recommendations for diagnosis, treatment and care for people with PD-­‐SMI were needed. Experts in the field for people with PD-­‐SMI were asked to be part of a working group. After a search of the literature the working group discussed relevant topics on diagnosis and treatment of and care for people with PD-­‐SMI and formulated recommendations. The working group formulated 12 recommendations to diagnose, treat and organize care for people with PD-­‐SMI. In this symposium these recommendations are discusses, different models to treat people with PD-­‐SMI are presented and the role of the family and friends is pointed out. Chair: Ad Kaasenbrood Speakers: Ad Kaasenbrood; Saskia Knapen; Erwin van Meekeren Perennial and new issues in the dimensional assessment of personality disorders DSM-­‐5 Section III “Emerging Models and Measures” represents a dramatic shift from the Section II categorical personality disorders. A hybrid model for personality disorders was defined with two innovative criteria: impairments in self and interpersonal functioning (criterion A), and the presence of pathological personality traits (criterion B). The Personality Inventory for DSM-­‐5 (PID-­‐5) was developed to operationalize these DSM-­‐5 traits, and 25 primary traits were organized by 5 higher-­‐order dimensions. Research is now needed to explore the convergence of the PID-­‐5 with other dimensional personality assessment tools, to differentiate criterion A and B, and to provide a systematic framework. Furthermore, the dimensional focus detracted attention from another important issue, namely the suitability of the criteria for measuring personality disorders across the life-­‐span. Therefore a first paper will discuss the advantages of dimensional personality trait assessment in youth, and provide examples from hormone-­‐
behavior associations. The second paper empirically tested the convergence of the PID-­‐5 with alternative models (CAT-­‐PD-­‐SF & FFMPD) of maladaptive personality traits in adults. The third paper evaluated the convergence and divergence of personality functioning versus traits, and compares a younger and an older age group. The fourth paper provides a systematic framework from contemporary interpersonal theory, integrating personality structure and dynamics to inform revision of the DSM-­‐5 alternative model. To conclude, Prof. Dr. Bagby, an authority in the domain of personality disorders and expert in dimensional models, will critically review the findings presented, their relationship to perennial/ new issues in research on PDs, and directions for future research. Chair: Gina Rossi Speakers: J.L. Tackett; C. Crego & T.A. Widiger; G. Rossi; A. Pincus, C.J. Hopwood, & A.G.C. Wright Discussant: M. Bagby Personality disorders and the Influence of culture Understanding of cultural influence on personality development and presentation has become increasingly important in studies and treatment of personality disorders. Culturally determined expressions of self and interpersonal functioning influence both the international generalizability of diagnosis and empirical studies, as well as the impact of moves and aculturation on identification and treatment of personality disorders. The Aim of this Symposium is to highlight and discuss significant cultural influence and aspects of personality disorders in five different countries in the world. Esen Karan M.Sc discusses cultural factors and family structure in borderline personality disorder (BPD) in Turkey, with specific focus on autonomy and relatedness expressed in parenting practices, ways of gender socialization, and experiences of aggression in the family dynamics. Dr. Nestor Koldobsky addresses challenges in diagnosis and registration of personality disorders in Argentina, and the influence of Argentinean culture, (i.e., war, dictatorial governments and repression, economic crisis, ethnic populations and external and internal immigration discrimination, violence, drugs, organized crime, corruption, inflation, etc.). Dr. Konstantinos Taliouridis outlines the effects of religion, traditions, family patterns and social expectations, on the development, manifestations and evaluation of personality disorders in Greece. Dr. Brin Grenyer identifies under diagnosed and untreated borderline personality disorder in Australian men, with high suicide rate, domestic violence, substance abuse patterns and complex mood disorders, and discusses cultural implications. Dr. Maria Ridolfi highlights how the development and functioning of borderline personality disorder can be impacted by Italian cultural and social factors such as religion, traditions, family patterns and social expectations. Chair: Dr. Elsa Ronningstam Speakers: Esen Karan; Nestor Koldobsky; Konstantinos Taliouridis; Brin Grenyer; Maria Elena Ridolfi Personality disorders in early to middle adulthood: genetic and environmental factors influencing the association with normal personality, clinical disorders and stability over time The relationship between personality disorders and normal personality and between personality disorders and clinical disorders is still not well understood. The mechanisms underlying the stability of personality disorders over time also remain unclear. Population-­‐based, longitudinal, genetically informative data are required to address these issues. Our research group at The Norwegian Institute of Public Health has collected data on personality disorders, clinical disorders and normal personality in young adult twins for more than 10 years. In this symposium we report on some of the most recent studies. Personality disorders have been hypothesized to represent maladaptive extremes of normal personality traits. The first presentation report results from an empirical investigation of the extent to which common genetic and environmental factors influence normal and abnormal personality. Personality disorders co-­‐occur with several clinical disorders. The second presentation describes a longitudinal study of genetic and environmental factors underlying the longitudinal association between social anxiety disorder and avoidant personality disorder. The relationship between liability to psychotic symptoms or psychotic like experiences and personality disorder traits is the focus of the third presentation. Previous studies indicate that personality disorder traits diminish with age. Avoidant and obsessive-­‐compulsive personality disorders are the focus in presentation four, and borderline and antisocial personality traits in presentation five. Development from early to middle adulthood is described and estimates of the influence of genetic and environmental factors on stability and change is reported. Chair: Ted Reichborn-­‐Kjennerud Speakers: Nikolai O. Czajkowski; Fartein A. Torvik; Eivind Ystrøm; Line C. Gjerde; Ted Reichborn-­‐Kjennerud Personality disorders in older adults: Tackling the challenge of clinical identification and charting the course of effective treatments Despite the limited number of empirical research studies on personality disorders (PDs) in older adults, including epidemiological, psychometric, and treatment studies, recent studies show a cautious optimistic future. There is a growing awareness of the utility of cross-­‐validation PD questionnaires in older populations that have been developed for younger age groups. In addition early feasibility studies show a cautious therapeutic optimism. However, many challenges remain. As a group, older adults are difficult to include in large-­‐scale studies due to the complexities of multi-­‐morbidity, high dropout rates, or lack of capacity to give informed consent (Van Alphen et al., 2015). In this symposium new information informing the diagnosis and treatment of PDs in older adults are presented and discussed. Chairs: Sebastiaan van Alphen and Erlene Rosowsky Speakers: Erlene Rosowsky; Inge Debast; Marjolein Legra; Arjan Videler Predicting psychotherapy outcomes for Borderline Personality Disorder: A focus on neurocognition and neuroimaging An important question facing psychotherapy researchers is understanding what factors may predict clinical outcomes for patients with borderline personality disorder (BPD). The aim of this symposium is to present new research exploring this issue using neurocognitive and neuroimaging measures in outpatients with BPD undergoing either dialectical behavior therapy (DBT) or mentalization-­‐based treatment (MBT). Dr. Anthony C. Ruocco (University of Toronto) will present research on neurocognitive deficits in BPD and their associations with dimensions of personality psychopathology. Next, Marianne Thomsen (University of Copenhagen) will describe neurocognitive findings from a treatment study of MBT carried out in Denmark. Finally, Achala Rodrigo (University of Toronto) will present innovative research using optical brain imaging to predict clinical outcomes for self-­‐harming patients with BPD undergoing DBT. Chair: Anthony Ruocco Speakers: Anthony C. Ruocco; Marianne Thomsen; Achala Rodrigo Predictive factors of treatment response for adolescents with Borderline Personality Disorder Given the difficulties of treating individuals with Borderline Personality Disorder (BPD), it is important to identify factors which may contribute to differential outcomes in order to provide optimal treatment response. This series of presentations will focus on three factors which can contribute significantly to better treatment response: treatment engagement, family functioning, and distress tolerance. While these key factors are important among adults, additional considerations are warranted in the treatment of adolescents with BPD considering the transitional period that adolescence represents. Health care professionals must pay specific attention to ensuring that continuity of care is withheld given that youths will often be referred to treatment rather than seeking help, and as such, are more at risk of noncompliance and dropout. Also, family functioning is a key consideration for the treatment of adolescents with BPD since they are still in the care of their parents in most cases; therefore maladaptive family systems must be addressed, with parents also being involved in the recovery process. Finally, response to treatment can also vary according to the application of distress tolerance and adaptive coping skills learned as a function of dialectical behaviour therapy. The ability to use and extend therapeutic gains beyond the therapy sessions can help consolidate gains. It is thus important to reflect on how the adolescent will engage in the therapeutic process, but also the family’s engagement, and their effects on the therapeutic response. These factors will therefore be explored in the purpose of informing better therapeutic practices. Chair: Johanne Renaud Speakers: Johanne Renaud; Lyne Desrosiers; Sasha MacNeil Primary emotions and emotional functioning in personality disorders: Associations with PD categories, mentalizing, and therapy outcomes Emotional personality traits reflect their presence and the ways humans are dealing with their primary emotions. They might be adaptive or maladaptive. Emotional dysfunctions are among the defining features of personality disorders (PDs). Awareness is growing that patient with PD feature problems with emotional functioning, including difficulties describing, tolerate, and adaptively express their own feelings. These problems are likely to influence symptoms, self and relational functioning. Although there are different theories about how the self is conceptualized and organized, both the concept of mentalizing and affective functioning, and their interrelationship, has received increasing interest, both in therapeutic field and in theoretical approaches where one tries to understand the self and implications for psychopathology and PDs. Despite the fact that emotional functioning theoretically are considered important underlying comprehension models for the self and relational problems in patients with PDs, few have investigated relationships between primary emotions and PD features, between emotions and mentalizing in clinical PD populations, and how change in emotional functioning influences personality functions during therapy. The authors of this symposium present material coming from partly different PD populations, using partly different instruments to explore correlations between emotions and PD features, mentalizing, and psychotherapy outcome. Results are discussed in order to advance our understanding of PD pathology and suggestions for refinement of existing treatments are provided. Chairs: Sigmund Karterud and Merete Selsbakk Johansen Speakers: Sigmund Karterud, Geir Pedersen, Merete Selsbakk Johansen, Theresa Wilberg, Kenneth L. Davis, Jaak Panksepp; Merete Selsbakk Johansen, Eivind Normann-­‐Eide, Sigmund Karterud, Elfrida Kvarstein, Theresa Wilberg; Eivind Normann-­‐Eide, Merete Selsbakk Johansen, Tone Normann-­‐Eide, Jens Egeland, Theresa Wilberg Psychiatric treatments for borderline personality disorder: New perspectives Good Psychiatric Management (GPM) is an effective treatment for borderline personality disorder (BPD). While its usefulness in this context is confirmed, there are a number of open questions which should be addressed by researchers and clinicians working with this model. The present panel will focus on three open questions. First, Brandon Unruh will elaborate on the use of GPM principles when reducing or ending treatment is needed. Then, Stephane Kolly will present data on therapist adherence to GPM principles in a different treatment context: a short-­‐term psychiatric intervention of 10 sessions. Finally, Patrick Charbon will elaborate on the role of co-­‐morbid depressive disorders on the early response and the therapeutic alliance within GPM treatments for BPD. Chair: Ueli Kramer Speakers: Brandon Unruh; Stephane Kolly; Patrick Charbon Discussant: Kenneth R. Silk Psychological mechanisms and processes in the treatment of personality disorders Background. Personality disorders (PDs) are generally diagnosed by identification of specific traits, codified in criteria. However psychotherapy of personalty disorders is more likely to focus on specific personality mechanisms and related processes than on the traits themselves. Examples of such mechanisms include defense and coping mechanisms, cognitive errors, and emotional processing. Methods. This panel examines these mechanisms and processes in clinical treatment of samples including a range of disorders, focusing on personality disorders. Results. The first presentation examines the role of emotional processing and the therapeutic interaction on outcome in PD patients undergoing a humanistic form of psychotherapy (Clarification-­‐oriented Psychotherapy or COP). The second study examines changes in cognitive errors in a sample of BPD patients undergoing 10-­‐sessions of Motive-­‐
oriented therapeutic Relationship treatment compared to a control treatment. The third study examines change in defense mechanisms over the course of up to 18-­‐month therapy for recurrent depression with or without concomitant PD in relationship to improvement in depression. The fourth study examines changes in coping action patterns and cognitive errors in the same sample as the third presentation. Conclusion. Together these studies demonstrate the utility of examining personality mechanisms in relationship to treatment. The study of therapeutic processes in relationship to change in these mechanisms and other outcomes is a likely way to discover ways to improve our treatments of individuals with personality disorders. Chair: John Perry Speakers: Ueli Kramer; Sabine Keller; J. Christopher Perry; Claire J. Starrs Psychopathology, functioning and premature mortality in youth with borderline personality disorder Although borderline personality disorder usually has its onset in young people, its diagnosis and treatment is often delayed. The past two decades has seen a rapid increase in evidence establishing that BPD can be diagnosed prior to age 18 years and that BPD in young people is both continuous with BPD in adults and more notable for its similarities than for any differences. Research conducted with youth presenting early in the course of borderline personality disorder can provide insights into this disorder by reducing the potential influence of duration of illness effects (e.g., cumulative traumatic events, recurrent mental state disorders, treatment/polypharmacy). This developmental period also provides a key opportunity for prevention and early intervention, informed by such research. This symposium presents research conducted with samples of youth (aged 15-­‐25 years) presenting clinically for the first time with borderline personality disorder. These studies contribute to our understanding of the psychopathology, functioning and premature mortality associated with BPD. Co-­‐chairs: Andrew Chanen, Carol Hulbert Presenters: Jennifer Betts; Carol Hulbert; Franco Scalzo; Laura Finlayson-­‐Short Psychotic symptoms and severe personality disorder Both psychotic disorders and severe personality disorder become clinically apparent over the period from puberty to young adulthood. Psychotic symptoms appear to be common among patients with severe personality disorder and vice versa. Their co-­‐occurrence is clinically well recognised, is associated with significant risks and is complex to treat. The separation of psychotic symptoms into ‘true’ and ‘quasi’ is clinically and scientifically problematic. Yet, there is currently no consensus regarding the authenticity, phenomenology, severity or treatment of these experiences. Evidence is accumulating for separate dimensional models of psychosis and personality disorder. Yet, there is little scientific literature integrating these fields. This symposium will address the phenomenology of psychotic symptoms and severe personality pathology. Chairs: Andrew Chanen, Karin Slotema Speakers: Andrew Chanen; Karin Slotema; Félix-­‐Antoine Bérubé; Martina Jovev Real life consequences of misdiagnosis, misunderstanding, mistreatment and stigmatization of Borderline Personality Disorder People with Borderline Personality Disorder (BPD) face a treatment crisis. Borderline Personality Disorder (BPD), prevalence 5.9%, generally goes misdiagnosed, undiagnosed, stigmatized and mistreated. BPD underlies major public health problems including substance abuse, alcoholism, domestic violence, impulse control disorders, incarceration and is the highest utilizer of emergency rooms and inpatient hospitalizations. Amongst veterans who are suicide attempters and completers, a recent study finds 94% meet criteria for BPD. Rampant professional stigma exists against BPD patients, seen as patients to be “avoided”, “treatment refractory,” “untreatable” and a “liability” due to increased risk of self-­‐injurious and suicidal behavior is a contributing factor to the BPD misdiagnosis that is the usual experience for patients. This results in wasted years, hopelessness and chaos, family crises along with severe personal and economic consequences to patients and families. for iatrogenic treatment. The need for assessment with validated diagnostic instruments to rule out or diagnose BPD, Bipolar, ADHD, substance abuse and other comorbid diagnoses as well as to diagnosis children and adolescents at the time symptoms appear will be discussed. Presentation of the shockingly few studies on BPD versus Bipolar will be presented and the consequences of failing to diagnose will be highlighted. The need for clinical education in evidence based BPD treatments, training, and supervision as well as patient and family psychoeducation as to improving outcome will be presented through findings from a TARA on-­‐line survey. A family member and a person with BPD will describe their journey through the mental health system. Chair: Valerie Porr Speakers: Valerie Porr. MA; Mark Zimmerman, MD; Regina Piscitelli; Alka Chaudhary Shame: The missing factor in conceptualizing and treating Borderline Personality Disorder: Impact on BPD sufferers Shame, a central self-­‐conscious emotion in BPD, has been generally overlooked despite its’ relationship to self-­‐injurious behavior, chronic suicidality, self-­‐esteem, quality of life, rumination and arousal of angry-­‐
hostile feelings. Evidence suggests that shame plays a major role in the lives of people with BPD. Patients describe feelings of shame when explaining their acute, aversive feelings of emotional pain and "badness" about themselves. Very little research has focused on the impact of shame on the person’s sense of self, behaviors and reactions. BPD symptoms and maladaptive behaviors may be the expression of and defenses against the painful emotion of shame. Shame-­‐proneness is related to anger arousal and the tendency to externalize attributions for one's own behavior by blaming others or not taking responsibility for one’s behavior. The relationship between shame-­‐proneness, BPD features, rumination and anger arousal has important implications for treatment. The presentation will present findings from a literature review on shame including Neurobiological findings from an fMRI evaluation of shame and guilt (Michl, P. 2011). Responses from a TARA internet survey Evaluating The Experience of Shame and a presentation on the impact of shame on a young woman with BPD will call attention to the degree of suffering and emotional pain associated with experiencing shame. The presentation will demonstrate through role play how TARA’s family psychoeducation program can help decrease or avoid BPD shame responses. Chair: Valerie Porr Speakers: Valerie Porr; Regina Piscitelli; Lori Scott; Alka Chaudhary Social cognition in borderline personality disorder Humans are social animals, and have a fundamental need to interact and belong. We call Social Cognition to the complex bio-­‐psycho-­‐social chain involving the encoding, storage, retrieval, and processing, of information about other persons. Borderline personality disorder (BPD) is characterized by serious problems in interpersonal relationships and emotional functioning. There is a lack of data regarding social cognition in Personality Disorders and specifically BPD. We approach that problem through three different studies exploring the ability to interpret facial expressions (key to understanding others minds), the tendency to jump too easily to conclusions in everyday reasoning (what may produce wrong judgments) and the presence of aberrant salience (eventually generating misinterpretation of current events). Three presentations will show data analysing those varaibles in BPD patients, compared to first episode psychotic patients and healthy controls. In the first presentation, Maider Gonzalez de Arataza will show how PD patients process the affective salience of sounds through the study of reactions to white noise. Then Ana Catalán will analyse their biased way of data gathering with a Beads Task test. Finally Miguel Angel Gonzalez-­‐Torres will address the issue of facial interpretation using a Degraded Faces test. Summarizing the results of the three studies, BPD do present difficulties in Social Cognition compared to controls, showing problems to interpret emotions in faces, often doing hasty evaluations and experiencing speech illusions more easily. These preliminary findings could signal basic problems under common clinical difficulties and eventually help us to design better therapeutic interventions. Chair: Miguel Angel Gonzalez-­‐Torres Speakers: Maider Gonzalez de Artaza; Ana Catalán; Miguel Angel Gonzalez-­‐Torres Stepped Care for patients with Borderline Personality Disorder: Theoretical approach, clinical management and research outcomes? Stepped Care is a treatment model for chronic disorders, in which patients follow steps from briefer and less resource-­‐intensive interventions to those requiring more time and professional input. The presenters will describe how this can be applied to BPD management on hospital wards, in out-­‐patient clinics (both short-­‐term and extended care), and suggest a model for change. Chair: Joel Paris, MD Speakers: Joel Paris, MD; Robert Biskin, MD; Ilana Kronik, PhD; Tonje Persson, PhD, Joelle Jobin, PhD, Lise Laporte, PhD Structural and functional brain imaging in adolescents and young adults with BPD and women with traumatic life experiences The past decade has brought an enormous increase of studies on the neurobiology of Borderline Personality Disorder (BPD). However, data on neurobiological factors in youth with BPD are rare. Neurobiological findings from adults with BPD, which are implicated in its aetiology, should already be present early in the course of BPD and studying BPD in youth is a means of decreasing the influence of ‘duration of illness’ effects (e.g., treatment). The aim of this symposium is to present recent studies of structural and functional brain imaging findings in BPD in adolescents and young adults as well as findings from a study which could demonstrate an altered neural activation in women with a history of traumatization when confronted with conflictual situations with their own child (First presentation: Prof. Sabine C. Herpertz et al.). The second presentation (Prof. Merav Silverman et al.) will show findings of disturbed connectivity patterns in patients with PBP as well with BPD traits. The third presentation (Prof. Marianne Goodman et al.) will present further evidence that a specific treatment (Dialectical Behavior Therapy) for patients with BPD is associated with changes of the amygdala activity and altered capacity for emotion regulation. The fourth presentation (Prof. Romuald Brunner) gives insight into a graph-­‐based network analysis in a sample of female adolescents with BPD which could reveal altered local measures in the frontotemporal network including the orbitofrontal cortex. Chair: Romuald Brunner Speakers: Sabine C. Herpertz; Merav Silverman; Marianne Goodman; Romuald Brunner Systems Training for Emotional Predictability and Problem Solving (STEPPS): New developments This symposium describes new developments in the STEPPS program for borderline personality disorder (BPD), and describes its use in diverse populations and treatment settings. The program is easily implemented by facilitators from a wide variety of theoretical orientations and training backgrounds. This evidence-­‐based program is typically implemented as a 20-­‐week (2 hr/2k) outpatient psychoeducational, cognitive-­‐behavioral, skills training approach. However, STEPPS has readily been adapted for use in widely diverse settings and the manual has been translated into several languages. STEPPS characterizes BPD as an emotional intensity disorder that clients learn to manage with specific emotion and behavior management skills. Key professionals, friends, and family members (clients’ “reinforcement team”) also learn to support and reinforce these skills, and group participants are encouraged to teach what they are learning to those identified as part of their system. The program has three components: awareness of illness, emotion management, and behavior management skills. A detailed facilitator and client manual with specific lesson plans is used. STEPPS is listed in the US Substance Abuse and Mental Health Services Administration's National Registry of Evidence-­‐Based Programs and Practices (NREPP). Presenters will describe new developments with STEPPS in the following settings: adult outpatients who may not be in a group setting (US); a new 18-­‐week program for adolescents, ages 15-­‐18, and a 13-­‐week program for adults with subsyndromal BPD (UK); STEPPS in a private practice setting (Switzerland); and its use in people with BPD plus antisocial personality disorder or its traits. Chair: Donald Black Speakers: Donald W Black, MD; Nancee Blum, MSW; Renee Harvey; Konstantinos Taliouridis, PhD; Horusta Freije The alternative DSM-­‐5 Model for personality disorders The Alternative DSM-­‐5 Model for Personality Disorders (AMPD), published in 2013 in Section III (“Emerging Measures and Models”) of DSM-­‐5, has stimulated a great deal of interest and research. Drs. Clark, Krueger, and Oldham were members of the DSM-­‐5 PD Work Group, and Drs. Hummelen and Zimmermann have led research projects to study aspects of the AMPD. Oldham will summarize the main elements of the AMPD and will introduce a new Structured Clinical Interview for the DSM-­‐5 Alternative Model for Personality Disorders (SCID-­‐AMPD). Hummelen and colleagues will report on the use of the SCID-­‐AMPD and a number of other instruments to assess impairment in personality functioning as defined by the AMPD. Zimmermann will report the results of a study of the Level of Personality Functioning Scale (LPFS) of the AMPD, and of the Personality Inventory for DSM-­‐5 (PID-­‐5), to investigate how the information obtained with these two instruments aligns with Criterion A and Criterion B of the Alternative Model. Clark will then discuss the overlap in self-­‐report and interview measures of both personality functioning (Criterion A) and traits (Criterion B) in the AMPD, with a focus on their predictive validity for psychosocial functioning. Finally, Krueger will serve as Discussant to respond to each of the presenters. Chair: John Oldham Presenters: John M. Oldham, MD; Benjamin Hummelen, MD, PhD; Johannes Zimmermann, PhD; Lee Anna Clark, PhD Discussant: Robert Krueger, PhD What’s the difference that makes the difference? Commonalities and differences across evidence based treatments for Borderline Personality Disorder Emergence of manualized therapies for BPD such as mentalization-­‐based treatment (MBT), Transference-­‐
Focused Psychotherapy (TFP), and Dialectical Behavior Therapy (DBT) bring hope to people with BPD. Attendees can learn about treatments from data showing their effectiveness but rarely get a chance to see master clinicians applying their treatment in actual therapy. In this seminar attendees experience master clinicians doing spontaneous therapy, first providing a high-­‐level description of their respective treatments, followed by a live clinical demonstration, commentary, and discussion, highlighting the structural, strategic, and stylistic similarities and differences between MBT , TFP , DBT, and an emerging integration of DBT and MBT for families, the TARA Method of Family Psychoeducation. Observing a master clinician treating a BPD client in crisis provides the opportunity to see how effective treatment is actually done and demonstrates how clients respond to efficacious treatment. Discussion following explores what might be needed to develop a new, integrated BPD treatment. The demonstrations will address how to determine which therapy is best suited for which client. While some advocate for comparison trials between these treatments to determine which is more effective, others argue against 'horse race' studies, advocating instead on improving each treatment through component analysis studies. Another approach is to examine the similarities and differences between each treatment approach to aid in treatment matching to the client and to refine each treatment by identifying common elements used across all three treatments. The role of family psychoeducation so as to engage families as treatment adjuncts has also been considered. Chair: Valerie Porr, MA Speakers: Valerie Porr, MA; Anthony Bateman; Martin Bohus; Eric Fertuck When Dialectical Behaviour Therapy isn’t enough: An integrated program for persons with Borderline Personality Disorder The efficacy and cost-­‐effectiveness of Dialectical Behaviour Therapy (DBT) for the treatment of Borderline Personality Disorder (BPD) is well established. However, implementing DBT is not the best solution for all public health care organizations. Adopting standard DBT was not well-­‐suited to our own Mental Health Program due to the up-­‐front training costs, the concern that DBT would not adequately address the needs of an especially marginalized and severe population, and a lack of consensus among Mental Health Program leaders regarding the best theoretical approach. Accordingly, our team developed an integrative treatment program for people with severe and persistent BPD. Jacqueline Cohen will outline the program, articulating how we integrate interpersonal, psychodynamic, acceptance and commitment-­‐based, and wellness approaches with DBT. Shelley Harvill will describe our Values/Wellness group, which uses acceptance and commitment therapy, positive psychology, wellness interventions, and drama and other creative arts therapies to help clients emotionally connect with and generalize their DBT skills. Deborah Parker will describe how exploring the parallels between the process dilemmas that take place in the interpersonal group and those occurring within our clinical team have helped us to identify and treat therapist-­‐ and team-­‐interfering behaviours within our consultation team. Discussion will highlight (a) the challenges of developing a program in which the various treatment components are mutually enhancing yet adherent to their own models, and (b) the process by which we have learned that while we have different models of how behaviour change occurs, our therapeutic methods are compatible and complementary. Chair: Jacqueline Cohen Speakers: Jacqueline N. Cohen; Deborah J. R. Parker; Shelley Harvill Why an integrated approach to treating personality disorder is necessary Psychotherapists and psychiatrists agree that Personality Disorders (PDs) are difficult to diagnose and to treat. Even if different manualized approach has been considered effective, as emerging also from several RCT studies, the results are however incomplete and the quality of life of the patient is not satisfying. One reason is that is not clear which psychopathological variables we have consider to focus an effective treatment and consequently one of the main limits of existing manualized therapies is that have a specific focus so that are efficient only on single aspects of Personality Disorder. This psychopathological complexity of PDs requires the need for interventions which use the rich repertoire of techniques available, but integration must come from a homogeneous and coherent case formulation which allows to establish the hierarchy of importance of various interventions, what is expected from each of them and, consequently, their succession in time that they not become a confusing juxtaposition of interventions. For this aim it is necessary a well structured organization which integrates the different competences in a delicate but efficient balance between eclecticism, synergy and order. In this symposium will discuss about structure and ingredients for a modern and effective treatment for patient with personality disorder in real world and in real setting.-­‐ The topic of this symposium will be the Metacognitive Interpersonal therapy standard approach form III centre of cognitive Psychotherapy in Rome with two presentation, first one about treatment organization and case formulation, the second about outcome data of 160 outpatients. The last presentation will discuss the problem t of comprehensive treatment that suggest the urgent need to move beyond the current situation of competing “schools” to a more trans-­‐theoretical approach. Chair: Antonio Semerari Speakers: Giuseppe Nicolo; Antonino Carcione; John Livesley Discussant: John Clarkin