Early Alliance, Alliance Ruptures, and Symptom Change in a Nonrandomized Trial of Cognitive Therapy for Avoidant and Obsessive-Compulsive Personality Disorders

ERIC Educational Resources Information Center

Strauss, Jennifer L.; Hayes, Adele M.; Johnson, Sheri L.; Newman, Cory F.; Brown, Gregory K.; Barber, Jaques P.; Lawrenceau, Jean-Philippe; Beck, Aaron T.

2006-01-01

Participants were 30 adult outpatients diagnosed with avoidant personality disorder or obsessive-compulsive personality disorder who enrolled in an open trial of cognitive therapy for personality disorders. Treatment consisted of up to 52 weekly sessions. Symptom evaluations were conducted at intake, at Sessions 17 and 34, and at the last…

Group schema therapy versus group cognitive behavioral therapy for social anxiety disorder with comorbid avoidant personality disorder: study protocol for a randomized controlled trial.

PubMed

Baljé, Astrid; Greeven, Anja; van Giezen, Anne; Korrelboom, Kees; Arntz, Arnoud; Spinhoven, Philip

2016-10-08

Social anxiety disorder (SAD) with comorbid avoidant personality disorder (APD) has a high prevalence and is associated with serious psychosocial problems and high societal costs. When patients suffer from both SAD and APD, the Dutch multidisciplinary guidelines for personality disorders advise offering prolonged cognitive behavioral therapy (CBT). Recently there is increasing evidence for the effectiveness of schema therapy (ST) for personality disorders such as borderline personality disorder and cluster C personality disorders. Since ST addresses underlying personality characteristics and maladaptive coping strategies developed in childhood, this treatment might be particularly effective for patients with SAD and comorbid APD. To our knowledge, there are no studies comparing CBT with ST in this particular group of patients. This superiority trial aims at comparing the effectiveness of these treatments. As an additional goal, predictors and underlying mechanisms of change will be explored. The design of the study is a multicentre two-group randomized controlled trial (RCT) in which the treatment effect of group cognitive behavioral therapy (GCBT) will be compared to that of group schema therapy (GST) in a semi-open group format. A total of 128 patients aged 18-65 years old will be enrolled. Patients will receive 30 sessions of GCBT or GST during a period of approximately 9 months. Primary outcome measures are the Liebowitz Social Anxiety Scale Self-Report (LSAS-SR) for social anxiety disorder and the newly developed Avoidant Personality Disorder Severity Index (AVPDSI) for avoidant personality disorder. Secondary outcome measures are the MINI section SAD, the SCID-II section APD, the Schema Mode Inventory (SMI-2), the Inventory of Depressive Symptomatology Self-Report (IDS-SR), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), the Difficulties in Emotion Regulation Scale (DERS), the Rosenberg Self-Esteem Scale (RSES) and the Acceptance and Action

Two-Year Stability and Change of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders

ERIC Educational Resources Information Center

Grilo, Carlos M.; Sanislow, Charles A.; Gunderson, John G.; Pagano, Maria E.; Yen, Shirley; Zanarini, Mary C.; Shea, Tracie M.; Skodol, Andrew E.; Stout, Robert L.; Morey, Leslie C.; McGlashan, Thomas H.

2004-01-01

The authors examined the stability of schizotypal (STPD), borderline (BPD), avoidant (AVPD) and obsessive-compulsive (OCPD) personality disorders (PDs) over 2 years of prospective multiwave follow-up. Six hundred thirty-three participants recruited at 4 collaborating sites who met criteria for 1 or more of the 4 PDs or for major depressive…

Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study.

PubMed

Yen, Shirley; Shea, M Tracie; Battle, Cynthia L; Johnson, Dawn M; Zlotnick, Caron; Dolan-Sewell, Regina; Skodol, Andrew E; Grilo, Carlos M; Gunderson, John G; Sanislow, Charles A; Zanarini, Mary C; Bender, Donna S; Rettew, Jennifer Bame; McGlashan, Thomas H

2002-08-01

The association between trauma and personality disorders (PDs), while receiving much attention and debate, has not been comprehensively examined for multiple types of trauma and PDs. The authors examined data from a multisite study of four PD groups: schizotypal, borderline (BPD), avoidant, and obsessive-compulsive, and a major depression comparison group. Rates of traumatic exposure to specific types of trauma, age of first trauma onset, and rates of posttraumatic stress disorder are compared. Results indicate that BPD participants reported the highest rate of traumatic exposure (particularly to sexual traumas, including childhood sexual abuse), the highest rate of posttraumatic stress disorder, and youngest age of first traumatic event. Those with the more severe PDs (schizotypal, BPD) reported more types of traumatic exposure and higher rates of being physically attacked (childhood and adult) when compared to other groups. These results suggest a specific relationship between BPD and sexual trauma (childhood and adult) that does not exist among other PDs. In addition, they support an association between severity of PD and severity of traumatic exposure, as indicated by earlier trauma onset, trauma of an assaultive and personal nature, and more types of traumatic events.

Examination of DSM-5 Section III avoidant personality disorder in a community sample.

PubMed

Sellbom, Martin; Carmichael, Kieran L C; Liggett, Jacqueline

2017-11-01

The current research evaluated the continuity between DSM-5 Section II and Section III diagnostic operationalizations of avoidant personality disorder (AvPD). More specifically, the study had three aims: (1) to examine which personality constructs comprise the optimal trait constellation for AvPD; (2) to investigate the utility of the proposed structure of the Section III AvPD diagnosis, in regard to combining functional impairment (criterion A) and a dimensional measure of personality (criterion B) variables; and (3) to determine whether AvPD-specific impairment confers incremental meaningful contribution above and beyond general impairment in personality functioning. A mixed sample of 402 university and community participants was recruited, and they were administered multiple measures of Section II PD, personality traits, and personality impairment. A latent measurement model approach was used to analyse data. Results supported the general continuity between Section II and Section III of the DSM-5; however, three of the four main criterion B traits were the stronger predictors. There was also some support for the trait unassertiveness augmenting the criterion B trait profile. The combination of using functional impairment criteria (criterion A) and dimensional personality constructs (criterion B) in operationalizing AvPD was supported; however, the reliance of disorder-specific over general impairment for criterion A was not supported. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Pre-treatment predictors and in-treatment factors associated with change in avoidant and dependent personality disorder traits among patients with social phobia.

PubMed

Borge, Finn-Magnus; Hoffart, Asle; Sexton, Harold; Martinsen, Egil; Gude, Tore; Hedley, Liv Margaret; Abrahamsen, Gun

2010-01-01

We examined changes in avoidant and dependent personality disorder dimensions, and pre-treatment and in-treatment factors associated with such changes in 77 patients, randomized to medication-free residential cognitive (CT) or residential interpersonal therapy for social phobia. Personality disorders and personality dimensions according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were assessed at pre-treatment and at one-year post-treatment. Both treatments were associated with a decrease in avoidant and dependent personality dimensions; dependent dimension decreased more in CT. Changes in cognitive factors predicted changes in both personality dimensions, whereas changes in symptoms or interpersonal factors did not. Change in the cognitive factor estimated cost was the most powerful predictor in the avoidant dimension, as it was the only predictor that remained significant in the forward regression analyses. Change in the cognitive factor estimated cost, and treatment were the most powerful predictors of change in the dependent dimension. Pre-treatment use of anxiolytics predicted larger changes in both PD dimensions.

Social phobia and avoidant personality disorder: similar but different?

PubMed

Lampe, Lisa; Sunderland, Matthew

2015-02-01

Avoidant personality disorder (AvPD) is regarded as a severe variant of social phobia (SP), consistent with a dimensional model. However, these conclusions are largely drawn from studies based on individuals with SP, with or without comorbid AvPD. The present study hypothesized that there are qualitative differences between AvPD and SP that are undermined by limiting research to participants with SP. The authors sought to test this hypothesis by comparing three groups-SP only, AvPD only, and SP+AvPD-using data extracted from an epidemiological sample of 10,641 adults aged 18 years and over. Screening questions were used in the epidemiological survey to identify ICD-10 personality disorders; from this the author developed a proxy measure for DSM-IV AvPD. Axis I diagnoses, including DSM-IV SP, were identified using the Composite International Diagnostic Interview (CIDI). In this sample, the majority of those with AvPD did not also have SP: The authors found 116 persons with AvPD only, 196 with SP only, and 69 with SP+AvPD. There was little difference between any of the groups on sex, marital status, employment, education, or impairment variables. The SP+AvPD group reported more distress and comorbidity than the SP only and AvPD only groups, which did not differentiate from each other. More feared social situations were endorsed in the SP only group compared to the AvPD only group. Although the finding of few differences between SP only and AvPD only groups among the variables measured in this epidemiological survey fails to provide support for the hypothesis of qualitative differences, the finding that the AvPD only group appears more similar to the SP only group than to the SP+AvPD group also fails to provide support for the alternative continuity hypothesis. The greater distress and additional comorbidity with depression associated with SP+AvPD may be due to the additional symptom load of a second disorder rather than simply representing a more severe variant of

Social anxiety disorders in clinical practice: differentiating social phobia from avoidant personality disorder.

PubMed

Lampe, Lisa

2015-08-01

To outline the problems around overlap between social phobia (SAD) and avoidant personality disorder (AVPD) and provide guidelines that may assist clinicians to differentiate these conditions. A constellation of symptoms can be identified that may distinguish AVPD from SAD, with key features being a strong and pervasively negative self-concept, a view of rejection as equating to a global evaluation of the individual as being of little worth and a sense of not fitting in socially that dates from early childhood. It is important to identify the presence of AVPD in order to anticipate potential problems with engagement and retention in therapy, to target treatment interventions and optimise outcome. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Personality disorders in persons with gender identity disorder.

PubMed

Duišin, Dragana; Batinić, Borjanka; Barišić, Jasmina; Djordjevic, Miroslav L; Vujović, Svetlana; Bizic, Marta

2014-01-01

Investigations in the field of gender identity disorder (GID) have been mostly related to psychiatric comorbidity and severe psychiatric disorders, but have focused less on personality and personality disorders (PDs). The aim of the study was to assess the presence of PDs in persons with GID as compared to cisgendered (a cisgender person is a person who is content to remain the gender they were assigned at birth) heterosexuals, as well as to biological sex. The study sample consisted of 30 persons with GID and 30 cisgendered heterosexuals from the general population. The assessment of PDs was conducted by application of the self-administered Structured Clinical Interview for DSM-IV Axis II PDs (SCID-II). Persons with GID compared to cisgender heterosexuals have higher presence of PDs, particularly Paranoid PD, avoidant PDs, and comorbid PDs. In addition, MtF (transwomen are people assigned male at birth who identify as women) persons are characterized by a more severe psychopathological profile. Assessment of PDs in persons with GID is of great importance as it comprises a key part of personalized treatment plan tailoring, as well as a prognostic factor for sex-reassignment surgery (SRS) outcome.

Personality disorders and traits in patients with body dysmorphic disorder.

PubMed

Phillips, K A; McElroy, S L

2000-01-01

Individuals with body dysmorphic disorder (BDD) have been postulated to have schizoid, narcissistic, and obsessional personality traits and to be sensitive, introverted, perfectionistic, and insecure. However, data on personality traits and disorders in BDD are limited. This study assessed 148 subjects with BDD, 26 of whom participated in a fluvoxamine treatment study; 74 subjects were assessed for personality disorders with the Structured Clinical Interview for DSMIII-R Personality Disorders (SCID-II), 100 subjects completed the NEO-Five Factor Inventory (NEO-FFI), and 51 subjects completed the Rathus Assertiveness Scale. Forty-two subjects (57%) had one or more personality disorders, with avoidant personality disorder (43%) being most common, followed by dependent (15%), obsessive-compulsive (14%), and paranoid (14%) personality disorders. On the NEO-FFI, the mean scores were in the very high range for neuroticism, the low range for extraversion and conscientiousness, the low-average range for agreeableness, and the average range for openness to experience. On the Rathus Assertiveness Scale, the mean score was -17.1 +/- 32.0 for women and -17.0 +/- 32.3 for men. Among fluvoxamine responders, the number of personality disorders significantly decreased between the study baseline and endpoint. These findings suggest that the rate of personality disorders in BDD is relatively high, with avoidant personality disorder being most common. The high neuroticism scores and low extraversion scores are consistent with this finding.

Avoidant personality disorder versus social phobia: the significance of childhood neglect.

PubMed

Eikenaes, Ingeborg; Egeland, Jens; Hummelen, Benjamin; Wilberg, Theresa

2015-01-01

Avoidant personality disorder (AvPD) and social phobia (SP) are common disorders both in the community and in clinical settings. Whether the two disorders represent different severity levels of social anxiety disorder is currently in dispute. The relationship between AvPD and SP is probably more complex than previously assumed. Several environmental, temperamental, and constitutional factors may play a role in the etiology of AvPD and SP. Better knowledge about childhood experiences may shed light on similarities and differences between the two disorders. The aim of this study was to compare self-reported childhood experiences in AvPD and SP patients. This is a cross-sectional multi-site study of 91 adult patients with AvPD and/ or SP. We compared patients with AvPD with and without SP (AvPD group) to patients with SP without AvPD (SP group). The patients were examined using structured diagnostic interviews and self-report measures, including Child Trauma Questionnaire, Parental Bonding Instrument, and Adult Temperament Questionnaire. Both AvPD and SP were associated with negative childhood experiences. AvPD patients reported more severe childhood neglect than patients with SP, most pronounced for physical neglect. The difference between the disorders in neglect remained significant after controlling for temperamental factors and concurrent abuse. The study indicates that childhood neglect is a risk factor for AvPD and may be one contributing factor to phenomenological differences between AvPD and SP.

Relations among symptoms of social phobia subtypes, avoidant personality disorder, panic, and depression.

PubMed

Carter, Shawn A; Wu, Kevin D

2010-03-01

This study's primary goal was to examine relations between symptoms of specific social phobia (SSP), generalized social phobia (GSP), avoidant personality disorder (APD), and panic and depression. Past research has suggested a single social phobia continuum in which SSP displays less symptom severity than GSP or APD. We found SSP symptoms correlated less strongly with depression but more strongly with panic relative to both GSP and APD symptoms. These findings challenge a unidimensional model of social phobia, suggesting a multidimensional model may be more appropriate. These findings also inform current research aimed at classifying mood and anxiety disorders more broadly by identifying that the different factors of fear versus distress appear to underlie different subtypes of social phobia. 2008. Published by Elsevier Ltd.

Personality Disorders in Persons with Gender Identity Disorder

PubMed Central

Duišin, Dragana; Batinić, Borjanka; Barišić, Jasmina; Djordjevic, Miroslav L.; Vujović, Svetlana; Bizic, Marta

2014-01-01

Background. Investigations in the field of gender identity disorder (GID) have been mostly related to psychiatric comorbidity and severe psychiatric disorders, but have focused less on personality and personality disorders (PDs). Aims. The aim of the study was to assess the presence of PDs in persons with GID as compared to cisgendered (a cisgender person is a person who is content to remain the gender they were assigned at birth) heterosexuals, as well as to biological sex. Methods. The study sample consisted of 30 persons with GID and 30 cisgendered heterosexuals from the general population. The assessment of PDs was conducted by application of the self-administered Structured Clinical Interview for DSM-IV Axis II PDs (SCID-II). Results. Persons with GID compared to cisgender heterosexuals have higher presence of PDs, particularly Paranoid PD, avoidant PDs, and comorbid PDs. In addition, MtF (transwomen are people assigned male at birth who identify as women) persons are characterized by a more severe psychopathological profile. Conclusions. Assessment of PDs in persons with GID is of great importance as it comprises a key part of personalized treatment plan tailoring, as well as a prognostic factor for sex-reassignment surgery (SRS) outcome. PMID:24959629

Short-term Beneficial Effects of 12 Sessions of Neurofeedback on Avoidant Personality Accentuation in the Treatment of Alcohol Use Disorder

PubMed Central

Dalkner, Nina; Unterrainer, Human F.; Wood, Guilherme; Skliris, Dimitris; Holasek, Sandra J.; Gruzelier, John H.; Neuper, Christa

2017-01-01

This study evaluated the effects of alpha/theta neurofeedback on Clinical Personality Accentuations in individuals with alcohol use disorder. Twenty-five males were investigated using a pre-test/post-test design with a waiting-list control group. Participants were randomly assigned either to an experimental group (n = 13) receiving 12 sessions of neurofeedback twice a week as a treatment adjunct over a period of 6 weeks, or to a control group (n = 12) receiving treatment as usual. The Inventory of Clinical Personality Accentuations and the NEO-Five-Factor Inventory were applied at pre- and post-test. The neurofeedback protocol focused on enhancement of the EEG alpha (8–12 Hz) and theta (4–7 Hz) and used a visual feedback paradigm. Analyses of covariance showed improvements in Avoidant Personality Accentuation within the experimental group. Our data suggest that 12 sessions of this neurofeedback intervention might be effective in reducing avoidant and stress-related personality traits in patients with alcohol use disorder. PMID:29018397

Short-term Beneficial Effects of 12 Sessions of Neurofeedback on Avoidant Personality Accentuation in the Treatment of Alcohol Use Disorder.

PubMed

Dalkner, Nina; Unterrainer, Human F; Wood, Guilherme; Skliris, Dimitris; Holasek, Sandra J; Gruzelier, John H; Neuper, Christa

2017-01-01

This study evaluated the effects of alpha/theta neurofeedback on Clinical Personality Accentuations in individuals with alcohol use disorder. Twenty-five males were investigated using a pre-test/post-test design with a waiting-list control group. Participants were randomly assigned either to an experimental group ( n = 13) receiving 12 sessions of neurofeedback twice a week as a treatment adjunct over a period of 6 weeks, or to a control group ( n = 12) receiving treatment as usual. The Inventory of Clinical Personality Accentuations and the NEO-Five-Factor Inventory were applied at pre- and post-test. The neurofeedback protocol focused on enhancement of the EEG alpha (8-12 Hz) and theta (4-7 Hz) and used a visual feedback paradigm. Analyses of covariance showed improvements in Avoidant Personality Accentuation within the experimental group. Our data suggest that 12 sessions of this neurofeedback intervention might be effective in reducing avoidant and stress-related personality traits in patients with alcohol use disorder.

Emotion avoidance and fear bradycardia in patients with borderline personality disorder and healthy controls.

PubMed

Stoffels, Malou; Nijs, Maurits; Spinhoven, Philip; Mesbah, Rahele; Hagenaars, Muriel A

2017-12-01

Exaggerated emotional reactivity is supposed to be essential in the etiology of borderline personality disorder (BPD). More specifically, models of defensive behavior would predict reduced freezing behavior -indicated by fear bradycardia-in response to threat. This study examined automatic fear bradycardia responses in BPD versus healthy controls and the role of emotion dysregulation, more specifically tendencies to avoid emotions. Patients with BPD (n = 23) and healthy controls (n = 18) completed questionnaires and then watched neutral, pleasant and unpleasant pictures while heart rate was assessed. Emotion avoidance interacted with group: it was associated with distinct autonomic responses in healthy controls but not in BPD patients. Controls with lower emotion avoidance tendencies showed bradycardia in response to unpleasant pictures, while controls with higher emotion avoidance tendencies did not. BPD patients showed no bradycardia, irrespective of their emotion avoidance tendencies. This study is limited by a small sample size. Comorbidity or medication intake were not controlled for. The results may suggest impaired automatic defense responses in BPD. Further understanding of the regulation of distress and defense responses might improve BPD treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Attachment and social cognition in borderline personality disorder: Specificity in relation to antisocial and avoidant personality disorders.

PubMed

Beeney, Joseph E; Stepp, Stephanie D; Hallquist, Michael N; Scott, Lori N; Wright, Aidan G C; Ellison, William D; Nolf, Kimberly A; Pilkonis, Paul A

2015-07-01

Theory and research point to the role of attachment difficulties in borderline personality disorder (BPD). Attachment insecurity is believed to lead to chronic problems in social relationships, attributable, in part, to impairments in social cognition, which comprise maladaptive mental representations of self, others, and self in relation to others. However, few studies have attempted to identify social-cognitive mechanisms that link attachment insecurity to BPD and to assess whether such mechanisms are specific to the disorder. For the present study, empirically derived indices of mentalization, self-other boundaries, and identity diffusion were tested as mediators between attachment style and personality disorder symptoms. In a cross-sectional structural equation model, mentalization and self-other boundaries mediated the relationship between attachment anxiety and BPD. Mentalization partially mediated the relationship between attachment anxiety and antisocial personality disorder (PD) symptoms, and self-other boundaries mediated the relationship between attachment anxiety. (c) 2015 APA, all rights reserved).

First evidence of a prospective relation between avoidance of internal states and borderline personality disorder features in adolescents.

PubMed

Sharp, Carla; Kalpakci, Allison; Mellick, William; Venta, Amanda; Temple, Jeff R

2015-03-01

At least two leading developmental models of borderline personality disorder (BPD) emphasize the role of accurate reflection and understanding of internal states as significant to the development of BPD features (Fonagy, Int J Psycho-Anal 72:639-656, 1991; Linehan, Cognitive-behavioral treatment of borderline personality disorder, 1993). The current study used the construct of experiential avoidance (EA) to operationalize avoidance of internal states and sought to examine (1) the concurrent relations between EA and borderline features in a large and diverse community sample; and (2) the prospective relation between EA and borderline features over a 1-year follow-up, controlling for baseline levels of borderline features. N = 881 adolescents recruited from public schools in a large metropolitan area participated in baseline assessments and N = 730 completed follow-up assessments. Two main findings were reported. First, EA was associated with borderline features, depressive, and anxiety symptoms at the bivariate level, but when all variables were considered together, depression and anxiety no longer remained significantly associated with borderline features, suggesting that the relations among these symptom clusters may be accounted for by EA as a cross-cutting underlying psychological process. Second, EA predicted levels of borderline symptoms at 1-year follow-up, controlling for baseline levels of borderline symptoms, and symptoms of anxiety and depression. Results are interpreted against the background of developmental theories of borderline personality disorder.

Affective Disorders among Patients with Borderline Personality Disorder

PubMed Central

Sjåstad, Hege Nordem; Gråwe, Rolf W.; Egeland, Jens

2012-01-01

Background The high co-occurrence between borderline personality disorder and affective disorders has led many to believe that borderline personality disorder should be considered as part of an affective spectrum. The aim of the present study was to examine whether the prevalence of affective disorders are higher for patients with borderline personality disorder than for patients with other personality disorders. Methods In a national cross-sectional study of patients receiving mental health treatment in Norway (N = 36 773), we determined whether psychiatric outpatients with borderline personality disorder (N = 1 043) had a higher prevalence of affective disorder in general, and whether they had an increased prevalence of depression, bipolar disorder or dysthymia specifically. They were compared to patients with paranoid, schizoid, dissocial, histrionic, obsessive-compulsive, avoidant, dependent, or unspecified personality disorder, as well as an aggregated group of patients with personality disorders other than the borderline type (N = 2 636). Odds ratios were computed for the borderline personality disorder group comparing it to the mixed sample of other personality disorders. Diagnostic assessments were conducted in routine clinical practice. Results More subjects with borderline personality disorder suffered from unipolar than bipolar disorders. Nevertheless, borderline personality disorder had a lower rate of depression and dysthymia than several other personality disorder groups, whereas the rate of bipolar disorder tended to be higher. Odds ratios showed 34% lower risk for unipolar depression, 70% lower risk for dysthymia and 66% higher risk for bipolar disorder in patients with borderline personality disorder compared to the aggregated group of other personality disorders. Conclusions The results suggest that borderline personality disorder has a stronger association with affective disorders in the bipolar spectrum than disorders in the unipolar

The prevalence of personality disorders in hypochondriasis.

PubMed

Sakai, Reiko; Nestoriuc, Yvonne; Nolido, Nyryan V; Barsky, Arthur J

2010-01-01

Although Axis I hypochondriasis is closely related to certain personality characteristics, the nature and extent of personality dysfunction in these patients still needs clarification. This study assessed the prevalence of personality disorders observed in hypochondriacal patients, described the types and comorbidity of personality disorders, and compared the psychological distress of patients with and without the most common comorbid personality disorder. One hundred fifteen patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for hypochondriasis completed self-administered assessments, including the Personality Diagnostic Questionnaire-4+ (PDQ-4+), the Hopkins Symptom Checklist-90-Revised (SCL-90-R), the Whiteley Index, and the Somatic Symptom Inventory. These data were taken from a study conducted between September 1997 and November 2001. Eighty-eight patients (76.5%) had 1 or more personality disorders, whereas 27 patients (23.5%) had no personality disorders. Fifty-one patients (44.3%) had more than 3 personality disorders. The most common personality disorder in the hypochondriacal patients was obsessive-compulsive personality disorder (OCPD; 55.7%), followed by avoidant personality disorder (40.9%). The comorbidity of OCPD and avoidant personality disorder was 53.1% (34 of 64 patients with OCPD). The total PDQ-4+ score of the 64 patients with OCPD was significantly higher than that of the 51 patients without OCPD. On the SCL-90-R, the 64 patients with OCPD showed significantly higher scores on all of 3 global indices and 7 of 10 primary symptom dimensions (paranoid ideation, depression, anxiety, phobic anxiety, obsessive-compulsive, interpersonal sensitivity, and psychoticism) on the SCL-90-R compared to the 51 patients without OCPD. The high prevalence of personality disorders, particularly OCPD, among patients with hypochondriasis suggests that consideration of personality features is important in assessment and

Personality Disorder and Changes in Affect Consciousness: A 3-Year Follow-Up Study of Patients with Avoidant and Borderline Personality Disorder

PubMed Central

Johansen, Merete Selsbakk; Normann-Eide, Tone; Egeland, Jens

2015-01-01

Personality disorders (PDs) are highly prevalent in patients receiving psychiatric services, and are associated with significant personal and social costs. Over the past two decades, an increasing number of treatment studies have documented the effectiveness of treatment for patients with PDs, especially when it comes to reduction of symptom distress, risk taking behavior, self-harm, or suicide attempts. However, less is known about the more complex aims of improving the personality structure itself, such as identity- and interpersonal disturbances. Emotional dysfunction is closely associated with PD pathology. The present study investigated changes in affect consciousness (AC) in patients with avoidant or borderline PD, and how these changes were associated with clinical status after 3 years of follow-up. The study included 52 individuals; 79 percent were females, and mean age was 30 years. The evaluations included the Affect Consciousness Interview, Symptom Checklist-90-R, Circumplex of Interpersonal Problems, the Index of Self-Esteem, and three domains (Identity Integration, Relational Capacities, and Self-Control) of the Severity Indices of Personality Problems (SIPP-118). There was a significant increase in the Global AC and AC scores for most of the specific affects from baseline to follow-up. As the present study did not include a control group, it cannot be concluded that changes in AC are effects of psychotherapy, and the possibility of age-related maturation processes cannot be excluded. The change in Global AC contributed significantly to explained variance in the follow-up levels of Circumplex of Interpersonal Problems, and the two SIPP-118 domains Relational Capacities and Identity Integration. Improved AC was not associated with change in the Self-Control domain or the Global Severity Index of Symptom Checklist-90-R. The results suggest that AC may be altered for patients with borderline and avoidant PDs, and this is the first study to report that

Longitudinal effects of dysfunctional perfectionism and avoidant personality style on postpartum mental disorders: Pathways through antepartum depression and anxiety.

PubMed

Oddo-Sommerfeld, Silvia; Hain, Sarah; Louwen, Frank; Schermelleh-Engel, Karin

2016-02-01

There is first evidence that some personality characteristics raise the risk of postpartum depression (PPD). The present longitudinal study investigates whether dysfunctional perfectionism and avoidant personality style predict PPD, postpartum anxiety (PPA) and bonding impairment (BI) directly or indirectly through antepartum anxiety (APA) and antepartum depression (APD). Pregnant women were recruited in two obstetric departments in Germany. The assessment occurred at two measurement time points: In the third trimester of pregnancy (N=297) and twelve weeks postpartum (N=266). Six questionnaires were administered during pregnancy: perfectionism, personality styles, anxiety, and depression. Postpartum, data on PPA, PPD and BI were collected. We conducted two path analyses in order to examine direct and indirect effects of the two personality characteristics on postpartum disorders. Testing for direct effects of dysfunctional perfectionism and avoidant personality style on PPD, PPA, and BI did not yield significant results. Instead, significant indirect effects were found: PPD, PPA, and BI were influenced indirectly by dysfunctional perfectionism and avoidant personality style via APD and APA. This model explained high portions of the variance of PPD, PPA, and impaired bonding. Each of the two personality characteristics explained a unique part of the outcome measures. The influence on BI was mediated by PPD. APD affected PPD and PPA more strongly than APA. Path models with manifest (observed) variables may lead to measurement errors. Self-rating questionnaires may raise the problem of social desirability. Dysfunctional perfectionism and avoidant personality style are significant risk factors for PPD, PPA, and BI. Screenings of both variables, as well as of APA and APD, which mediated the effect of personality traits on postpartum syndromes, are necessary. Copyright © 2015 Elsevier B.V. All rights reserved.

Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive–compulsive personality disorder over two years

PubMed Central

SKODOL, ANDREW E.; PAGANO, MARIA E.; BENDER, DONNA S.; SHEA, M. TRACIE; GUNDERSON, JOHN G.; YEN, SHIRLEY; STOUT, ROBERT L.; MOREY, LESLIE C.; SANISLOW, CHARLES A.; GRILO, CARLOS M.; ZANARINI, MARY C.; McGLASHAN, THOMAS H.

2012-01-01

Background A defining feature of personality disorder (PD) is an enduring pattern of inner experience and behavior that is stable over time. Follow-up and follow-along studies have shown considerable diagnostic instability of PDs, however, even over short intervals. What, then, about personality disorder is stable ? The purpose of this study was to determine the stability of impairment in psychosocial functioning in patients with four different PDs, in contrast to patients with major depressive disorder (MDD) and no PD, prospectively over a 2-year period. Method Six hundred treatment-seeking or treated patients were recruited primarily from clinical services in four metropolitan areas of the Northeastern USA. Patients were assigned to one of five diagnostic groups: schizotypal (STPD) (n=81), borderline (BPD) (n=155), avoidant (AVPD) (n=137), or obsessive–compulsive (OCPD) (n=142) personality disorders or MDD and no PD (n=85), based on the results of semi-structured interview assessments and self-report measures. Impairment in psychosocial functioning was measured using the Longitudinal Interval Follow-up Evaluation (LIFE) at baseline and at three follow-up assessments. Results Significant improvement in psychosocial functioning occurred in only three of seven domains of functioning and was largely the result of improvements in the MDD and no PD group. Patients with BPD or OCPD showed no improvement in functioning overall, but patients with BPD who experienced change in personality psychopathology showed some improvement in functioning. Impairment in social relationships appeared most stable in patients with PDs. Conclusion Impairment in functioning, especially social functioning, may be an enduring component of personality disorder. PMID:15841879

Tridimensional Personality Questionnaire data on alcoholic violent offenders: specific connections to severe impulsive cluster B personality disorders and violent criminality.

PubMed

Tikkanen, Roope; Holi, Matti; Lindberg, Nina; Virkkunen, Matti

2007-07-30

The validity of traditional categorical personality disorder diagnoses is currently re-evaluated from a continuous perspective, and the evolving DSM-V classification may describe personality disorders dimensionally. The utility of dimensional personality assessment, however, is unclear in violent offenders with severe personality pathology. The temperament structure of 114 alcoholic violent offenders with antisocial personality disorder (ASPD) was compared to 84 offenders without ASPD, and 170 healthy controls. Inclusion occurred during a court-ordered mental examination preceded by homicide, assault, battery, rape or arson. Participants underwent assessment of temperament with the Tridimensional Personality Questionnaire (TPQ) and were diagnosed with DSM-III-R criteria. The typical temperament profile in violent offender having ASPD comprised high novelty seeking, high harm avoidance, and low reward dependence. A 21% minority scored low in trait harm avoidance. Results, including the polarized harm avoidance dimension, are in accordance with Cloninger's hypothesis of dimensional description of ASPD. The low harm avoidance offenders committed less impulsive violence than high harm avoidance offenders. High harm avoidance was associated with comorbid antisocial personality disorder and borderline personality disorder. Results indicate that the DSM based ASPD diagnosis in alcoholic violent offenders associates with impulsiveness and high novelty seeking but comprises two different types of ASPD associated with distinct second-order traits that possibly explain differences in type of violent criminality. Low harm avoidance offenders have many traits in common with high scorers on the Hare Psychopathy Checklist-Revised (PCL-R). Results link high harm avoidance with broad personality pathology and argue for the usefulness of self-report questionnaires in clinical praxis.

Interrelationship of Personality Disorders: Theoretical Formulations and Anecdotal Evidence.

ERIC Educational Resources Information Center

Vincent, Ken R.

1987-01-01

Attempts to define interrelationship of personality disorders. Discusses relationships between and among three major groupings of Diagnostic and Statistical Manual of Mental Disorders. Suggests that passive aggressive, avoidant, and borderline personality disorders serve as bridges between these groupings. Discusses placement within groupings with…

Longitudinal comparison of depressive personality disorder and dysthymic disorder.

PubMed

Markowitz, John C; Skodol, Andrew E; Petkova, Eva; Xie, Hui; Cheng, Jianfeng; Hellerstein, David J; Gunderson, John G; Sanislow, Charles A; Grilo, Carlos M; McGlashan, Thomas H

2005-01-01

Few studies have compared the related diagnostic constructs of depressive personality disorder (DPD) and dysthymic disorder (DD). The authors attempted to replicate findings of Klein and Shih in longitudinally followed patients with personality disorder or major depressive disorder (MDD) in the Collaborative Longitudinal Personality Disorders Study. Subjects (N = 665) were evaluated at baseline and over 2 years (n = 546) by reliably trained clinical interviewers using semistructured interviews and self-report personality questionnaires. Only 44 subjects (24.6% of 179 DPD and 49.4% of 89 early-onset dysthymic subjects) met criteria for both disorders at baseline. Depressive personality disorder was associated with increased comorbidity of some axis I anxiety disorders and other axis II diagnoses, particularly avoidant (71.5%) and borderline (55.9%) personality disorders. Depressive personality disorder was associated with low positive and high negative affectivity on dimensional measures of temperament. Depressive personality disorder subjects had lower likelihood of remission of baseline MDD at 2-year follow-up, whereas DD subjects did not. The DPD diagnosis appeared unstable over 2 years of follow-up, as only 31% (n = 47) of 154 subjects who had DPD at baseline and also had follow-up assessment met criteria on blind retesting. Results from this sample may not generalize to other populations. Depressive personality disorder and dysthymic disorder appear to be related but differ in diagnostic constructs. Its moderating effect on MDD and predicted relationship to measures of temperament support the validity of DPD, but its diagnostic instability raises questions about its course, utility, and measurement.

Tridimensional Personality Questionnaire data on alcoholic violent offenders: specific connections to severe impulsive cluster B personality disorders and violent criminality

PubMed Central

Tikkanen, Roope; Holi, Matti; Lindberg, Nina; Virkkunen, Matti

2007-01-01

Background The validity of traditional categorical personality disorder diagnoses is currently re-evaluated from a continuous perspective, and the evolving DSM-V classification may describe personality disorders dimensionally. The utility of dimensional personality assessment, however, is unclear in violent offenders with severe personality pathology. Methods The temperament structure of 114 alcoholic violent offenders with antisocial personality disorder (ASPD) was compared to 84 offenders without ASPD, and 170 healthy controls. Inclusion occurred during a court-ordered mental examination preceded by homicide, assault, battery, rape or arson. Participants underwent assessment of temperament with the Tridimensional Personality Questionnaire (TPQ) and were diagnosed with DSM-III-R criteria. Results The typical temperament profile in violent offender having ASPD comprised high novelty seeking, high harm avoidance, and low reward dependence. A 21% minority scored low in trait harm avoidance. Results, including the polarized harm avoidance dimension, are in accordance with Cloninger's hypothesis of dimensional description of ASPD. The low harm avoidance offenders committed less impulsive violence than high harm avoidance offenders. High harm avoidance was associated with comorbid antisocial personality disorder and borderline personality disorder. Conclusion Results indicate that the DSM based ASPD diagnosis in alcoholic violent offenders associates with impulsiveness and high novelty seeking but comprises two different types of ASPD associated with distinct second-order traits that possibly explain differences in type of violent criminality. Low harm avoidance offenders have many traits in common with high scorers on the Hare Psychopathy Checklist-Revised (PCL-R). Results link high harm avoidance with broad personality pathology and argue for the usefulness of self-report questionnaires in clinical praxis. PMID:17662159

Self-mutilation and suicide attempts: relationships to bipolar disorder, borderline personality disorder, temperament and character.

PubMed

Joyce, Peter R; Light, Katrina J; Rowe, Sarah L; Cloninger, C Robert; Kennedy, Martin A

2010-03-01

Self-mutilation has traditionally been associated with borderline personality disorder, and seldom examined separately from suicide attempts. Clinical experience suggests that self-mutilation is common in bipolar disorder. A family study was conducted on the molecular genetics of depression and personality, in which the proband had been treated for depression. All probands and parents or siblings were interviewed with a structured interview and completed the Temperament and Character Inventory. Fourteen per cent of subjects interviewed reported a history of self-mutilation, mostly by wrist cutting. Self-mutilation was more common in bipolar I disorder subjects then in any other diagnostic groups. In multiple logistic regression self-mutilation was predicted by mood disorder diagnosis and harm avoidance, but not by borderline personality disorder. Furthermore, the relatives of non-bipolar depressed probands with self-mutilation had higher rates of bipolar I or II disorder and higher rates of self-mutilation. Sixteen per cent of subjects reported suicide attempts and these were most common in those with bipolar I disorder and in those with borderline personality disorder. On multiple logistic regression, however, only mood disorder diagnosis and harm avoidance predicted suicide attempts. Suicide attempts, unlike self-mutilation, were not familial. Self-mutilation and suicide attempts are only partially overlapping behaviours, although both are predicted by mood disorder diagnosis and harm avoidance. Self-mutilation has a particularly strong association with bipolar disorder. Clinicians need to think of bipolar disorder, not borderline personality disorder, when assessing an individual who has a history of self-mutilation.

Two-Year Stability and Change of Schizotypal, Borderline, Avoidant, and Obsessive–Compulsive Personality Disorders

PubMed Central

Grilo, Carlos M.; Shea, M. Tracie; Sanislow, Charles A.; Skodol, Andrew E.; Gunderson, John G.; Stout, Robert L.; Pagano, Maria E.; Yen, Shirley; Morey, Leslie C.; Zanarini, Mary C.; McGlashan, Thomas H.

2012-01-01

The authors examined the stability of schizotypal (STPD), borderline (BPD), avoidant (AVPD) and obsessive– compulsive (OCPD) personality disorders (PDs) over 2 years of prospective multiwave follow-up. Six hundred thirty-three participants recruited at 4 collaborating sites who met criteria for 1 or more of the 4 PDs or for major depressive disorder (MDD) without PD were assessed with semistructured interviews at baseline, 6, 12, and 24 months. Lifetable survival analyses revealed that the PD groups had slower time to remission than the MDD group. Categorically, PD remission rates range from 50% (AVPD) to 61% (STPD) for dropping below diagnostic threshold on a blind 24-month reassessment but range from 23% (STPD) to 38% (OCPD) for a more stringent definition of improvement. Dimensionally, these findings suggest that PDs may be characterized by maladaptive trait constellations that are stable in their structure (individual differences) but can change in severity or expression over time. PMID:15482035

Personality disorder traits as predictors of subsequent first-onset panic disorder or agoraphobia

PubMed Central

Bienvenu, O. Joseph; Stein, Murray B.; Samuels, Jack F.; Onyike, Chiadi U.; Eaton, William W.; Nestadt, Gerald

2009-01-01

Determining how personality disorder traits and panic disorder and/or agoraphobia relate longitudinally is an important step in developing a comprehensive understanding of the etiology of panic/agoraphobia. In 1981, a probabilistic sample of adult (≥ 18 years old) residents of east Baltimore were assessed for Axis I symptoms and disorders using the Diagnostic Interview Schedule (DIS); psychiatrists re-evaluated a sub-sample of these participants and made Axis I diagnoses, as well as ratings of individual DSM-III personality disorder traits. Of the participants psychiatrists examined in 1981, 432 were assessed again in 1993–1996 using the DIS. Excluding participants who had baseline panic attacks or panic-like spells from the risk groups, baseline timidity (avoidant, dependent, and related traits) predicted first-onset DIS panic disorder or agoraphobia over the follow-up period. These results suggest that avoidant and dependent personality traits are predisposing factors, or at least markers of risk, for panic disorder and agoraphobia - not simply epiphenomena. PMID:19374963

Personality disorder symptomatology among Vietnam veterans with combat-related PTSD.

PubMed

Richman, H; Frueh, B C

1996-01-01

This research examined self-report personality profiles of 42 Vietnam veterans with combat-related posttraumatic stress disorder (PTSD) evaluated at an outpatient Veteran's Administration hospital PTSD clinic. Assessment was via the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev; DSM-III-R) Personality Disorders-II (SCID-II) self-report. Self-reported personality disorder symptomatology of PTSD patients was contrasted with that of 51 outpatients with a primary diagnosis of an anxiety disorder other than PTSD and with 16 patients with a primary diagnosis of major depressive disorder (MDD). Symptomatology from each of the 11 DSM-III-R categories and from the three personality disorder "clusters" was calculated in terms of percentage of possible traits endorsed, thus creating personality "profiles" for the three groups. PTSD veterans endorsed more traits overall than did both the mixed anxiety and MDD groups, particularly on the Cluster A, avoidant, and borderline scales. Results suggest a PTSD-related personality profile characterized by emotional lability/poor anger control, paranoia/suspiciousness, identity disturbance/confusion, social withdrawal/avoidance, and feelings of emptiness and boredom.

Personality disorders: review and clinical application in daily practice.

PubMed

Angstman, Kurt B; Rasmussen, Norman H

2011-12-01

Personality disorders have been documented in approximately 9 percent of the general U.S. population. Psychotherapy, pharmacotherapy, and brief interventions designed for use by family physicians can improve the health of patients with these disorders. Personality disorders are classified into clusters A, B, and C. Cluster A includes schizoid, schizotypal, and paranoid personality disorders. Cluster B includes borderline, histrionic, antisocial, and narcissistic personality disorders. Cluster C disorders are more prevalent and include avoidant, dependent, and obsessive-compulsive personality disorders. Many patients with personality disorders can be treated by family physicians. Patients with borderline personality disorder may benefit from the use of omega-3 fatty acids, second-generation antipsychotics, and mood stabilizers. Patients with antisocial personality disorder may benefit from the use of mood stabilizers, antipsychotics, and antidepressants. Other therapeutic interventions include motivational interviewing and solution-based problem solving.

Impulsivity, Rejection Sensitivity, and Reactions to Stressors in Borderline Personality Disorder

PubMed Central

Berenson, Kathy R.; Gregory, Wesley Ellen; Glaser, Erin; Romirowsky, Aliza; Rafaeli, Eshkol; Yang, Xiao; Downey, Geraldine

2016-01-01

This research investigated baseline impulsivity, rejection sensitivity, and reactions to stressors in individuals with borderline personality disorder compared to healthy individuals and those with avoidant personality disorder. The borderline group showed greater impulsivity than the avoidant and healthy groups both in a delay-discounting task with real monetary rewards and in self-reported reactions to stressors; moreover, these findings could not be explained by co-occurring substance use disorders. Distress reactions to stressors were equally elevated in both personality disorder groups (relative to the healthy group). The borderline and avoidant groups also reported more maladaptive reactions to a stressor of an interpersonal vs. non-interpersonal nature, whereas the healthy group did not. Finally, self-reported impulsive reactions to stressors were associated with baseline impulsivity in the delay-discounting task, and greater self-reported reactivity to interpersonal than non-interpersonal stressors was associated with rejection sensitivity. This research highlights distinct vulnerabilities contributing to impulsive behavior in borderline personality disorder. PMID:27616800

Predicting personality disorder functioning styles by the Chinese Adjective Descriptors of Personality: a preliminary trial in healthy people and personality disorder patients.

PubMed

Fan, Hongying; Zhu, Qisha; Ma, Guorong; Shen, Chanchan; Zhang, Bingren; Wang, Wei

2016-08-30

Cultural and personality factors might contribute to the clinical differences of psychiatric patients all over the world including China. One cultural oriented Chinese Adjective Descriptors of Personality (CADP) designed to measure normal personality traits, might be specifically associated with different personality disorder functioning styles. We therefore have invited 201 healthy volunteers and 67 personality disorder patients to undergo CADP, the Parker Personality Measure (PERM), and the Plutchik-van Praag Depression Inventory (PVP) tests. Patients scored significantly higher on PVP scale and all 11 PERM personality disorder functioning styles, as well as CADP Emotional and Unsocial traits. The PVP was significantly correlated with some CADP traits and PERM styles in both groups. In healthy volunteers, only one CADP trait, Unsocial, prominently predicted 11 PERM styles. By contrast in patients, CADP Intelligent predicted the PERM Narcissistic and Passive-Aggressive styles; CADP Emotional the PERM Paranoid, Borderline, and Histrionic styles; CADP Conscientious the PERM Obsessive-Compulsive style; CADP Unsocial the PERM Schizotypal, Antisocial, Narcissistic, Avoidant, Dependent, and Passive-Aggressive styles; CADP Agreeable the PERM Antisocial style. As a preliminary study, our results demonstrated that, in personality disorder patients, all five CADP traits were specifically associated with almost all 11 personality disorder functioning styles, indicating that CADP might be used as an aid to diagnose personality disorders in China.

Early improvement in eating attitudes during cognitive behavioural therapy for eating disorders: the impact of personality disorder cognitions.

PubMed

Park, Emma C; Waller, Glenn; Gannon, Kenneth

2014-03-01

The personality disorders are commonly comorbid with the eating disorders. Personality disorder pathology is often suggested to impair the treatment of axis 1 disorders, including the eating disorders. This study examined whether personality disorder cognitions reduce the impact of cognitive behavioural therapy (CBT) for eating disorders, in terms of treatment dropout and change in eating disorder attitudes in the early stages of treatment. Participants were individuals with a diagnosed eating disorder, presenting for individual outpatient CBT. They completed measures of personality disorder cognitions and eating disorder attitudes at sessions one and six of CBT. Drop-out rates prior to session six were recorded. CBT had a relatively rapid onset of action, with a significant reduction in eating disorder attitudes over the first six sessions. Eating disorder attitudes were most strongly associated with cognitions related to anxiety-based personality disorders (avoidant, obsessive-compulsive and dependent). Individuals who dropped out of treatment prematurely had significantly higher levels of dependent personality disorder cognitions than those who remained in treatment. For those who remained in treatment, higher levels of avoidant, histrionic and borderline personality disorder cognitions were associated with a greater change in global eating disorder attitudes. CBT's action and retention of patients might be improved by consideration of such personality disorder cognitions when formulating and treating the eating disorders.

Brain structural anomalies in borderline and avoidant personality disorder patients and their associations with disorder-specific symptoms.

PubMed

Denny, Bryan T; Fan, Jin; Liu, Xun; Guerreri, Stephanie; Mayson, Sarah Jo; Rimsky, Liza; McMaster, Antonia; Alexander, Heather; New, Antonia S; Goodman, Marianne; Perez-Rodriguez, Mercedes; Siever, Larry J; Koenigsberg, Harold W

2016-08-01

Borderline personality disorder (BPD) and avoidant personality disorder (AvPD) are characterized by hyper-reactivity to negatively-perceived interpersonal cues, yet they differ in degree of affective instability. Recent work has begun to elucidate the neural (structural and functional) and cognitive-behavioral underpinnings of BPD, although some initial studies of brain structure have reached divergent conclusions. AvPD, however, has been almost unexamined in the cognitive neuroscience literature. In the present study we investigated group differences among 29 BPD patients, 27 AvPD patients, and 29 healthy controls (HC) in structural brain volumes using voxel-based morphometry (VBM) in five anatomically-defined regions of interest: amygdala, hippocampus, medial prefrontal cortex (MPFC), dorsolateral prefrontal cortex (DLPFC), and anterior cingulate cortex (ACC). We also examined the relationship between individual differences in brain structure and self-reported anxiety and affective instability in each group. We observed reductions in MPFC and ACC volume in BPD relative to HC, with no significant difference among patient groups. No group differences in amygdala volume were found. However, BPD and AvPD patients each showed a positive relationship between right amygdala volume and state-related anxiety. By contrast, in HC there was an inverse relationship between MPFC volume and state and trait-related anxiety as well as between bilateral DLPFC volume and affective instability. Current sample sizes did not permit examination of gender effects upon structure-symptom correlations. These results shed light on potentially protective, or compensatory, aspects of brain structure in these populations-namely, relatively reduced amygdala volume or relatively enhanced MPFC and DLPFC volume. Published by Elsevier B.V.

Associations in the Course of Personality Disorders and Axis I Disorders Over Time

PubMed Central

Shea, M. Tracie; Yen, Shirley; Pagano, Maria E.; Morey, Leslie C.; McGlashan, Thomas H.; Grilo, Carlos M.; Sanislow, Charles A.; Stout, Robert L.; Skodol, Andrew E.; Gunderson, John G.; Bender, Donna S.; Zanarini, Mary C.

2012-01-01

In this study, the authors examined time-varying associations between schizotypal (STPD), borderline (BPD), avoidant (AVPD), or obsessive–compulsive (OCPD) personality disorders and co-occurring Axis I disorders in 544 adult participants from the Collaborative Longitudinal Personality Disorders Study. The authors tested predictions of specific longitudinal associations derived from a model of crosscutting psychobiological dimensions (L. J. Siever & K. L. Davis, 1991) with participants with the relevant Axis I disorders. The authors assessed participants at baseline and at 6-, 12-, and 24-month follow-up evaluations. BPD showed significant longitudinal associations with major depressive disorder and posttraumatic stress disorder. AVPD was significantly associated with anxiety disorders (specifically social phobia and obsessive–compulsive disorder). Two of the four personality disorders under examination (STPD and OCPD) showed little or no association with Axis I disorders. PMID:15535783

A longitudinal, population-based twin study of avoidant and obsessive-compulsive personality disorder traits from early to middle adulthood.

PubMed

Gjerde, L C; Czajkowski, N; Røysamb, E; Ystrom, E; Tambs, K; Aggen, S H; Ørstavik, R E; Kendler, K S; Reichborn-Kjennerud, T; Knudsen, G P

2015-12-01

The phenotypic stability of avoidant personality disorder (AVPD) and obsessive-compulsive personality disorder (OCPD) has previously been found to be moderate. However, little is known about the longitudinal structure of genetic and environmental factors for these disorders separately and jointly, and to what extent genetic and environmental factors contribute to their stability. AVPD and OCPD criteria were assessed using the Structured Interview for DSM-IV Personality in 2793 young adult twins (1385 pairs, 23 singletons) from the Norwegian Institute of Public Health Twin Panel at wave 1 and 2282 (986 pairs, 310 singletons) of these on average 10 years later at wave 2. Longitudinal biometric models were fitted to AVPD and OCPD traits. For twins who participated at both time-points, the number of endorsed sub-threshold criteria for both personality disorders (PDs) decreased 31% from wave 1 to wave 2. Phenotypic correlations between waves were 0.54 and 0.37 for AVPD and OCPD, respectively. The heritability estimates of the stable PD liabilities were 0.67 for AVPD and 0.53 for OCPD. The genetic correlations were 1.00 for AVPD and 0.72 for OCPD, while the unique environmental influences correlated 0.26 and 0.23, respectively. The correlation between the stable AVPD and OCPD liabilities was 0.39 of which 63% was attributable to genetic influences. Shared environmental factors did not significantly contribute to PD variance at either waves 1 or 2. Phenotypic stability was moderate for AVPD and OCPD traits, and genetic factors contributed more than unique environmental factors to the stability both within and across phenotypes.

Personality dimensions in bulimia nervosa, binge eating disorder, and obesity.

PubMed

Peterson, Carol B; Thuras, Paul; Ackard, Diann M; Mitchell, James E; Berg, Kelly; Sandager, Nora; Wonderlich, Stephen A; Pederson, Melissa W; Crow, Scott J

2010-01-01

The purpose of this investigation was to examine differences in personality dimensions among individuals with bulimia nervosa, binge eating disorder, non-binge eating obesity, and a normal-weight comparison group as well as to determine the extent to which these differences were independent of self-reported depressive symptoms. Personality dimensions were assessed using the Multidimensional Personality Questionnaire in 36 patients with bulimia nervosa, 54 patients with binge eating disorder, 30 obese individuals who did not binge eat, and 77 normal-weight comparison participants. Participants with bulimia nervosa reported higher scores on measures of stress reaction and negative emotionality compared to the other 3 groups and lower well-being scores compared to the normal-weight comparison and the obese samples. Patients with binge eating disorder scored lower on well-being and higher on harm avoidance than the normal-weight comparison group. In addition, the bulimia nervosa and binge eating disorder groups scored lower than the normal-weight group on positive emotionality. When personality dimensions were reanalyzed using depression as a covariate, only stress reaction remained higher in the bulimia nervosa group compared to the other 3 groups and harm avoidance remained higher in the binge eating disorder than the normal-weight comparison group. The higher levels of stress reaction in the bulimia nervosa sample and harm avoidance in the binge eating disorder sample after controlling for depression indicate that these personality dimensions are potentially important in the etiology, maintenance, and treatment of these eating disorders. Although the extent to which observed group differences in well-being, positive emotionality, and negative emotionality reflect personality traits, mood disorders, or both, is unclear, these features clearly warrant further examination in understanding and treating bulimia nervosa and binge eating disorder.

Personality Disorders in Gay, Lesbian, Bisexual and Transgender Chemically Dependent Patients

PubMed Central

Grant, Jon E.; Flynn, Meredith; Odlaug, Brian L.; Schreiber, Liana R.N.

2011-01-01

This study sought to examine personality disorders and their related clinical variables in a sample of gay, lesbian, bisexual and transgender (GLBT) individuals with substance use disorders. Study participants were 145 GLBT patients who were admitted to a residential dual diagnosis chemical dependency treatment program. A total of 136 (93.8%) had at least one personality disorder. The most common personality disorders were borderline (n=93; 64.1%), obsessive-compulsive (n=82; 56.6%), and avoidant (n=71; 49.0%) personality disorders. Preliminary data suggests there is a high prevalence of personality disorders in the GLBT population undergoing chemical dependency treatment. PMID:21838838

A longitudinal, population-based twin study of avoidant and obsessive-compulsive personality disorder traits from early to middle adulthood

PubMed Central

Gjerde, L. C.; Czajkowski, N.; Røysamb, E.; Ystrom, E.; Tambs, K.; Aggen, S. H.; Ørstavik, R. E.; Kendler, K. S.; Reichborn-Kjennerud, T.; Knudsen, G. P.

2015-01-01

Background The phenotypic stability of avoidant personality disorder (AVPD) and obsessive-compulsive personality disorder (OCPD) has previously been found to be moderate. However, little is known about the longitudinal structure of genetic and environmental factors for these disorders separately and jointly, and to what extent genetic and environmental factors contribute to their stability. Method AVPD and OCPD criteria were assessed using the Structured Interview for DSM-IV Personality in 2793 young adult twins (1385 pairs, 23 singletons) from the Norwegian Institute of Public Health Twin Panel at wave 1 and 2282 (986 pairs, 310 singletons) of these on average 10 years later at wave 2. Longitudinal biometric models were fitted to AVPD and OCPD traits. Results For twins who participated at both time-points, the number of endorsed sub-threshold criteria for both personality disorders (PDs) decreased 31% from wave 1 to wave 2. Phenotypic correlations between waves were 0.54 and 0.37 for AVPD and OCPD, respectively. The heritability estimates of the stable PD liabilities were 0.67 for AVPD and 0.53 for OCPD. The genetic correlations were 1.00 for AVPD and 0.72 for OCPD, while the unique environmental influences correlated 0.26 and 0.23, respectively. The correlation between the stable AVPD and OCPD liabilities was 0.39 of which 63% was attributable to genetic influences. Shared environmental factors did not significantly contribute to PD variance at either waves 1 or 2. Conclusion Phenotypic stability was moderate for AVPD and OCPD traits, and genetic factors contributed more than unique environmental factors to the stability both within and across phenotypes. PMID:26273730

The psychological costs and benefits of being highly persistent: personality profiles distinguish mood disorders from anxiety disorders.

PubMed

Cloninger, C Robert; Zohar, Ada H; Hirschmann, Schmuel; Dahan, Dana

2012-02-01

The personality trait of Persistence is highly valued by conscientious overachievers, but it has both psychological costs and benefits. The interactions among multiple personality factors influencing the development of mood and anxiety disorders have been confounded in prior clinical samples, but can be disentangled in terms of their underlying brain circuitry and influence on perception of emotional stimuli. 285 individuals who represented the full range of personality variation in a large sample of adult volunteers from the general community of Israel were selected for follow-up by psychiatric interviews, cognitive testing, and medical examinations. The Temperament and Character Inventory (TCI) measured profiles of traits that distinguished individuals with diagnoses of mood and/or anxiety disorders using linear discriminant analysis and non-linear profile analysis. High Harm Avoidance and low Self-directedness strongly distinguished people with mood and/or anxiety disorders from those with neither. High Persistence distinguished people with only anxiety disorders from those with mood disorders. High Persistence was associated with greater health and happiness overall, but also led to more negative emotions than in people with low Persistence unless they were both unusually tolerant of frustration (i.e., low in Harm Avoidance) and self-accepting of personal limitations (i.e. high in Self-directedness). Subjects were volunteers over 40 years of age at assessment. People who are highly persistent (i.e., persevering, ambitious, perfectionistic) are more likely to have anxiety disorders than mood disorders, even when they have other traits increasing risk for both (i.e., high Harm Avoidance and low Self-directedness). High Persistence increases both positive and negative emotions in most people. However, high Persistence reduces negative emotions and increases positive emotions if a person is easy-going (i.e., "happy-go-lucky" when low in both Harm Avoidance and Self

Change in personality status in neurotic disorders.

PubMed

Seivewright, Helen; Tyrer, Peter; Johnson, Tony

2002-06-29

Personality disorders are generally thought not to change by much over time. We assessed the personality status of 202 patients who had a defined diagnostic and statistical manual (DSM)-III neurotic disorder, dysthymia, panic disorder, or generalised anxiety. All patients had had drug and psychological treatment in a randomised controlled trial. 12 years after entry to the study, we reassessed the personality status of 178 (88%) of these patients using the same test (personality assessment schedule). The personality traits of patients in the cluster B flamboyant group (antisocial, histrionic) became significantly less pronounced over 12 years, but those in the cluster A odd, eccentric group (schizoid, schizotypal, paranoid), and the cluster C anxious, fearful group (obsessional, avoidant) became more pronounced. The measure of agreement between baseline and 12-year personality clusters was poor or slight (kappa=0.14, 95% CI 0.04-0.23). Our results suggest that the assumption that personality characteristics do not change with time is incorrect.

Are personality disorders associated with social welfare burden in the United States?

PubMed

Vaughn, Michael G; Fu, Quana; Beaver, Devin; DeLisi, Matt; Perron, Brian; Howard, Matthew

2010-12-01

This study examined the association between personality disorders and use of major social welfare services in a nationally representative sample of U.S. adults (N = 43,093). Social welfare services received and diagnoses of personality, substance use, mood, and anxiety disorders were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV-version. Analyses quantified the association between personality disorders and forms of public assistance while controlling for numerous confounds. Logistic regression analyses revealed dependent personality disorder, paranoid personality disorder, antisocial personality disorder, and avoidant personality disorder were significantly associated with increased odds of receiving public assistance. In contrast, persons diagnosed with histrionic, schizoid, and obsessive-personality disorder were not significantly more likely to receive any public welfare service. Development of effective prevention and treatment of personality disorders would likely lead to reductions in overall social welfare burden.

The profile and familiality of personality traits in mood disorder families.

PubMed

Wu, Pei-Jung; Chang, Sheng-Mao; Lu, Ming-Kun; Chen, Wei J; Yang, Yen-Kuang; Yeh, Tzung-Lieh; Liao, Shin-Cheng; Lu, Ru-Band; Kuo, Po-Hsiu

2012-05-01

Personality traits have impacts on individuals' response to stress and mood expression. The current study aimed to investigate the profile of personality traits in patients with bipolar disorders and major depressive disorder (MDD). Familial aggregation of personality traits in mood disorder families was also evaluated. We recruited 260 clinical patients of MDD (92), bipolar disorder-I and II (BP-I=111, BP-II=57), 190 first-degree relatives, and 180 controls. Four personality traits were assessed using the Eysenck and Tridimensional Personality Questionnaires, including Extraversion (E), Neuroticism (N), Harm Avoidance (HA), and Novelty Seeking (NS). The magnitude of familiality of personality traits in mood disorder families was evaluated by mixed models and intra-class correlation coefficients (ICC). Patients with mood disorders had lower E, and higher N, HA and NS than controls. Unaffected relatives were not differed from controls in the four personality traits. BP-I had higher E, NS and lower N, HA than MDD patients (p<0.01). The scale N further distinguished BP-I from BP-II (p=0.02) with lower N among BP-I patients. There exhibited moderate familiality in E (ICC=0.184-0.239) and HA (ICC=0.355) in bipolar disorder families. Personality traits were accessed cross-sectionally without quantitatively controlled severity of mood symptoms. Different patterns of personality traits distinguish patients from unaffected individuals as well as separate diagnoses of mood disorders, indicating the usage of more comprehensive evaluation of personality traits in clinical settings. Familiality of extraversion and harm avoidance in bipolar disorder families provides insights for further investigating correlates of comorbid behavioral problems in bipolar disorders. Copyright © 2012 Elsevier B.V. All rights reserved.

Temperament and personality in bipolar II disorder.

PubMed

Fletcher, Kathryn; Parker, Gordon; Barrett, Melissa; Synnott, Howe; McCraw, Stacey

2012-02-01

There is limited research examining temperament and personality in bipolar II disorder. We sought to determine any over-represented temperament and personality features in bipolar II disorder compared to other affective groups. Scores on a self-report measure of temperament and personality were examined in a sample of 443 participants diagnosed with unipolar, bipolar I and bipolar II disorder. After controlling for age, gender, age of depression onset and current depression severity, those with bipolar II disorder were characterized by higher irritability, anxious worrying, self-criticism and interpersonal sensitivity scores, and with lower social avoidance scores compared to unipolar participants. No differences were found between bipolar sub-types on any temperament and personality sub-scales. Limitations included the lack of a control group, a relatively small sample of bipolar I participants, and with the cross-sectional design disallowing conclusions regarding premorbid personality traits as opposed to illness 'scarring' effects. Further research should seek to clarify whether certain temperament and personality styles are over-represented in bipolar II disorder. Any over-represented characteristics may assist with diagnostic differentiation from phenomenologically similar conditions and lead to more appropriate clinical management. Copyright © 2011 Elsevier B.V. All rights reserved.

Relating DSM-5 section III personality traits to section II personality disorder diagnoses.

PubMed

Morey, L C; Benson, K T; Skodol, A E

2016-02-01

The DSM-5 Personality and Personality Disorders Work Group formulated a hybrid dimensional/categorical model that represented personality disorders as combinations of core impairments in personality functioning with specific configurations of problematic personality traits. Specific clusters of traits were selected to serve as indicators for six DSM categorical diagnoses to be retained in this system - antisocial, avoidant, borderline, narcissistic, obsessive-compulsive and schizotypal personality disorders. The goal of the current study was to describe the empirical relationships between the DSM-5 section III pathological traits and DSM-IV/DSM-5 section II personality disorder diagnoses. Data were obtained from a sample of 337 clinicians, each of whom rated one of his or her patients on all aspects of the DSM-IV and DSM-5 proposed alternative model. Regression models were constructed to examine trait-disorder relationships, and the incremental validity of core personality dysfunctions (i.e. criterion A features for each disorder) was examined in combination with the specified trait clusters. Findings suggested that the trait assignments specified by the Work Group tended to be substantially associated with corresponding DSM-IV concepts, and the criterion A features provided additional diagnostic information in all but one instance. Although the DSM-5 section III alternative model provided a substantially different taxonomic structure for personality disorders, the associations between this new approach and the traditional personality disorder concepts in DSM-5 section II make it possible to render traditional personality disorder concepts using alternative model traits in combination with core impairments in personality functioning.

Embodiment Mediates the Relationship between Avoidant Attachment and Eating Disorder Psychopathology.

PubMed

Monteleone, Alessio Maria; Castellini, Giovanni; Ricca, Valdo; Volpe, Umberto; De Riso, Francesco; Nigro, Massimiliano; Zamponi, Francesco; Mancini, Milena; Stanghellini, Giovanni; Monteleone, Palmiero; Treasure, Janet; Maj, Mario

2017-11-01

The overvaluation of body shape and weight of persons with eating disorders (EDs) is putatively explained by a disturbance in the way they experience their own body (embodiment). Moreover, attachment disorders seem to promote the use of body as source for self-definition. Therefore, we assessed the role of embodiment in the connection between attachment styles and ED psychopathology. One-hundred and thirteen ED patients and 117 healthy subjects completed the Identity and Eating Disorders (IDEA) Questionnaire, the Eating Disorder Inventory-2 (EDI-2) and the Experiences in Close Relationships Scale. Eating disorder patients displayed IDEA, EDI-2 and Experiences in Close Relationships scores significantly higher than controls. IDEA total and subtotal scores mediated entirely the influence of avoidant attachment on EDI-2 interoceptive awareness and impulsivity. These findings demonstrate a relationship between insecure attachment and disorders of identity and embodiment and point to embodiment as a possible mediator between avoidant attachment and specific ED psychopathological traits. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

The Dynamics of Self-Esteem in Cognitive Therapy for Avoidant and Obsessive-Compulsive Personality Disorders: An Adaptive Role of Self-Esteem Variability?

PubMed Central

Cummings, Jorden A.; Hayes, Adele M.; Cardaciotto, LeeAnn; Newman, Cory F.

2011-01-01

Self-esteem variability is often associated with poor functioning. However, in disorders with entrenched negative views of self and in a context designed to challenge those views, variable self-esteem might represent a marker of change. We examined self-esteem variability in a sample of 27 patients with Avoidant and Obsessive-Compulsive Personality Disorders who received Cognitive Therapy (CT). A therapy coding system was used to rate patients’ positive and negative views of self expressed in the first ten sessions of a 52-week treatment. Ratings of negative (reverse scored) and positive view of self were summed to create a composite score for each session. Self-esteem variability was calculated as the standard deviation of self-esteem scores across sessions. More self-esteem variability predicted more improvement in personality disorder and depression symptoms at the end of treatment, beyond baseline and average self-esteem. Early variability in self-esteem, in this population and context, appeared to be a marker of therapeutic change. PMID:22923855

Personality Disorder Symptoms Are Differentially Related to Divorce Frequency

PubMed Central

Disney, Krystle L.; Weinstein, Yana; Oltmanns, Thomas F.

2013-01-01

Divorce is associated with a multitude of outcomes related to health and well-being. Data from a representative community sample (N = 1,241) of St. Louis residents (ages 55–64) were used to examine associations between personality pathology and divorce in late midlife. Symptoms of the 10 DSM–IV personality disorders were assessed with the Structured Interview for DSM–IV Personality and the Multisource Assessment of Personality Pathology (both self and informant versions). Multiple regression analyses showed Paranoid and Histrionic personality disorder symptoms to be consistently and positively associated with number of divorces across all three sources of personality assessment. Conversely, Avoidant personality disorder symptoms were negatively associated with number of divorces. The present paper provides new information about the relationship between divorce and personality pathology at a developmental stage that is understudied in both domains. PMID:23244459

[Time for cluster C personality disorders: state of the art].

PubMed

Hutsebaut, J; Willemsen, E M C; Van, H L

Compared to cluster B personality disorders, the assessment and treatment of people with obsessive-compulsive, dependent, and avoidant personality disorders (cluster C) is given little attention in the field of research and clinical practice. Presenting the current state of affairs in regard to cluster C personality disorders. A systematic literature search was conducted using the main data bases. Cluster C personality disorders are present in approximately 3-9% of the general population. In about half of the cases of mood, anxiety, and eating disorders, there is co-morbid cluster C pathology. This has a major influence on the progression of symptoms, treatment effectiveness and potential relapse. There are barely any well conducted randomized studies on the treatment of cluster-C in existence. Open cohort studies, however, show strong, lasting treatment effects. Given the frequent occurrence of cluster C personality disorders, the burden of disease, associated societal costs and the prognostic implications in case of a co-morbid cluster C personality disorder, early detection and treatment of these disorders is warranted.

Personality Disorder Features and Insomnia Status amongst Hypnotic-Dependent Adults

PubMed Central

Ruiter, Megan E.; Lichstein, Kenneth L.; Nau, Sidney D.; Geyer, James

2012-01-01

Objective To determine the prevalence of personality disorders and their relation to insomnia parameters among persons with chronic insomnia with hypnotic dependence. Methods Eighty-four adults with chronic insomnia with hypnotic dependence completed the SCID-II personality questionnaire, two-weeks of sleep diaries, polysomnography, and measures of insomnia severity, impact, fatigue severity, depression, anxiety, and quality of life. Frequencies, between-subjects t-tests and hierarchical regression models were conducted. Results Cluster C personality disorders were most prevalent (50%). Obsessive-compulsive personality disorder (OCPD) was most common (n=39). These individuals compared to participants with no personality disorders did not differ in objective and subjective sleep parameters. Yet, they had poorer insomnia-related daytime functioning. OCPD and Avoidant personality disorders features were associated with poorer daytime functioning. OCPD features were related to greater fatigue severity, and overestimation of time awake was trending. Schizotypal and Schizoid features were positively associated with insomnia severity. Dependent personality disorder features were related to underestimating time awake. Conclusions Cluster C personality disorders were highly prevalent in patients with chronic insomnia with hypnotic dependence. Features of Cluster C and A personality disorders were variously associated with poorer insomnia-related daytime functioning, fatigue, and estimation of nightly wake-time. Future interventions may need to address these personality features. PMID:22938862

Personality disorder features and insomnia status amongst hypnotic-dependent adults.

PubMed

Ruiter, Megan E; Lichstein, Kenneth L; Nau, Sidney D; Geyer, James D

2012-10-01

To determine the prevalence of personality disorders and their relation to insomnia parameters among persons with chronic insomnia with hypnotic dependence. Eighty-four adults with chronic insomnia with hypnotic dependence completed the SCID-II personality questionnaire, two-weeks of sleep diaries, polysomnography, and measures of insomnia severity, impact, fatigue severity, depression, anxiety, and quality of life. Frequencies, between-subjects t-tests and hierarchical regression models were conducted. Cluster C personality disorders were most prevalent (50%). Obsessive-Compulsive personality disorder (OCPD) was most common (n=39). These individuals compared to participants with no personality disorders did not differ in objective and subjective sleep parameters. Yet, they had poorer insomnia-related daytime functioning. OCPD and Avoidant personality disorders features were associated with poorer daytime functioning. OCPD features were related to greater fatigue severity, and overestimation of time awake was trending. Schizotypal and Schizoid features were positively associated with insomnia severity. Dependent personality disorder features were related to underestimating time awake. Cluster C personality disorders were highly prevalent in patients with chronic insomnia with hypnotic dependence. Features of Cluster C and A personality disorders were variously associated with poorer insomnia-related daytime functioning, fatigue, and estimation of nightly wake-time. Future interventions may need to address these personality features. Copyright © 2012 Elsevier B.V. All rights reserved.

Personality disorder symptoms are differentially related to divorce frequency.

PubMed

Disney, Krystle L; Weinstein, Yana; Oltmanns, Thomas F

2012-12-01

Divorce is associated with a multitude of outcomes related to health and well-being. Data from a representative community sample (N = 1,241) of St. Louis residents (ages 55-64) were used to examine associations between personality pathology and divorce in late midlife. Symptoms of the 10 DSM-IV personality disorders were assessed with the Structured Interview for DSM-IV Personality and the Multisource Assessment of Personality Pathology (both self and informant versions). Multiple regression analyses showed Paranoid and Histrionic personality disorder symptoms to be consistently and positively associated with number of divorces across all three sources of personality assessment. Conversely, Avoidant personality disorder symptoms were negatively associated with number of divorces. The present paper provides new information about the relationship between divorce and personality pathology at a developmental stage that is understudied in both domains. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Personality disorders and treatment drop out in the homeless

PubMed Central

Salavera, Carlos; Tricás, José M; Lucha, Orosia

2013-01-01

The homeless drop out of treatment relatively frequently. Also, prevalence rates of personality disorders are much higher in the homeless group than in the general population. We hypothesize that when both variables coexist — homelessness and personality disorders — the possibility of treatment drop out grows. The aim of this study was to analyze the hypotheses, that is, to study how the existence of personality disorders affects the evolution of and permanence in treatment. One sample of homeless people in a therapeutic community (N = 89) was studied. The structured clinical interview for the diagnostic and statistical manual of mental disorders (DSM-IV-TR) was administered and participants were asked to complete the Millon Clinical Multiaxial Inventory-II (MCMI-II). Cluster B personality disorders (antisocial, borderline, and narcissistic) avoided permanence in the treatment process while cluster C disorders, as dependent, favored adhesion to the treatment and improved the prognosis. Knowledge of these personality characteristics should be used to advocate for better services to support homeless people and prevent their dropping out before completing treatment. PMID:23569378

An investigation of experiential avoidance, emotion dysregulation, and distress tolerance in young adult outpatients with borderline personality disorder symptoms.

PubMed

Iverson, Katherine M; Follette, Victoria M; Pistorello, Jacqueline; Fruzzetti, Alan E

2012-10-01

In this study we investigated 3 domains of emotional functioning--emotion dysregulation, distress tolerance, and experiential avoidance--in young adult outpatients with borderline personality disorder (BPD) symptoms. Participants were 40 young adult outpatients at a university counseling center who reported current suicidal ideation and met diagnostic criteria for BPD or experienced subthreshold BPD symptoms (i.e., met diagnostic criteria for 3 or 4 symptoms). Participants completed 3 self-report measures of emotional functioning-experiential avoidance (Acceptance and Action Questionnaire-2; Bond et al., 2011; Hayes et al., 2004), emotion dysregulation (Difficulties in Emotion Regulation Scale; Gratz & Roemer, 2004), and distress tolerance (Distress Tolerance Scale; Simons & Gaher, 2005)-and a behavioral measure of distress tolerance (Paced Auditory Serial Addition Task-Computerized; Lejuez, Kahler, & Brown, 2003), in addition to self-report measures of depression and BPD symptom severity. Partial correlations demonstrated that both emotion dysregulation and experiential avoidance were significantly associated with BPD symptom severity after accounting for depression. However, neither the self-report nor behavioral measure of distress tolerance were related to BPD symptom severity. A regression analysis with emotion dysregulation and experiential avoidance as independent variables revealed that only experiential avoidance was significantly associated with BPD symptom severity after controlling for depression symptoms. The current findings suggest that experiential avoidance may be a central process in BPD symptom severity. Future research directions are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Personality Disorders in Hypochondriasis: Prevalence and comparison with two anxiety disorders

PubMed Central

Fallon, Brian A.; Harper, Katy M.; Landa, Alla; Pavlicova, Martina; Schneier, Franklin R.; Carson, Amanda; Harding, Kelli; Keegan, Kathryn; Schwartz, Theresa; Liebowitz, Michael R.

2012-01-01

Objective Symptoms of hypochondriasis are sometimes attributed to personality psychopathology by health care providers. The goals of this study were to assess the prevalence of personality disorder comorbidity (PD) in hypochondriasis (HYP) and to compare the PD comorbidity profile of patients with HYP to that found among patients with other disorders characterized by intrusive thoughts and fears. Methods SCID-I and SCID-II were administered to 179 individuals: 62 with HYP, 46 with Obsessive Compulsive Disorder (OCD), and 71 with Social Anxiety Disorder (SAD). For group contrasts, the samples were “purified” of the comparison comorbid disorders. General linear models were used to test the combined effect of group (HYP, OCD, SAD), age, and gender on the PD outcome variables. Results 59.7% of HYP subjects had no Axis II comorbidity. The most common PDs in HYP were paranoid (19.4%), avoidant (17.7%), and obsessive compulsive (14.5%). HYP significantly differed from SAD in the likelihood of a cluster C disorder, whereas no significant difference was noted for HYP vs OCD. The proportion of subjects having at least two PDs was not significantly different for HYP vs OCD or for HYP vs SAD. Conclusion Although 40% of patients with hypochondriasis have PD comorbidity as assessed by the SCID-II, the amount of PD comorbidity is not significantly different than found among individuals with two comparison anxiety disorders. Therefore, health providers should be aware that PD may complicate the clinical profile of HYP but they should avoid assuming that PD psychopathology is the primary source of hypochondriacal distress. PMID:22658329

DSM-III-R personality disorders in a mood and anxiety disorders clinic: prevalence, comorbidity, and clinical correlates.

PubMed

Flick, S N; Roy-Byrne, P P; Cowley, D S; Shores, M M; Dunner, D L

1993-02-01

This study examined the prevalence, comorbidity, and clinical correlates of personality disorders in an outpatient sample (N = 352) with anxiety and depression. Subjects were diagnosed using the Structured Clinical Interview for DSM-III-R (SCID) on Axes I and II, and they also completed interview and self-report measures of symptoms. Subjects with a personality disorder were less likely to be married, more likely to be single or divorced, had lower family incomes, had more severe symptoms of both anxiety and depression, and had a greater number of lifetime Axis I diagnoses. Subjects with dysthymic and bipolar disorders were more likely, and subjects with panic disorder uncomplicated by agoraphobia were less likely to have a personality disorder compared to the rest of the sample. The most prevalent personality disorders were Avoidant, Obsessive-Compulsive, Paranoid, and Borderline. Paranoid co-occurred with Narcissistic, and Borderline co-occurred with Histrionic personality disorder significantly more often than chance and base rates would predict.

Explicit and inferred motives for nonsuicidal self-injurious acts and urges in borderline and avoidant personality disorders.

PubMed

Snir, Avigal; Rafaeli, Eshkol; Gadassi, Reuma; Berenson, Kathy; Downey, Geraldine

2015-07-01

Nonsuicidal self-injury (NSSI) is a perplexing phenomenon that may have differing motives. The present study used experience sampling methods (ESM) which inquired explicitly about the motives for NSSI, but also enabled a temporal examination of the antecedents/consequences of NSSI; these allow us to infer other motives which were not explicitly endorsed. Adults (n = 152, aged 18-65) with borderline personality disorder (BPD), avoidant personality disorder (APD), or no psychopathology participated in a 3-week computerized diary study. We examined 5 classes of explicit motives for engaging in NSSI, finding support primarily for internally directed rather than interpersonally directed ones. We then used multilevel regression to examine changes in affect, cognition, and behavior surrounding moments of NSSI acts/urges compared with control moments (i.e., without NSSI). We examined changes in 5 scales of inferred motives, designed to correspond to the 5 classes of explicit motives. The results highlight differing motives for NSSI among individuals with BPD and APD, with some similarities (mostly in the explicit motives) and some differences (mostly in the inferred motives) between the disorders. Despite their infrequent explicit endorsement, fluctuations in interpersonally oriented scales were found surrounding NSSI acts/urges. This highlights the need to continue attending to interpersonal aspects of NSSI in research and in clinical practice. Additionally, NSSI urges, like acts, were followed by decline in affective/interpersonal distress (although in a delayed manner). Thus, interventions that build distress tolerance and enhance awareness for affective changes, and for antecedent/consequence patterns in NSSI, could help individuals resist the urge to self-injure. (c) 2015 APA, all rights reserved).

Attachment Style and Resiliency in Patients with Obsessive-Compulsive Personality Disorder

PubMed Central

Zakiei, Ali; Farnia, Vahid; Khkian, Zinab; Shakeri, Jalal; Golshani, Sanobar

2017-01-01

Background The goal of the present study was to determine the relationships between attachment styles and resiliency in obsessive-compulsive personality disorder. Methods A random sample of 260 subjects was obtained from the population of undergraduate students of the Nour Branch of Islamic Azad University, which is located in Mazandaran, and these subjects were enrolled in this descriptive and correlational study. The collected data included the subjects' responses to an adult attachment style questionnaire, resilience scale, and obsessive-compulsive personality disorder questionnaire. The data were analyzed with Pearson correlation coefficient indices and multiple regressions. Results The results of the data analysis showed a positive correlation (relationship) between ambivalent/avoidant attachment styles and obsessive-compulsive personality disorder and a negative correlation between resilience and obsessive-compulsive personality disorder. Furthermore, these results demonstrated that attachment style and resiliency can predict obsessive-compulsive personality disorder. In addition, no significant relationships were found between the demographic variables (convertibles) and obsessive-compulsive personality disorder. Conclusion These results suggested that attachment style and resiliency contribute to the development of obsessive-compulsive personality disorder. PMID:28197331

Attachment Style and Resiliency in Patients with Obsessive-Compulsive Personality Disorder.

PubMed

Zakiei, Ali; Alikhani, Mostafa; Farnia, Vahid; Khkian, Zinab; Shakeri, Jalal; Golshani, Sanobar

2017-01-01

The goal of the present study was to determine the relationships between attachment styles and resiliency in obsessive-compulsive personality disorder. A random sample of 260 subjects was obtained from the population of undergraduate students of the Nour Branch of Islamic Azad University, which is located in Mazandaran, and these subjects were enrolled in this descriptive and correlational study. The collected data included the subjects' responses to an adult attachment style questionnaire, resilience scale, and obsessive-compulsive personality disorder questionnaire. The data were analyzed with Pearson correlation coefficient indices and multiple regressions. The results of the data analysis showed a positive correlation (relationship) between ambivalent/avoidant attachment styles and obsessive-compulsive personality disorder and a negative correlation between resilience and obsessive-compulsive personality disorder. Furthermore, these results demonstrated that attachment style and resiliency can predict obsessive-compulsive personality disorder. In addition, no significant relationships were found between the demographic variables (convertibles) and obsessive-compulsive personality disorder. These results suggested that attachment style and resiliency contribute to the development of obsessive-compulsive personality disorder.

Self-esteem and other-esteem in college students with borderline and avoidant personality disorder features: An experimental vignette study.

PubMed

Bowles, David P; Armitage, Chris J; Drabble, Jennifer; Meyer, Björn

2013-11-01

An experimental study investigated self-esteem and other-esteem responses to either fully supportive or less supportive interpersonal feedback in college students with avoidant and borderline personality disorder features (APD and BPD respectively). Disturbances in self-esteem and in evaluations of others are central to definitions of both APD and BPD, but the extent to which such interpersonal appraisals are responsive to contextual features, such as evaluative feedback from others, is not yet clear. In theory, we would expect that individuals with pronounced PD features would show more inflexible and more negative self-evaluations and others- evaluations than those without PD features. In this study with 169 undergraduates, APD but not BPD features were associated with other-contingent state self-esteem and other-esteem. A significant interaction indicated that highly avoidant respondents felt particularly negatively about themselves and their close others in situations that conveyed subtle criticism but not in situations signalling unequivocal support. This suggests that their self-esteem and other-esteem, rather than being rigidly negative, are instead highly contingent upon interpersonal feedback. Such context contingency has implications for the trait-like description of diagnostic characteristics within current taxonomies and is in line with contemporary dynamic models of personality structure and process. Copyright © 2013 John Wiley & Sons, Ltd.

Public speaking avoidance as a treatment moderator for social anxiety disorder.

PubMed

Mesri, Bita; Niles, Andrea N; Pittig, Andre; LeBeau, Richard T; Haik, Ethan; Craske, Michelle G

2017-06-01

Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have both garnered empirical support for the effective treatment of social anxiety disorder. However, not every patient benefits equally from either treatment. Identifying moderators of treatment outcome can help to better understand which treatment is best suited for a particular patient. Forty-nine individuals who met criteria for social anxiety disorder were assessed as part of a randomized controlled trial comparing 12 weeks of CBT and ACT. Pre-treatment avoidance of social situations (measured via a public speaking task and clinician rating) was investigated as a moderator of post-treatment, 6-month follow-up, and 12-month follow-up social anxiety symptoms, stress reactivity, and quality of life. Public speaking avoidance was found to be a robust moderator of outcome measures, with more avoidant individuals generally benefitting more from CBT than ACT by 12-month follow-up. In contrast, clinician-rated social avoidance was not found to be a significant moderator of any outcome measure. Results were found only at 12-month follow-up. More comprehensive measures of avoidance would be useful for the field moving forward. Findings inform personalized medicine, suggesting that social avoidance measured behaviorally via a public speaking task may be a more robust factor in treatment prescription compared to clinician-rated social avoidance. Published by Elsevier Ltd.

Relationship of Personality Disorders to the Course of Major Depressive Disorder in a Nationally Representative Sample

PubMed Central

Skodol, Andrew E.; Grilo, Carlos M.; Keyes, Katherine; Geier, Timothy; Grant, Bridget F.; Hasin, Deborah S.

2011-01-01

Objective The purpose of this study was to examine the effects of specific personality disorder co-morbidity on the course of major depressive disorder in a nationally-representative sample. Method Data were drawn from 1,996 participants in a national survey. Participants who met criteria for major depressive disorder at baseline in face-to-face interviews (2001–2002) were re-interviewed three years later (2004–2005) to determine persistence and recurrence. Predictors included all DSM-IV personality disorders. Control variables included demographic characteristics, other Axis I disorders, family and treatment histories, and previously established predictors of the course of major depressive disorder. Results 15.1% of participants had persistent major depressive disorder and 7.3% of those who remitted had a recurrence. Univariate analyses indicated that avoidant, borderline, histrionic, paranoid, schizoid, and schizotypal personality disorders all elevated the risk for persistence. With Axis I co-morbidity controlled, all but histrionic personality disorder remained significant. With all other personality disorders controlled, borderline and schizotypal remained significant predictors. In final, multivariate analyses that controlled for age at onset of major depressive disorder, number of previous episodes, duration of current episode, family history, and treatment, borderline personality disorder remained a robust predictor of major depressive disorder persistence. Neither personality disorders nor other clinical variables predicted recurrence. Conclusions In this nationally-representative sample of adults with major depressive disorder, borderline personality disorder robustly predicted persistence, a finding that converges with recent clinical studies. Personality psychopathology, particularly borderline personality disorder, should be assessed in all patients with major depressive disorder, considered in prognosis, and addressed in treatment. PMID:21245088

The Impact of Comorbid Dysthymic Disorder on Outcome in Personality Disorders

PubMed Central

Hellerstein, David J.; Skodol, Andrew E.; Petkova, Eva; Xie, Hui; Markowitz, John C.; Yen, Shirley; Gunderson, John; Grilo, Carlos; Daversa, Maria T.; McGlashan, Thomas H.

2009-01-01

Objective The goal of our study was to investigate the impact of dysthymic disorder (DD), a form of chronic depression, on naturalistic outcome in individuals with personality disorders (PD). Method The Collaborative Longitudinal Personality Disorders Study is a cohort initially including 573 subjects with four targeted PDs (borderline, avoidant, schizotypal and obsessive-compulsive) and 95 subjects with major depression but no PD. At baseline, 115 subjects were diagnosed with coexisting dysthymic disorder (DD), of whom 109 (94.8%) were PD subjects. Regression analyses were performed to predict three classes of broad clinical outcome after two years of prospective follow-up. We hypothesized that DD diagnosis at baseline would be associated with worse outcome on 1) persistence of a PD diagnosis, 2) impairment in psychosocial functioning (as measured by the Longitudinal Interval Follow-up Evaluation [LIFE]), and 3) crisis-related treatment utilization. Results Baseline DD diagnosis was associated with persistence of PD diagnosis at 2 years, particularly for borderline and avoidant PDs. It was associated with worse outcome on global social adjustment, life satisfaction, recreation, and friendships, but not employment or relationship with spouse. Contrary to expectation, DD did not increase suicide attempts, emergency room visits, or psychiatric hospitalizations. Conclusions Comorbidity of DD is associated with persistence of PD diagnosis, and with worse outcome on many, but not all, measures of psychosocial functioning. PMID:20728000

Personality disorders and normal personality dimensions in obsessive-compulsive disorder.

PubMed

Samuels, J; Nestadt, G; Bienvenu, O J; Costa, P T; Riddle, M A; Liang, K Y; Hoehn-Saric, R; Grados, M A; Cullen, B A

2000-11-01

Little is known about personality disorders and normal personality dimensions in relatives of patients with obsessive-compulsive disorder (OCD). To determine whether specific personality characteristics are part of a familial spectrum of OCD. Clinicians evaluated personality disorders in 72 OCD case and 72 control probands and 198 case and 207 control first-degree relatives. The selfcompleted Revised NEO Personality Inventory was used for assessment of normal personality dimensions. The prevalence of personality disorders and scores on normal personality dimensions were compared between case and control probands and between case and control relatives. Case probands and case relatives had a high prevalence of obsessive-compulsive personality disorder (OCPD) and high neuroticism scores. Neuroticism was associated with OCPD in case but not control relatives. Neuroticism and OCPD may share a common familial aetiology with OCD.

A Non-linear Predictive Model of Borderline Personality Disorder Based on Multilayer Perceptron.

PubMed

Maldonato, Nelson M; Sperandeo, Raffaele; Moretto, Enrico; Dell'Orco, Silvia

2018-01-01

Borderline Personality Disorder is a serious mental disease, classified in Cluster B of DSM IV-TR personality disorders. People with this syndrome presents an anamnesis of traumatic experiences and shows dissociative symptoms. Since not all subjects who have been victims of trauma develop a Borderline Personality Disorder, the emergence of this serious disease seems to have the fragility of character as a predisposing condition. Infect, numerous studies show that subjects positive for diagnosis of Borderline Personality Disorder had scores extremely high or extremely low to some temperamental dimensions (harm Avoidance and reward dependence) and character dimensions (cooperativeness and self directedness). In a sample of 602 subjects, who have had consecutive access to an Outpatient Mental Health Service, it was evaluated the presence of Borderline Personality Disorder using the semi-structured interview for the DSM IV-TR personality disorders. In this population we assessed the presence of dissociative symptoms with the Dissociative Experiences Scale and the personality traits with the Temperament and Character Inventory developed by Cloninger. To assess the weight and the predictive value of these psychopathological dimensions in relation to the Borderline Personality Disorder diagnosis, a neural network statistical model called "multilayer perceptron," was implemented. This model was developed with a dichotomous dependent variable, consisting in the presence or absence of the diagnosis of borderline personality disorder and with five covariates. The first one is the taxonomic subscale of dissociative experience scale, the others are temperamental and characterial traits: Novelty-Seeking, Harm-Avoidance, Self-Directedness and Cooperativeness. The statistical model, that results satisfactory, showed a significance capacity (89%) to predict the presence of borderline personality disorder. Furthermore, the dissociative symptoms seem to have a greater influence than

Schizoid Personality Disorder

MedlinePlus

... you mostly work alone. Schizotypal personality disorder and schizophrenia Although a different disorder, schizoid personality disorder can ... some similar symptoms to schizotypal personality disorder and schizophrenia, such as a severely limited ability to make ...

Personality disorders in hypochondriasis: prevalence and comparison with two anxiety disorders.

PubMed

Fallon, Brian A; Harper, Katy M; Landa, Alla; Pavlicova, Martina; Schneier, Franklin R; Carson, Amanda; Harding, Kelli; Keegan, Kathryn; Schwartz, Theresa; Liebowitz, Michael R

2012-01-01

Symptoms of hypochondriasis are sometimes attributed to personality psychopathology by health care providers. The goals of this study were to assess the prevalence of personality disorder (PD) comorbidity in hypochondriasis (HYP) and to compare the PD comorbidity profile of patients with HYP with that found among patients with other disorders characterized by intrusive thoughts and fears. Structured Clinical Interview for DSM-IV Axis I and Axis II Disorders (SCID-I and SCID-II) were administered to 179 individuals: 62 with HYP, 46 with obsessive-compulsive disorder (OCD), and 71 with social anxiety disorder (SAD). For group contrasts, the samples were "purified" of the comparison comorbid disorders. General linear models were used to test the combined effect of group (HYP, OCD, SAD), age, and gender on the PD outcome variables. 59.7% of HYP subjects had no Axis II comorbidity. The most common PDs in HYP were paranoid (19.4%), avoidant (17.7%), and obsessive-compulsive (14.5%). HYP significantly differed from SAD in the likelihood of a cluster C disorder, whereas no significant difference was noted for HYP vs. OCD. The proportion of subjects having at least two PDs was not significantly different for HYP vs. OCD or for HYP vs. SAD. Although 40% of patients with hypochondriasis have PD comorbidity as assessed by the SCID-II, the amount of PD comorbidity is not significantly different than found among individuals with two comparison anxiety disorders. Therefore, health providers should be aware that PD may complicate the clinical profile of HYP, but they should avoid assuming that PD psychopathology is the primary source of hypochondriacal distress. Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

The association of childhood trauma and personality disorders with chronic depression: A cross-sectional study in depressed outpatients.

PubMed

Klein, Jan Philipp; Roniger, Antje; Schweiger, Ulrich; Späth, Christina; Brodbeck, Jeannette

2015-06-01

Chronic depression has often been associated with childhood trauma. There may, however, be an interaction between personality pathology, childhood trauma, and chronic depression. This interaction has not yet been studied. This retrospective analysis is based on 279 patients contacted for a randomized trial in an outpatient psychotherapy center over a period of 18 months from 2010 to 2012. Current diagnoses of a personality disorder and presence of chronic depression were systematically assessed using the Structured Clinical Interview for DSM-IV. Retrospective reports of childhood trauma were collected using the short form of the Childhood Trauma Questionnaire (CTQ-SF). DSM-IV-defined chronic depression was the primary outcome. The association between chronic depression, childhood trauma, and personality disorders was analyzed using correlations. Variables that had at least a small effect on correlation analysis were entered into a series of logistic regression analyses to determine the predictors of chronic depression and the moderating effect of childhood trauma. The presence of avoidant personality disorder, but no CTQ-SF scale, was associated with the chronicity of depression (odds ratio [OR] = 2.20, P = .015). The emotional abuse subscale of the CTQ-SF did, however, correlate with avoidant personality disorder (OR = 1.15, P = .000). The level of emotional abuse had a moderating effect on the effect of avoidant personality disorder on the presence of chronic depression (OR = 1.08, P = .004). Patients who did not suffer from avoidant personality disorder had a decreased rate of chronic depression if they retrospectively reported more severe levels of emotional abuse (18.9% vs 39.7%, respectively). The presence of avoidant personality pathology may interact with the effect of childhood trauma in the development of chronic depression. This has to be confirmed in a prospective study. ClinicalTrials.gov identifier: NCT01226238. © Copyright 2015 Physicians

Differentiating normal and disordered personality using the General Assessment of Personality Disorder (GAPD).

PubMed

Hentschel, Annett G; John Livesley, W

2013-05-01

Criteria to differentiate personality disorder from extremes of normal personality variations are important given growing interest in dimensional classification because an extreme level of a personality dimension does not necessarily indicate disorder. The DSM-5 proposed classification of personality disorder offers a definition of general personality disorder based on chronic interpersonal and self/identity pathology. The ability of this approach to differentiate personality disorder from other mental disorders was evaluated using a self-report questionnaire, the General Assessment of Personality Disorder (GAPD). This measure was administered to a sample of psychiatric patients (N = 149) from different clinical sub-sites. Patients were divided into personality disordered and non-personality disordered groups on the basis of the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). The results showed a hit rate of 82% correct identified patients and a good accuracy of the predicted model. There was a substantial agreement between SCID-II interview and GAPD personality disorder diagnoses. The GAPD appears to predict personality disorder in general, which provides support of the DSM-5 general diagnostic criteria of personality disorder. Copyright © 2012 John Wiley & Sons, Ltd.

Anorexia nervosa 6 years after onset: Part I. Personality disorders.

PubMed

Gillberg, I C; Råstam, M; Gillberg, C

1995-01-01

Fifty-one adolescent-onset anorexia nervosa (AN) cases recruited after community screening were compared with 51 age-, sex-, and school-matched cases with regard to personality disorders and autism-spectrum disorders (ASD)/empathy disorders at age 21 years. All 102 cases had originally been examined at a mean age of 16 years, slightly over a year after the reported onset of the eating disorder. Structured Clinical Interview for DSM-III-R (SCID) interviews were performed by a psychiatrist blind to the original eating disorder diagnosis. Most of the former AN cases were recovered with respect to weight, but the outcome in social areas was restricted. Personality disorders coded on axis II in the DSM-III-R and empathy disorders were much more common in the AN group than in the comparison (COMP) group. Obsessive-compulsive (OCD) and avoidant personality disorders were particularly common. Obsessive-compulsive behaviors showed a high degree of stability over time and were unrelated to weight problems. Together with empathy disorder, they tended to predict outcome better than the eating disorder as such. It is concluded that in some cases, AN may be seen to reflect but one axis I diagnosis occurring in the life of an individual with a chronic personality disorder.

Attachment insecurity and obsessive-compulsive personality disorder among inpatients with serious mental illness.

PubMed

Wiltgen, Anika; Adler, Herman; Smith, Ryan; Rufino, Katrina; Frazier, Christopher; Shepard, Christopher; Booker, Kirk; Simmons, Diedra; Richardson, Leah; Allen, Jon G; Fowler, J Christopher

2015-03-15

Obsessive-compulsive personality disorder (OCPD) is characterized by traits such as extreme rigidity, perfectionism, and controlling behavior, all of which have a negative impact on interpersonal functioning. Attachment theory provides a useful framework to elucidate the interpersonal dysfunction characteristic of OCPD; yet, there is a dearth of attachment research on OCPD in the context of severe mental illness. Attachment security and personality disorders were assessed in adult inpatients with severe mental illness. Propensity Score Matching (PSM) was used to match OCPD and control subjects on age, gender, number of psychiatric disorders, and number of criteria endorsed for borderline personality disorder. Consistent with hypotheses, the OCPD group (n=61) showed greater attachment avoidance than controls (n=61), and the avoidance was manifested in a predominance of the most insecure attachment style, fearful attachment. Correlations between attachment anxiety/avoidance with specific OCPD diagnostic criteria revealed that attachment avoidance was correlated with four of eight OCPD criteria across the full sample. Within the subset of OCPD patients, attachment avoidance was significantly correlated with OCPD criterion 3 (is excessively devoted to work and productivity to the exclusion of leisure activities and friendships). The use of self-report measure of attachment and the high burden of illness in the SMI population may not generalize to interview based assessment or outpatients, respectively. Findings attest to the severity of impairment in interpersonal functioning and attachment avoidance, in particular, is characteristic of OCPD patients. These results suggest that viable treatment targets include interpersonal functioning along with more classical features of OCPD such as perfectionism and obsessiveness in task performance. Copyright © 2014 Elsevier B.V. All rights reserved.

Behavioral activation in the treatment of metacognitive dysfunctions in inhibited-type personality disorders.

PubMed

Gordon-King, Keely; Schweitzer, Robert D; Dimaggio, Giancarlo

2017-09-01

Behavioral interventions are proposed as a critical treatment component in psychotherapy for personality disorders. The current study explores behavioral interventions as a mechanism of change in Metacognitive Interpersonal Therapy, an integrative psychotherapy for personality disorders. The goals and implementation of behavioral principles are illustrated through the single case study of Roger, a 57-year-old man diagnosed with avoidant personality disorder and depressive personality disorder. Transcripts of interviews and therapy sessions illustrate the role of behavioral interventions, including behavioral activation, in Roger's treatment. Roger demonstrated a reliable change from baseline to posttreatment across all measures. He also showed gains with regard to his occupational functioning, interpersonal relationships, and sense of fulfilment. Implications with regard to treatment planning for personality disorders are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The impact of comorbid dysthymic disorder on outcome in personality disorders.

PubMed

Hellerstein, David J; Skodol, Andrew E; Petkova, Eva; Xie, Hui; Markowitz, John C; Yen, Shirley; Gunderson, John; Grilo, Carlos; Daversa, Maria T; McGlashan, Thomas H

2010-01-01

The goal of our study was to investigate the impact of dysthymic disorder (DD), a form of chronic depression, on naturalistic outcome in individuals with personality disorders (PDs). The Collaborative Longitudinal Personality Disorders Study is a cohort initially including 573 subjects with 4 targeted PDs (borderline, avoidant, schizotypal, and obsessive-compulsive) and 95 subjects with major depression but no PD. At baseline, 115 subjects were diagnosed with coexisting DD, of whom 109 (94.8%) were PD subjects. Regression analyses were performed to predict 3 classes of broad clinical outcome after 2 years of prospective follow-up. We hypothesized that DD diagnosis at baseline would be associated with worse outcome on (1) persistence of a PD diagnosis, (2) impairment in psychosocial functioning (as measured by the Longitudinal Interval Follow-up Evaluation), and (3) crisis-related treatment utilization. Baseline DD diagnosis was associated with persistence of PD diagnosis at 2 years, particularly for borderline and avoidant PDs. It was associated with worse outcome on global social adjustment, life satisfaction, recreation, and friendships, but not employment or relationship with spouse. Contrary to expectation, DD did not increase suicide attempts, emergency room visits, or psychiatric hospitalizations. Comorbidity of DD is associated with persistence of PD diagnosis and with worse outcome on many, but not all, measures of psychosocial functioning. Copyright 2010 Elsevier Inc. All rights reserved.

The effect of parental alcohol and drug disorders on adolescent personality.

PubMed

Elkins, Irene J; McGue, Matt; Malone, Steve; Iacono, William G

2004-04-01

The relationship of parental alcohol or drug diagnosis to offspring personality was examined in a population-based sample of 17-year-old twins (568 girls and 479 boys) participating in the Minnesota Twin Family Study. Whether offspring personality characteristics 1) are specific to the type of substance use disorder in parents (alcohol versus drug) and 2) are found in high-risk offspring without substance use disorders as well as in offspring with substance use disorders was investigated. Personality was assessed with the Multidimensional Personality Questionnaire; substance use disorders were assessed in person through diagnostic interviews. In both male and female offspring, parental history of alcohol dependence was associated with greater negative emotionality, aggression, stress reaction, and alienation but lower well-being; parental history of drug disorders was associated with lower constraint, control, harm avoidance, and traditionalism but higher social potency. Excluding offspring with a substance use disorder had virtually no effect on the statistical significance of these findings. In contrast to findings in some adult samples, personality characteristics associated with a family history of substance use disorders are found even in adolescent offspring who have not yet developed these disorders themselves, suggesting that personality might be one indicator of familial risk for substance use disorders during this developmental stage. Personality profiles of offspring of parents with substance use disorders also show some diagnostic specificity, with constraint associated with parental drug abuse and negative emotionality with parental alcoholism.

Personality Disorders

MedlinePlus

Personality disorders are a group of mental illnesses. They involve long-term patterns of thoughts and behaviors ... serious problems with relationships and work. People with personality disorders have trouble dealing with everyday stresses and ...

Personality Disorders and Psychological Functioning Among Latina Women with Eating Disorders.

PubMed

Minnick, Alyssa M; Cachelin, Fary M; Durvasula, Ramani S

2017-01-01

Little is known about personality disorders (PD) and comorbidities among Latinas with eating disorders (ED). The dysregulation and chronicity of PDs can complicate and augment the symptomatology of EDs. This set of analyses provides a preliminary examination of PD and psychopathology in a sample of Latina women with ED. Participants (N = 34) were administered the Structured Clinical Interview for the Diagnostic and Statistical Manual, Eating Disorders Examination, and Millon Clinical Multiaxial Inventory-III to assess personality pathology, and questionnaires (Beck Depression Inventory-II and Brief Symptom Inventory) to assess psychological functioning. Results indicated the most common clinically significant trait in the sample was depressive personality (50% of the sample had a score of 75 or higher on this trait). For Bulimia Nervosa (BN) and Binge Eating Disorder (BED), avoidant (41%) and depressive (65%) personalities, respectively, were the most common clinically significant traits. Anxiety disorders were the most common psychiatric diagnoses, and 52.9% of the sample reported both clinically significant PD traits and other major psychopathology. There were no significant differences between the BED and BN groups on prevalence of PD traits and psychopathology. This pilot study highlights the need for further examination of PD and psychopathology in Latinas with ED. Unlike previous research with White women, we found no differences on PD and psychopathology between BED and BN, and the most prevalent PDs among Latinas were different than White women. Personality and psychological functioning should be assessed in all patients with ED, with ongoing research focused on identifying patterns in understudied groups such as Latinas, a practice that may improve treatment for this underserved population.

Primary emotional traits in patients with personality disorders.

PubMed

Karterud, Sigmund; Pedersen, Geir; Johansen, Merete; Wilberg, Theresa; Davis, Ken; Panksepp, Jaak

2016-11-01

There is a longstanding tradition that connects temperament pathology and personality disorders. Emotions are the major constituents of temperament. In mammals, seven primary emotions have been identified: SEEKING, FEAR, CARE, RAGE, SADNESS/PANIC, LUST and PLAY. The study aimed at exploring the relationship between primary emotions and personality disorders (PDs). Five hundred forty-six patients with different degrees and qualities of personality pathology, admitted to treatment in specialized PD services, were diagnosed according to Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and their primary emotional profiles were assessed by the Affective Neuroscience Personality Scales. The Affective Neuroscience Personality Scales explained 19% of the variance in borderline and avoidant criteria. The DSM-IV PD categories displayed different patterns of association to the primary emotions, e.g. the borderline PD profile suggested low thresholds for RAGE and SADNESS, but on the positive side a propensity for SEEKING. In contrast, the dependent PD profile suggested a low threshold for SADNESS but a high threshold for RAGE and SEEKING. The results are promising for a more coherent and evolution-based overall theory of PDs, and the correlations found in this study indicate testable causal pathways to PDs. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Association between a serotonin transporter promoter polymorphism (5-HTTLPR) and personality disorder traits in a community sample

PubMed Central

Blom, Rianne M.; Samuels, Jack F.; Riddle, Mark A.; Bienvenu, O. Joseph; Grados, Marco A.; Reti, Irving M.; Eaton, William W.; Liang, Kung-Yee; Nestadt, Gerald

2011-01-01

Background The serotonin transporter (SERT) polymorphism (5HTTLPR) has been reported to be associated with several psychiatric conditions. Specific personality disorders could be intermediate factors in the known relationship between 5HTTLPR and psychiatric disorders. This is the first study to test the association between this polymorphism and dimensions of all DSM-IV personality disorders in a community sample. Methods 374 white participants were assessed by clinical psychologists using the International Personality Disorder Examination (IPDE). Associations between dimensions of each DSM-IV personality disorder and the long (l) and short (s) alleles of the 5HTTLPR were evaluated using nonparametric tests and regression models. Results The s allele of the 5HTTLPR polymorphism was significantly associated with higher avoidant personality trait scores in the whole sample. Males with the s allele had a significantly lower likelihood of higher obsessive-compulsive personality disorder (OCPD) trait scores, whereas females with the s allele were likely to have higher OCPD personality trait scores. Conclusion This paper provides preliminary data on the relationship between personality disorders and the 5HTTLPR polymorphism. The relationship of the s allele and avoidant PD is consistent with findings of a nonspecific relationship of this polymorphism to anxiety and depressive disorders. Concerning the unusual sexual dimorphic result with OCPD, several hypotheses are presented. These findings need further replication, including a more detailed study of additional variants in SERT. PMID:21450307

Impact of obsessive-compulsive personality disorder symptoms in Internet users.

PubMed

Chamberlain, Samuel R; Redden, Sarah A; Stein, Dan J; Lochner, Christine; Grant, Jon E

2017-08-01

Internet use is pervasive in many cultures. Little is known about the impact of obsessive-compulsive personality disorder (OCPD) symptoms on impulsive and compulsive psychopathologies in people who use the Internet. Adult Internet users (N = 1,323) completed an online questionnaire quantifying OCPD symptoms, likely occurrence of select mental disorders (obsessive-compulsive disorder, attention-deficit/hyperactivity disorder [ADHD], problematic Internet use, generalized anxiety disorder), and personality questionnaires of impulsivity and compulsivity. Predictors of the presence of OCPD symptoms (endorsement of at least 4 of 8 DSM-5 criteria) were identified using binary logistic regression. In regression (P < .001, area under the curve, 0.77), OCPD symptoms were significantly associated with (in order of decreasing effect size) lower non-planning impulsivity, higher ADHD symptoms, problematic Internet use, avoidant personality disorder, female sex, generalized anxiety disorder, and some types of compulsions (checking, dressing/washing). These data suggest that OCPD symptoms, defined in terms of at least 4 of 8 DSM criteria being met, are common in Internet users. OCPD symptoms were associated with considerably higher levels of psychopathology relating to both impulsive (ADHD) and compulsive (OCD-related and problematic Internet use) disorders. These data merit replication and extension using standard in-person clinical assessments, because the current study relied on self-report over the Internet.

Personality Disorders, Narcotics, and Stimulants; Relationship in Iranian Male Substance Dependents Population.

PubMed

Noorbakhsh, Simasadat; Zeinodini, Zahra; Khanjani, Zeynab; Poorsharifi, Hamid; Rajezi Esfahani, Sepideh

2015-06-01

Individuals with certain personality disorders, especially the antisocial and borderline personality disorders, are more prone to substance use disorders. Regarding the importance of substance use disorders, this study aimed to explore the association between personality disorders and types of used drugs (narcotics and stimulants) in Iranian male substance users. The current study was a correlation study. We evaluated 285 male substance users and excluded 25 according to exclusion criteria. A total of 130 narcotic users and 130 stimulant users were recruited randomly in several phases from January 2013 to October 2013. All participants were referred to Substance Dependency Treatment Clinics in Tehran, Iran. Data collection process was accomplished by means of clinical interview based on DSM-V criteria for substance use disorders, Iranian version of addiction severity index (ASI), and Millon clinical multi-axial inventory-III (MCMI-III). Data were analyzed by SPSS 21 using Pearson correlation coefficient and regression, the. There was a significant correlation between stimulant use and histrionic personality disorder (P < 0.001) and antisocial and narcissistic personality disorders (P < 0.05). In addition, correlation between avoidant, histrionic, and narcissistic personality disorders (P < 0.05) and depressed, antisocial, and borderline personality disorders (P < 0.001) with narcotics consumption were significant. In clusters, there was a significant correlation between cluster B personality disorders, and narcotic and stimulants consumption (P < 0.001). In addition, this association was explored between cluster C personality disorder and narcotics (P < 0.001). The results of this study in terms of personality disorders and types of used drugs were in accordance with the previous studies results. It is necessary to design appropriate treatment plans for medical treatment of those with personality disorders.

Personality disorders and associated features in cocaine-dependent inpatients.

PubMed

Kranzler, H R; Satel, S; Apter, A

1994-01-01

Previous research has shown a high prevalence of comorbid personality disorders among individuals seeking treatment for cocaine dependence. We studied axis II disorders (using the Structured Clinical Interview for DSM-III-R Personality Disorders [SCID-II]) in 50 patients admitted for inpatient rehabilitation. All patients met lifetime criteria for cocaine dependence and reported cocaine use during the month before admission. Seventy percent of patients met criteria for at least one axis II diagnosis; the mean number of axis II diagnoses among these patients was 2.54 (range, one to six). The most common axis II diagnosis was borderline (34% of all patients), followed by antisocial and narcissistic (each 28%), avoidant and paranoid (each 22%), obsessive-compulsive (16%), and dependent (10%). To evaluate the relationship between comorbid personality pathology, substance abuse, and other psychiatric symptomatology, patients were divided into two groups based on whether they received an axis II disorder diagnosis. The groups did not differ on substance abuse variables. However, there were significant group differences on a measure of psychosis proneness and in the number of comorbid depressive and anxiety disorder diagnoses. These results are consistent with other studies of personality disorders in substance abuse patients, and suggest that it may be clinically useful to characterize cocaine-dependent patients with respect to comorbid axis II disorders.

Attachment priming and avoidant personality features as predictors of social-evaluation biases.

PubMed

Bowles, David P; Meyer, Björn

2008-02-01

Personality research has shown that negativity in social situations (e.g., negative evaluations of others) can be reduced by the activation of participants' sense of attachment security. Individuals with avoidant personality disorder (APD), however, are theoretically less responsive to context or situational cues because of the inflexible nature of their personality disposition. This idea of individual differences in context-responsiveness was tested in a sample of 169 undergraduates who were assessed for APD features and assigned to positive, negative, or neutral attachment priming conditions. More pronounced APD features were associated with more negative responses to vignettes describing potentially distressing social situations. A significant interaction showed that participants with more avoidant features consistently appraised the vignettes relatively more negatively, regardless of priming condition. Those without APD features, by contrast, did not exhibit negative appraisals/evaluations unless negatively primed (curvilinear effect). This effect could not be explained by depression, current mood, or attachment insecurity, all of which related to negative evaluative biases, but none of which related to situation inflexibility. These findings provide empirical support for the notion that negative information-processing is unusually inflexible and context-unresponsive among individuals with more pronounced features of APD.

[Effect of developmental disorders on personality and personality disorders].

PubMed

Honda, Hideo

2013-01-01

Developmental disorders (DD) are now so common that it is even more necessary to investigate the relationship between DD and personality disorders (PD). Despite the lack of studies, DD and PD have much in common. For research on personality and its disorders, direct, real-time observation by researchers themselves on the "black box" of temperament and its interaction with the environment is needed. For research on DD, especially in those with mild DD symptoms, how developmental characteristics and their interaction with the environment affect the personality in adulthood should be investigated.

A personality classification system for eating disorders: a longitudinal study.

PubMed

Thompson-Brenner, Heather; Eddy, Kamryn T; Franko, Debra L; Dorer, David J; Vashchenko, Maryna; Kass, Andrea E; Herzog, David B

2008-01-01

Studies of eating disorders (EDs) suggest that empirically derived personality subtypes may explain heterogeneity in ED samples that is not captured by the current diagnostic system. Longitudinal outcomes for personality subtypes have not been examined. In this study, personality pathology was assessed by clinical interview in 213 individuals with anorexia nervosa and bulimia nervosa at baseline. Interview data on EDs, comorbid diagnoses, global functioning, and treatment utilization were collected at baseline and at 6-month follow-up intervals over a median of 9 years. Q-factor analysis of the participants based on personality items produced a 5-prototype system, including high-functioning, behaviorally dysregulated, emotionally dysregulated, avoidant-insecure, and obsessional-sensitive types. Dimensional prototype scores were associated with baseline functioning and longitudinal outcome. Avoidant-Insecure scores showed consistent associations with poor functioning and outcome, including failure to show ED improvement, poor global functioning after 5 years, and high treatment utilization after 5 years. Behavioral dysregulation was associated with poor baseline functioning but did not show strong associations with ED or global outcome when histories of major depression and substance use disorder were covaried. Emotional dysregulation and obsessional-sensitivity were not associated with negative outcomes. High-functioning prototype scores were consistently associated with positive outcomes. Longitudinal results support the importance of personality subtypes to ED classification.

The Stability of DSM Personality Disorders over Twelve to Eighteen Years

PubMed Central

Nestadt, Gerald; Di, Chongzhi; Samuels, J F; Bienvenu, O J; Reti, I M; Costa, P; Eaton, William W; Bandeen-Roche, Karen

2009-01-01

Background Stability of personality disorders is assumed in most nomenclatures; however, the evidence for this is limited and inconsistent. The aim of this study is to investigate the stability of DSM-III personality disorders in a community sample of eastern Baltimore residents unselected for treatment. Methods Two hundred ninety four participants were examined on two occasions by psychiatrists using the same standardized examination twelve to eighteen years apart. All the DSM-III criteria for personality disorders were assessed. Item-response analysis was adapted into two approaches to assess the agreement between the personality measures on the two occasions. The first approach estimated stability in the underlying disorder, correcting for error in trait measurement, and the second approach estimated stability in the measured disorder, without correcting for item unreliability. Results Five of the ten personality disorders exhibited moderate stability in individuals: antisocial, avoidant, borderline, histrionic, and schizotypal. Associated estimated ICCs for stability of underlying disorder over time ranged between approximately 0.4 and 0.7–0.8. A sixth disorder, OCPD, exhibited appreciable stability with estimated ICC of approximately 0.2–0.3. Dependent, narcissistic, paranoid, and schizoid disorders were not demonstrably stable. Conclusions The findings suggest that six of the DSM personality disorder constructs themselves are stable, but that specific traits within the DSM categories are both of lesser importance than the constructs themselves and require additional specification. PMID:19656527

Personality Disorders in Hypochondriasis: A Comparison to Panic Disorder and Healthy Controls.

PubMed

Weck, Florian; Nagel, Laura Carlotta; Richtberg, Samantha; Neng, Julia M B

2017-08-01

Previous studies found high prevalence rates of personality disorders (PDs) in patients with hypochondriasis; however, assessment was often based only on questionnaires. In the current study, a sample of 68 patients with hypochondriasis was compared to 31 patients with panic disorder and to 94 healthy controls. Participants were investigated with the Structured Clinical Interview for DSM-IV Personality Disorders questionnaire (SCID-II questionnaire) and the SCID-II interview. Based on the cut-off scores of the SCID-II questionnaire, we found a prevalence rate of 45.6% for PD in patients with hypochondriasis. In comparison to healthy controls, patients with hypochondriasis showed characteristics of paranoid, borderline, avoidant, and dependent PDs in the dimensional assessment significantly more often. However, no significant differences were found between the clinical samples. Based on the SCID-II interview, only 2.9% of the patients with hypochondriasis fulfilled the criteria for a PD. These results suggest that PDs are not a specific characteristic of hypochondriasis.

Differential Impairment as an Indicator of Sex Bias in DSM-IV Criteria for Four Personality Disorders

ERIC Educational Resources Information Center

Boggs, Christina D.; Morey, Leslie C.; Skodol, Andrew E.; Shea, M. Tracie; Sanislow, Charles A.; Grilo, Carlos M.; McGlashan, Thomas H.; Zanarini, Mary C.; Gunderson, John G.

2005-01-01

The aim of the present study was to investigate the possibility of sex bias in the diagnostic criteria for borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders. A clinical sample of 668 individuals was evaluated for personality disorder criteria using a semistructured interview, and areas of functional impairment were…

Cognitive factors in panic disorder, agoraphobic avoidance and agoraphobia.

PubMed

Berle, David; Starcevic, Vladan; Hannan, Anthony; Milicevic, Denise; Lamplugh, Claire; Fenech, Pauline

2008-02-01

There remains a lack of consensus regarding the possibility that especially high levels of panic-related cognitions characterise panic disorder with agoraphobia. We administered the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire and the Anxious Thoughts and Tendencies Scale as well as measures of agoraphobic avoidance to patients diagnosed with panic disorder with agoraphobia (n=75) and without agoraphobia (n=26). Patients with panic disorder with agoraphobia did not score significantly higher on any of the cognitive variables than did panic disorder patients without agoraphobia. However, most of the cognitive variables showed small to moderate-strength correlations with self-report measures of agoraphobic avoidance. Our findings suggest that anxiety sensitivity, catastrophising of the consequences of panic and a general anxiety-prone cognitive style, although to some extent associated with agoraphobic avoidance, do not discriminate panic disorder with agoraphobia from panic disorder without agoraphobia.

Association between a serotonin transporter promoter polymorphism (5HTTLPR) and personality disorder traits in a community sample.

PubMed

Blom, Rianne M; Samuels, Jack F; Riddle, Mark A; Joseph Bienvenu, O; Grados, Marco A; Reti, Irving M; Eaton, William W; Liang, Kung-Yee; Nestadt, Gerald

2011-09-01

The serotonin transporter (SERT) polymorphism (5HTTLPR) has been reported to be associated with several psychiatric conditions. Specific personality disorders could be intermediate factors in the known relationship between 5HTTLPR and psychiatric disorders. This is the first study to test the association between this polymorphism and dimensions of all DSM-IV personality disorders in a community sample. 374 white participants were assessed by clinical psychologists using the International Personality Disorder Examination (IPDE). Associations between dimensions of each DSM-IV personality disorder and the long (l) and short (s) alleles of the 5HTTLPR were evaluated using non-parametric tests and regression models. The s allele of the 5HTTLPR polymorphism was significantly associated with higher avoidant personality trait scores in the whole sample. Males with the s allele had a significantly lower likelihood of higher obsessive-compulsive personality disorder (OCPD) trait scores, whereas females with the s allele were likely to have higher OCPD personality trait scores. This paper provides preliminary data on the relationship between personality disorders and the 5HTTLPR polymorphism. The relationship of the s allele and avoidant PD is consistent with findings of a nonspecific relationship of this polymorphism to anxiety and depressive disorders. Concerning the unusual sexual dimorphic result with OCPD, several hypotheses are presented. These findings need further replication, including a more detailed study of additional variants in SERT. Copyright © 2011 Elsevier Ltd. All rights reserved.

Factor structure and diagnostic efficiency of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for avoidant personality disorder in Hispanic men and women with substance use disorders.

PubMed

Becker, Daniel F; Añez, Luis Miguel; Paris, Manuel; Bedregal, Luis; Grilo, Carlos M

2009-01-01

This study examined the internal consistency, factor structure, and diagnostic efficiency of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for avoidant personality disorder (AVPD) and the extent to which these metrics may be affected by sex. Subjects were 130 monolingual Hispanic adults (90 men, 40 women) who had been admitted to a specialty clinic that provides psychiatric and substance abuse services to Spanish-speaking patients. All were reliably assessed with the Spanish-Language Version of the Diagnostic Interview for DSM-IV Personality Disorders. The AVPD diagnosis was determined by the best-estimate method. After evaluating internal consistency of the AVPD criterion set, an exploratory factor analysis was performed using principal components extraction. Afterward, diagnostic efficiency indices were calculated for all AVPD criteria. Subsequent analyses examined men and women separately. For the overall group, internal consistency of AVPD criteria was good. Exploratory factor analysis revealed a 1-factor solution (accounting for 70% of the variance), supporting the unidimensionality of the AVPD criterion set. The best inclusion criterion was "reluctance to take risks," whereas "interpersonally inhibited" was the best exclusion criterion and the best predictor overall. When men and women were examined separately, similar results were obtained for both internal consistency and factor structure, with slight variations noted between sexes in the patterning of diagnostic efficiency indices. These psychometric findings, which were similar for men and women, support the construct validity of the DSM-IV criteria for AVPD and may also have implications for the treatment of this particular clinical population.

Harm avoidance and persistence are associated with somatoform disorder psychopathology: A study in Taiwan.

PubMed

Huang, Wei-Lieh; Chen, Tzu-Ting; Chen, I-Ming; Chang, Li-Ren; Lin, Yu-Hsuan; Liao, Shih-Cheng; Gau, Susan Shur-Fen

2016-05-15

Whether personality features affect the development of somatoform disorders and their psychopathologies is an important issue. Aim of this study was to resolve this issue by comparing indicators of psychopathology and personality features in subjects with somatoform disorders and healthy controls. This study recruited 148 subjects with somatoform disorders and 146 healthy controls. The severity of psychopathology was measured with the Patient Health Questionnaire-15 (PHQ-15), Health Anxiety Questionnaire (HAQ), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI). The Tridimensional Personality Questionnaire (TPQ) was used to assess personality features. Demographic data, psychopathology indicators, and TPQ scores were compared between groups. Correlation and multivariate linear regression analysis were used to identify the personality dimensions or demographic variables associated with psychopathology. The somatoform group had lower novelty seeking (NS) and reward dependence (RD) and higher harm avoidance (HA) and severity of psychopathologies. Multiple regression analysis revealed that fatigability, persistence, gender, and education level were predictive of PHQ-15; HA, educational level, persistence, and dependence were predictive of HAQ; HA, persistence, education level, and NS were predictive of BDII-II; and fatigability, education level, persistence, and anticipatory worry were predictive of BAI. The development of somatoform disorders was associated with fatigability, age, residence location, education level, and attachment. The limitations include heterogeneity of the diagnosis, the high proportion of undifferentiated somatoform disorder, and the cross-sectional study design. HA/fatigability, persistence, and education level are associated with each type of psychopathology. Fatigability is a powerful predictor of somatoform disorder development. Copyright © 2016. Published by Elsevier B.V.

Histrionic personality disorder

MedlinePlus

Personality disorder - histrionic; Attention seeking - histrionic personality disorder ... delayed gratification Needing to be the center of attention ( self-centeredness ) Quickly changing emotions, which may seem ...

Schizotypal Personality Disorder

MedlinePlus

... often bullied or teased. Schizotypal personality disorder vs. schizophrenia Schizotypal personality disorder can easily be confused with schizophrenia, a severe mental illness in which people lose ...

Relationship between personality disorder dimensions and verbal memory functioning in a community population.

PubMed

Park, Subin; Hong, Jin Pyo; Lee, Hochang B; Samuels, Jack; Bienvenu, O Joseph; Chung, Hye Yoon; Eaton, William W; Costa, Paul T; Nestadt, Gerald

2012-03-30

Based on the Baltimore Epidemiologic Catchment Area (ECA) follow-up survey, we examined relationships between dimensions of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) personality disorders and both subjective and objective memory functioning in a community population. Our study subjects consisted of 736 individuals from the ECA follow-up study of the original Baltimore ECA cohort, conducted between 1993 and 1996 and available for assessment in the Hopkins Epidemiology Study of Personality Disorders from 1997 to 1999. Subjects were assessed for DSM-IV personality disorders using a semi-structured instrument, the International Personality Disorder Examination, and were asked about a subjective appraisal of memory. Verbal memory function, including immediate recall, delayed recall, and recognition, were also evaluated. Multiple linear regression analyses were used to determine associations between personality dimensions of DSM-IV Axis II traits and subjective and objective memory functioning. Scores on schizoid and schizotypal personality dimensions were associated with subjective and objective memory dysfunction, both with and without adjustment for Axis I disorders. Borderline, antisocial, avoidant, and dependent personality disorder scores were associated with subjective memory impairment only, both with and without adjustment for Axis I disorders. This study suggests that subjective feelings of memory impairment and/or objective memory dysfunction are associated with specific personality disorder dimensions. Copyright © 2011 Elsevier Ltd. All rights reserved.

Prevalence of personality disorders in patients with chronic migraine.

PubMed

Kayhan, Fatih; Ilik, Faik

2016-07-01

The present study aimed to investigate the prevalence of personality disorders (PDs) in patients with chronic migraine (CM). This study included 105 CM patients who were diagnosed according to the criteria of the International Headache Society (IHS) and 100 healthy volunteers. PDs were diagnosed with the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, and pain severity and level of disability were assessed with the Migraine Disability Assessment (MIDAS) test. Of the 105 CM patients, 85 (81%) had at least one PD. PDs were more prevalent in the patient group than in the healthy control group, and the most common PDs were obsessive-compulsive (n=53, 50.5%), dependent (n=20, 19%), avoidant (n=20, 19%), and passive-aggressive (n=14, 13.3%) PDs. The MIDAS scores of the CM patients with PDs were higher than those of the CM patients without PDs. PDs, particularly obsessive-compulsive, dependent, avoidant, and passive-aggressive PDs, were frequently observed in CM patients in the present study. Copyright © 2016 Elsevier Inc. All rights reserved.

Psychopathy/antisocial personality disorder conundrum.

PubMed

Ogloff, James R P

2006-01-01

Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly affective deficits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder, and dissocial personality disorder are distinct. In this article, the relevant historical and contemporary literature concerning psychopathy is briefly reviewed. The diagnostic criteria for psychopathy, antisocial personality disorder, and dissocial personality disorder are compared. Consideration is given to the assessment, prevalence, and implications of psychopathy for violence risk and treatment efficacy. The DSM-IV-TR criteria for antisocial personality disorder, in particular, are largely behaviourally based. The ICD criteria for dissocial personality disorder, while paying more attention to affective deficits, also do not represent the broad personality and behavioural components of psychopathy. Since 1980, a great deal of research on these disorders has been conducted, using the Hare Psychopathy Checklist, Revised (PCL-R). The PCL-R assesses both personality (interpersonal and affective) and behavioural (lifestyle and antisocial) deficits. As such, the research and clinical implications of psychopathy, as operationalised by the PCL-R, cannot be readily extrapolated to the diagnoses of antisocial personality disorder and dissocial personality disorder. As currently construed, the diagnosis of antisocial personality disorder grossly over-identifies people, particularly those with offence histories, as meeting the criteria for the diagnosis. For example, research shows that between 50% and 80% of prisoners meet the criteria for a diagnosis of antisocial personality disorder, yet only approximately 15% of prisoners would be expected to be psychopathic, as assessed by the PCL-R. As such, the characteristics and research findings drawn from the psychopathy research may not be relevant for those

Treatment of personality disorder.

PubMed

Bateman, Anthony W; Gunderson, John; Mulder, Roger

2015-02-21

The evidence base for the effective treatment of personality disorders is insufficient. Most of the existing evidence on personality disorder is for the treatment of borderline personality disorder, but even this is limited by the small sample sizes and short follow-up in clinical trials, the wide range of core outcome measures used by studies, and poor control of coexisting psychopathology. 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 synergistic or antagonistic interaction of psychotherapies and drugs for treating personality disorder should be studied in conjunction with their mechanisms of change throughout the development of each. Copyright © 2015 Elsevier Ltd. All rights reserved.

Sex- and Subtype-Related Differences of Personality Disorders (Axis II) and Personality Traits in Persistent ADHD.

PubMed

Jacob, Christian P; Gross-Lesch, Silke; Reichert, Susanne; Geissler, Julia; Jans, Thomas; Kittel-Schneider, Sarah; Nguyen, Trang T; Romanos, Marcel; Reif, Andreas; Dempfle, Astrid; Lesch, Klaus-Peter

2016-12-01

Despite growing awareness of adult ADHD and its comorbidity with personality disorders (PDs), little is known about sex- and subtype-related differences. In all, 910 patients (452 females, 458 males) affected with persistent adult ADHD were assessed for comorbid PDs with the Structured Clinical Interview of DSM-IV and for personality traits with the revised NEO personality inventory, and the Tridimensional Personality Questionnaire. The most prevalent PDs were narcissistic PD in males and histrionic PD in females. Affected females showed higher Neuroticism, Openness to Experience, and Agreeableness scores as well as Harm Avoidance and Reward Dependence scores. Narcissistic PD and antisocial PD have the highest prevalence in the H-type, while Borderline PD is more frequent in the C-type. Sex- and subtype-related differences in Axis II disorder comorbidity as well as impairment-modifying personality traits have to be taken into account in epidemiological studies of persistent ADHD. © The Author(s) 2014.

Borderline personality disorder

MedlinePlus

... this page: //medlineplus.gov/ency/article/000935.htm Borderline personality disorder To use the sharing features on this page, please enable JavaScript. Borderline personality disorder (BPD) is a mental condition in which ...

Personality and posttraumatic stress disorder among directly exposed survivors of the Oklahoma City bombing.

PubMed

North, Carol S; Abbacchi, Anna; Cloninger, C Robert

2012-01-01

Few disaster studies have specifically examined personality in association with exposure to disaster and development of posttraumatic stress disorder (PTSD). A study of survivors of the Oklahoma City bombing examined PTSD and personality measured after the disaster. In a random sample of 255 survivors from a bombing survivor registry, 151 (59%) completed both full PTSD and personality assessments using the Diagnostic Interview Schedule and the Temperament and Character Inventory, respectively. Postbombing PTSD was associated with low self-directedness and low cooperativeness, and also with high self-transcendence and harm avoidance in most configurations. Disorganized (schizotypal) character and explosive (borderline) temperament configurations were associated with PTSD; creative and autocratic character configurations were negatively associated with PTSD. Clinicians should be vigilant for PTSD among individuals with personality disorders and also be aware that personality disorders are likely to be overrepresented among people with PTSD. Treatment of PTSD may need to take into account comorbid personality disorders and personality features. Copyright © 2012 Elsevier Inc. All rights reserved.

Diagnostic agreement between the SCID-II screening questionnaire and the Personality Disorder Examination.

PubMed

Jacobsberg, L; Perry, S; Frances, A

1995-12-01

Instruments to assess personality disorders offer reliability, but at the cost of large amounts of a skilled clinician's time to make assessments. The Structured Clinical Interview for DSM-III Axis II (SCID-II; Spitzer, Williams, Gibbon, & First, 1990), incorporates a self-report screening questionnaire, reducing the number of items needing evaluation by the interviewer. However, false negative responses may cause clinically important areas to be overlooked. To establish the rate of false negative responses, we compared participant self-report on the SCID-II with Axis II diagnostic assessment done by clinicians using the Personality Disorder Examination (Loranger, Susman, Oldham, & Russakoff, 1987). The false negative rate was low for every diagnosis, supporting validity of following up with clinician questioning only those diagnostic elements endorsed in the self-report. Avoidant and dependent personality disorders were accurately self-reported. This, an efficient assessment instrument for personality disorders might combine self-report of those disorders where self-report is reliable, with clinician assessment where needed.

The relevance of personality traits in impulsivity-related disorders: From substance use disorders and gambling disorder to bulimia nervosa

PubMed Central

del Pino-Gutiérrez, Amparo; Jiménez-Murcia, Susana; Fernández-Aranda, Fernando; Agüera, Zaida; Granero, Roser; Hakansson, Anders; Fagundo, Ana B.; Bolao, Ferran; Valdepérez, Ana; Mestre-Bach, Gemma; Steward, Trevor; Penelo, Eva; Moragas, Laura; Aymamí, Neus; Gómez-Peña, Mónica; Rigol-Cuadras, Assumpta; Martín-Romera, Virginia; Menchón, José M.

2017-01-01

Background and aims The main aim of this study was to analyze and describe the clinical characteristics and shared personality traits in different impulsivity–compulsivity spectrum disorders: substance use disorders (SUD), gambling disorder (GD), and bulimia nervosa (BN). The specific aims were to compare personality differences among individuals with pure SUD, BN with and without SUD, and GD with and without SUD. In addition, we assessed the differential predictive capacity of clinical and personality variables in relation to diagnostic subtype. Methods The sample comprised 998 subjects diagnosed according to DSM-IV-TR criteria: 101 patients were diagnosed with SUD, 482 with GD, 359 with BN, 11 with GD + SUD, and 45 patients with BN + SUD. Various assessment instruments were administered, as well as other clinical measures, to evaluate their predictive capacity. Results Marked differences in personality traits were observed between groups. Novelty seeking, harm avoidance, self-directedness, cooperation, and self-transcendence best differentiated the groups. Notably, novelty seeking was significantly higher in the two dual pathology subgroups. Patients with dual pathology showed the most dysfunctional personality profiles. Discussion and conclusion Our results indicate the existence of shared dysfunctional personality traits among the groups studied, especially in novelty seeking and self-directedness. PMID:28838248

The relevance of personality traits in impulsivity-related disorders: From substance use disorders and gambling disorder to bulimia nervosa.

PubMed

Del Pino-Gutiérrez, Amparo; Jiménez-Murcia, Susana; Fernández-Aranda, Fernando; Agüera, Zaida; Granero, Roser; Hakansson, Anders; Fagundo, Ana B; Bolao, Ferran; Valdepérez, Ana; Mestre-Bach, Gemma; Steward, Trevor; Penelo, Eva; Moragas, Laura; Aymamí, Neus; Gómez-Peña, Mónica; Rigol-Cuadras, Assumpta; Martín-Romera, Virginia; Menchón, José M

2017-09-01

Background and aims The main aim of this study was to analyze and describe the clinical characteristics and shared personality traits in different impulsivity-compulsivity spectrum disorders: substance use disorders (SUD), gambling disorder (GD), and bulimia nervosa (BN). The specific aims were to compare personality differences among individuals with pure SUD, BN with and without SUD, and GD with and without SUD. In addition, we assessed the differential predictive capacity of clinical and personality variables in relation to diagnostic subtype. Methods The sample comprised 998 subjects diagnosed according to DSM-IV-TR criteria: 101 patients were diagnosed with SUD, 482 with GD, 359 with BN, 11 with GD + SUD, and 45 patients with BN + SUD. Various assessment instruments were administered, as well as other clinical measures, to evaluate their predictive capacity. Results Marked differences in personality traits were observed between groups. Novelty seeking, harm avoidance, self-directedness, cooperation, and self-transcendence best differentiated the groups. Notably, novelty seeking was significantly higher in the two dual pathology subgroups. Patients with dual pathology showed the most dysfunctional personality profiles. Discussion and conclusion Our results indicate the existence of shared dysfunctional personality traits among the groups studied, especially in novelty seeking and self-directedness.

Validity of the MMPI Personality Disorder scales (MMPI-PD).

PubMed

Schuler, C E; Snibbe, J R; Buckwalter, J G

1994-03-01

The MMPI Personality Disorder scales, developed by Morey, Waugh, and Blashfield (1985), were validated on an inpatient population by comparing 104 patients' MMPI-PD scores with the MCMI and with DSM-III-R diagnosis. Conservative significance levels were used to ensure more valid conclusions. Schizoid, Avoidant, Dependent, Histrionic, and Narcissistic scales were correlated significantly. Passive-Aggressive, Schizotypal, and Borderline scales did not correlate with corresponding MCMI scales. The MMPI-PD nonoverlapping scales were most effective in predicting diagnosis, specifically the Personality Disorder NOS, Eccentric and Borderline groups. The overlapping scales were not as effective in predicting diagnosis, but best predicted the Eccentric and Borderline groups. This study provides support for the validity of specific scales and circumscribed diagnostic utility for both measures.

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders.

PubMed

Karukivi, Max; Vahlberg, Tero; Horjamo, Kalle; Nevalainen, Minna; Korkeila, Jyrki

2017-01-14

Current categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance. The sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder). The proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p < 0.05) from the other groups regarding the BDI, 15D, and MHI-5 scores as well as the number of Axis I diagnoses. Patients with complex/severe personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but

Likelihood and predictors of detention in patients with personality disorder compared with other mental disorders: A retrospective, quantitative study of Mental Health Act assessments.

PubMed

Olajide, Kike; Tyrer, Peter; Singh, Swaran P; Burns, Tom; Rugkåsa, Jorun; Thana, Lavanya; Paul, Moli; Islam, Zoebia; Crawford, Mike J

2016-08-01

The UK guidelines on the treatment of personality disorder recommend avoiding compulsory treatment except in extreme situations. Little is known about how often patients with personality disorder are detained or how this compares with the treatment of other mental disorders. Our aim is to test the hypothesis that people with personality disorder are infrequently detained under the Mental Health Act (MHA) and that risk factors associated with detention are the same as those for people with other mental disorders. We used a retrospective, quantitative study of MHA assessments. Of the 2 087 assessments undertaken, 204 (9.8%) patients had a diagnosis of personality disorder; 40.7% of assessments in the personality disorder group resulted in detention, as did 69.7% of patients with other mental disorders. A higher proportion of people with personality disorder received no intervention following assessment compared with those with other mental disorders (20.6% vs. 4.7%, p < 0.001). Study centre and a history of admission were risk factors for detention in both groups. Risk was a predictor of detention in those with other mental disorders. Detention rates in patients with personality disorder are lower than those for other disorders but are still substantial. Risk factors for detention in patients with personality disorder differ from those with other mental disorders. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Personality disorder and treatment outcome in alcohol use disorder.

PubMed

Newton-Howes, Giles; Foulds, James

2018-01-01

As personality disorder impacts the outcome of most major mental disorders, it would be consistent for it to impact negatively on the outcome of alcohol use disorders (AUDs). This update is to provide an up-to-date overview of the recent literature examining the impact of personality disorder and personality traits on the treatment outcome of AUDs. Comorbidity between personality disorder and AUD is significant and approaches 50%. Patients with AUD and comorbid personality disorder are substantially less likely to remain in treatment, drink more per drinking day and drink more frequently. If retained in treatment, comorbidity does not, however, lead to poorer outcomes. Relapse to drinking is more common in patient with high novelty seeking and lower reward dependence and persistence. Reporting from most studies is of moderate-to-poor quality and a single high-quality study may alter these findings. Landmark alcohol studies are notably quiet on the impact of personality on AUD treatment outcome. Both personality disorder and higher novelty seeking impact negatively on the treatment outcome of AUD. As personality disorder is common in this group, clinicians engaged in AUD treatment should screen for personality disturbance, either disorder or high novelty seeking.

The Stigma of Personality Disorders.

PubMed

Sheehan, Lindsay; Nieweglowski, Katherine; Corrigan, Patrick

2016-01-01

This article reviews the recent literature on the stigma of personality disorders, including an overview of general mental illness stigma and an examination of the personality-specific stigma. Overall, public knowledge of personality disorders is low, and people with personality disorders may be perceived as purposefully misbehaving rather than experiencing an illness. Health provider stigma seems particularly pernicious for those with borderline personality disorder. Most stigma research on personality disorders has been completed outside the USA, and few stigma-change interventions specific to personality disorder have been scientifically tested. Limited evidence suggests that health provider training can improve stigmatizing attitudes and that interventions combining positive messages of recovery potential with biological etiology will be most impactful to reduce stigma. Anti-stigma interventions designed specifically for health providers, family members, criminal justice personnel, and law enforcement seem particularly beneficial, given these sources of stigma.

[Personality disorders, violence and criminal behaviour].

PubMed

Palmstierna, Tom

2016-12-06

Personality disorders, violence and criminal behaviour The importance of personality disorders for violent and criminal behaviour is illustrated by their high prevalence in prison populations. Especially antisocial personality disorder and antisocial personality traits are linked to violence. During diagnostic assessment of personality disorders, violence risk screening is recommended. Cognitive behaviour treatment focused on violent behaviour has some effect in criminal populations, but the antisocial personality traits are resistant to treatment. Evidence for pharmacological treatment of repetitive aggressive behaviour is weak. But, bensodiazepines seem to increase the risk of violent behaviour among patients with personality disorders. Antisocial personality traits diminish over time. This spontaneous decrease can be delayed by comorbidity such as other personality disorder, substance use disorder, psychosis and attention deficit disorders. Therefore it is recommended to actively treat these comorbid conditions.

The Relation between Anxiety Disorder and Experiential Avoidance in Inpatient Adolescents

ERIC Educational Resources Information Center

Venta, Amanda; Sharp, Carla; Hart, John

2012-01-01

The current study aimed to examine the relation between experiential avoidance and anxiety disorders, as well as the usefulness of the Avoidance and Fusion Questionnaire for Youth (AFQ-Y; Greco, Lambert, & Baer, 2008) in detecting anxiety disorder in a sample of adolescent inpatients. First, the relation between experiential avoidance and anxiety…

[The relevance of sexuality in the treatment of borderline personality disorder].

PubMed

Neeleman, A J F

2007-01-01

Although many articles about borderline personality disorder have been published over the last 25 years, sexuality has not received much attention. Sexual functioning may however be relevant for the treatment of this disorder. To find out from research reports, the literature and clinical practice whether they contain evidence of varying degrees of problematical sexuality in borderline patients, and if so, to make an inventory of the evidence. A literature search was conducted via PubMed and Psycinfo using the search terms 'borderline personality disorder', 'sexuality' and 'research'. In addition, the literature was searched manually. Only six empirical studies about the sexual functioning of patients with borderline personality disorder were found. The research findings provided information about patients' problems with regard to intimate and sexual relations. These problems related to heightened sexual impulsivity, reduced satisfaction, increased sexual boredom, greater preoccupation with sex, avoidance of sex and a range of other sexual complaints. In addition, there is evidence that homosexuality and vulnerability regarding gender identity occur more frequently in these patients. Helping to integrate love and sexuality with a suitable partner seems to be an important developmental assignment for persons assisting borderline patients.

Bipolar obsessive-compulsive disorder and personality disorders.

PubMed

Maina, Giuseppe; Albert, Umberto; Pessina, Enrico; Bogetto, Filippo

2007-11-01

Relatively few systematic data exist on the clinical impact of bipolar comorbidity in obsessive-compulsive disorder (OCD) and no studies have investigated the influence of such a comorbidity on the prevalence and pattern of Axis II comorbidity. The aim of the present study was to explore the comorbidity of personality disorders in a group of patients with OCD and comorbid bipolar disorder (BD). The sample consisted of 204 subjects with a principal diagnosis of OCD (DSM-IV) and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score>or=16 recruited from all patients consecutively referred to the Anxiety and Mood Disorders Unit, Department of Neuroscience, University of Turin over a period of 5 years (January 1998-December 2002). Diagnostic evaluation and Axis I comorbidities were collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Personality status was assessed by using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Socio-demographic and clinical features (including Axis II comorbidities) were compared between OCD patients with and without a lifetime comorbidity of BD. A total of 21 patients with OCD (10.3%) met DSM-IV criteria for a lifetime BD diagnosis: 4 (2.0%) with BD type I and 17 (8.3%) with BD type II. Those without a BD diagnosis showed significantly higher rates of male gender, sexual and hoarding obsessions, repeating compulsions and lifetime comorbid substance use disorders, when compared with patients with BD/OCD. With regard to personality disorders, those with BD/OCD showed higher prevalence rates of Cluster A (42.9% versus 21.3%; p=0.027) and Cluster B (57.1% versus 29.0%; p=0.009) personality disorders. Narcissistic and antisocial personality disorders were more frequent in BD/OCD. Our results point towards clinically relevant effects of comorbid BD on the personality profiles of OCD patients, with higher rates of narcissistic and antisocial personality disorders in BD/OCD patients.

[Borderline personality disorder and transsexualism].

PubMed

Seikowski, Kurt; Gollek, Sabine; Harth, Wolfgang; Reinhardt, Michaela

2008-04-01

The study addresses the question whether, as often assumed, the symptoms of borderline personality disorders occur more frequently in transsexuals or not. We examined 164 transsexuals. The subjects completed the following questionnaires: The Borderline-Personality Inventory (BPI), the Freiburg Personality Inventory (FPI) and the Questionnaire for Assessment of One's Own Body (FbeK). In 80 % of all the examined transsexuals, there was evidence of symptoms of neither a borderline personality disorder nor of other personality disorders. If borderline symptoms occurred, they were predictable from the variables depressivity, low composure, low sociability and lack of confidence in relation to the external appearance. The data obtained refute the often-assumed increased relationship between borderline personality disorders and transsexuality. It should be assumed that a borderline personality disorder is primarily a psychiatric illness, while transsexuality is a disorder of gender identity in which secondary borderline symptoms may arise in some cases.

Impact of obsessive-compulsive personality disorder (OCPD) symptoms in Internet users

PubMed Central

Chamberlain, Samuel R.; Leppink, Eric W.; Redden, Sarah A.; Stein, Dan J.; Lochner, Christine; Grant, Jon E.

2017-01-01

Background Internet use is pervasive in many cultures. Little is known about the impact of Obsessive-Compulsive Personality Disorder (OCPD) symptoms on impulsive and compulsive psychopathologies in people who use the Internet. Method 1323 adult Internet users completed an online questionnaire quantifying OCPD symptoms, likely occurrence of select mental disorders (OCD, ADHD, problematic Internet use, anxiety), and personality questionnaires of impulsivity (Barratt) and compulsivity (Padua). Predictors of presence of OCPD symptoms (endorsement of at least 4 of 8 DSM criteria) were identified using binary logistic regression. Results In regression (p<0.001, AUC 0.77), OCPD symptoms were significantly associated with (in order of decreasing effect size): lower non-planning impulsivity, higher ADHD symptoms, problematic Internet use, avoidant personality disorder, female gender, generalized anxiety disorder, and some types of compulsions (checking, dressing/washing). Conclusions These data suggest that OCPD symptoms, defined in terms of at least 4 of 8 DSM tick-list criteria being met, are common in Internet users. OCPD symptoms were associated with considerably higher levels of psychopathology relating to both impulsive (ADHD) and compulsive (OC-related and problematic Internet use) disorders. These data merit replication and extension using gold-standard in-person clinical assessments, as the current study relied on self-report over the Internet. PMID:28738097

School climate and continuity of adolescent personality disorder symptoms.

PubMed

Kasen, Stephanie; Cohen, Patricia; Chen, Henian; Johnson, Jeffrey G; Crawford, Thomas N

2009-12-01

Schools are key social contexts for shaping development and behavior in youths; yet, little is known of their influence on adolescent personality disturbance. A community-based sample of 592 adolescents was assessed for family and school experiences, Axis I psychiatric disorders, and Axis II personality disorder (PD) symptoms, and followed into young adulthood. Multiple regression analysis was used to estimate associations between adolescent-reported school climate and young adult PD symptoms independent of age, sex, family socioeconomic status; childhood maltreatment; Axis I disorder, PD symptoms, academic grades, and parental punishment in adolescence; and four dimensions of school climate. Schools characterized as high in learning focus were related to cluster B (antisocial, borderline, histrionic, and narcissistic PD) symptom declines, whereas schools characterized as high in opportunities for student autonomy were related to cluster A (paranoid, schizoid, and schizotypal PD) symptom declines. In contrast, schools characterized as conflictual or supporting interpersonal informality/familiarity among students and teachers were related to increases in cluster A symptoms and cluster C (avoidant, dependent, and obsessive-compulsive PD) symptoms. Schools may exert both positive and negative influences on continuity of adolescent personality disturbance. The role of the school in guiding young people toward more favorable developmental pathways and alleviating personality disturbance is discussed.

Alexithymia and personality disorder functioning styles in paranoid schizophrenia.

PubMed

Yu, Shaohua; Li, Huichun; Liu, Weibo; Zheng, Leilei; Ma, Ying; Chen, Qiaozhen; Chen, Yiping; Yu, Hualiang; Lu, Yunrong; Pan, Bing; Wang, Wei

2011-01-01

Personality disorder functioning styles might contribute to the inconclusive findings about alexithymic features in schizophrenia. We therefore studied the relationship between alexithymia and personality styles in paranoid schizophrenia. We administered the Chinese versions of the Toronto Alexithymia Scale (TAS-20), the Parker Personality Measure (PERM), the Positive and Negative Syndrome Scale as well as the Hamilton Anxiety and Depression Scales to 60 paranoid schizophrenia patients and 60 healthy control subjects. Patients scored significantly higher on the Positive and Negative Syndrome Scale, TAS 'difficulty identifying feelings' and 'difficulty describing feelings', Hamilton Depression Scale and most PERM scales. In healthy subjects, difficulty identifying feelings predicted the PERM 'dependent' style, and the Hamilton Anxiety Scale predicted difficulty identifying feelings and difficulty describing feelings. In patients, difficulty identifying feelings nonspecifically predicted all the PERM scales; by contrast, the PERM 'antisocial' style predicted difficulty identifying feelings, the 'avoidant' style predicted difficulty describing feelings, and the 'histrionic' and 'paranoid (-)' styles predicted 'externally oriented thinking'. Personality disorder functioning styles - instead of anxiety, depression, psychotic symptoms or disease duration - were specifically associated with alexithymia scales in our patients, which sheds light on a cognitive-personological substrate in paranoid schizophrenia on the one hand, and calls for a longitudinal design to discover how premorbid or postacute residual personality styles contribute to the sluggish disorder on the other. Copyright © 2011 S. Karger AG, Basel.

Struggling for existence—Life situation experiences of older persons with mental disorders

PubMed Central

Fagerberg, Ingegerd; Lindholm, Christina; Wiklund-Gustin, Lena

2012-01-01

Older persons with mental disorders represent a vulnerable group of people with extensive and complex needs. The older population is rapidly increasing worldwide and, as a result of deinstitutionalization in mental health care, older persons are remaining at home to a greater extent. Although they constitute a large proportion of the population, older persons with mental disorders have been neglected in research as well as in care organizations. As there is little previous knowledge concerning older persons’ experiences of their own situations, this study aimed to illuminate the meaning of the life situation as experienced by older persons with mental disorders (excluding dementia disorders). Interviews were conducted with seven older persons and the text was analyzed using a phenomenological hermeneutical research method, inspired by the philosophy of Paul Ricoeur. “Struggling for existence” emerged as a main theme in the older persons’ narratives, understood as a loss of dignity of identity and involving being troubled and powerless as well as yearning for respect. The older persons fought to master their existence and to be seen for who they are. The study highlights the importance for caregivers, both formal and informal, to avoid focusing on the diagnoses and rather acknowledge the older persons and their lifeworld, be present in the relation and help them rebuild their dignity of identity. This study brings a new understanding about older persons with mental disorders that may help reduce stigma and contribute to planning future mental health care. PMID:22693537

The Prevalence of Comorbid Personality Disorders in Treatment-Seeking Problem Gamblers: A Systematic Review and Meta-Analysis.

PubMed

Dowling, Nicki A; Cowlishaw, S; Jackson, A C; Merkouris, S S; Francis, K L; Christensen, D R

2015-12-01

The aim of this study was to systematically review and meta-analyze the prevalence of comorbid personality disorders among treatment-seeking problem gamblers. Almost one half (47.9%) of problem gamblers displayed comorbid personality disorders. They were most likely to display Cluster B disorders (17.6%), with smaller proportions reporting Cluster C disorders (12.6%) and Cluster A disorders (6.1%). The most prevalent personality disorders were narcissistic (16.6%), antisocial (14.0%), avoidant (13.4%), obsessive-compulsive (13.4%), and borderline (13.1%) personality disorders. Sensitivity analyses suggested that these prevalence estimates were robust to the inclusion of clinical trials and self-selected samples. Although there was significant variability in reported rates, subgroup analyses revealed no significant differences in estimates of antisocial personality disorder according to problem gambling severity, measure of comorbidity employed, and study jurisdiction. The findings highlight the need for gambling treatment services to conduct routine screening and assessment of co-occurring personality disorders and to provide treatment approaches that adequately address these comorbid conditions.

In-depth study of personality disorders in first-admission patients with substance use disorders

PubMed Central

2012-01-01

Background Assessment of comorbid personality disorders (PDs) in patients with substance use disorders (SUDs) is challenging due to symptom overlap, additional mental and physical disorders, and limitations of the assessment methods. Our in-depth study applied methods to overcome these difficulties. Method A complete catchment area sample of 61 consecutively admitted patients with SUDs, with no previous history of specialized treatment (addiction clinics, psychiatry) were studied, addressing PDs and associated clinical and demographic variables. The thorough assessments included the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Results Forty-six percent of the SUD patients had at least one PD (16% antisocial [males only]; 13% borderline; and 8% paranoid, avoidant, and obsessive-compulsive, respectively). Cluster C disorders were as prevalent as Cluster B disorders. SUD patients with PDs were younger at the onset of their first SUD and at admission; used more illicit drugs; had more anxiety disorders, particularly social phobia; had more severe depressive symptoms; were more distressed; and less often attended work or school. Conclusion The psychiatric comorbidity and symptom load of SUD patients with PDs differed from those of SUD patients without PDs, suggesting different treatment needs, and stressing the value of the assessment of PDs in SUD patients. PMID:23107025

Co-occurrence of dissociative identity disorder and borderline personality disorder.

PubMed

Ross, Colin A; Ferrell, Lynn; Schroeder, Elizabeth

2014-01-01

The literature indicates that, among individuals with borderline personality disorder, pathological dissociation correlates with a wide range of impairments and difficulties in psychological function. It also predicts a poorer response to dialectical behavior therapy for borderline personality disorder. We hypothesized that (a) dissociative identity disorder commonly co-occurs with borderline personality disorder and vice versa, and (b) individuals who meet criteria for both disorders have more comorbidity and trauma than individuals who meet criteria for only 1 disorder. We interviewed a sample of inpatients in a hospital trauma program using 3 measures of dissociation. The most symptomatic group was those participants who met criteria for both borderline personality disorder and dissociative identity disorder on the Dissociative Disorders Interview Schedule, followed by those who met criteria for dissociative identity disorder only, then those with borderline personality disorder only, and finally those with neither disorder. Greater attention should be paid to the relationship between borderline personality disorder and dissociative identity disorder.

Treatment of borderline personality disorder and co-occurring anxiety disorders

PubMed Central

Valenstein, Helen R.

2013-01-01

Anxiety disorders are highly prevalent among individuals with borderline personality disorder, with comorbidity rates of up to 90%. Anxiety disorders have been found to reduce the likelihood of achieving remission from borderline personality disorder over time and to increase the risk of suicide and self-injury in this population. Evidence-based treatments for borderline personality disorder have not sufficiently focused on targeting anxiety disorders, and their effects on these disorders are either limited or unknown. Conversely, evidence-based treatments for anxiety disorders typically exclude suicidal, self-injuring, and seriously comorbid patients, thereby limiting their generalizability to individuals with borderline personality disorder. To address these limitations, recent research has begun to emerge focused on developing and evaluating treatments for individuals with co-occurring borderline personality disorder and anxiety disorders, specifically posttraumatic stress disorder (PTSD), with promising initial results. However, there is a need for additional research in this area, particularly studies evaluating the treatment of anxiety disorders among high-risk and complex borderline personality disorder patients. PMID:23710329

Clinical study of the relation of borderline personality disorder to Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders.

PubMed

Hudziak, J J; Boffeli, T J; Kreisman, J J; Battaglia, M M; Stanger, C; Guze, S B; Kriesman, J J

1996-12-01

The criteria for borderline personality disorder seem to select patients with very high rates of Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders. This study was undertaken to determine whether systematic assessment of patients with borderline personality disorder would reveal characteristic features of that condition which would distinguish it from these other disorders. Eighty-seven white female patients (75 in St. Louis and 12 in Milan, Italy) who had borderline personality disorder according to both the DSM-III-R criteria and the Revised Diagnostic Interview for Borderlines were further examined with the DSM-III-R Checklist and the Perley-Guze Hysteria Checklist to determine their patterns of psychiatric comorbidity. Every patient had at least one additional DSM diagnosis. Patients in St. Louis and Milan averaged five and four additional diagnoses, respectively. Eighty-four percent of the patients in St. Louis met criteria for either somatization disorder, Briquet's syndrome, antisocial personality disorder, or substance abuse disorders. Patterns of comorbidity for panic (51%), generalized anxiety disorder (55%), and major depression (87%) in St. Louis were consistent with those in other studies. The data indicate that the boundaries for the borderline condition are not specific and identify a high percentage of patients with these other disorders. Furthermore, the comorbidity profiles closely resemble the psychiatric profiles of patients with these disorders. If the borderline syndrome is meant to include all of these disorders, its usefulness as a diagnosis is limited. Until the fundamental features of borderline personality disorder that distinguish it from the others are identified, it is recommended that clinicians carefully assess patients for these other diagnoses. Efforts should be made to change the borderline personality disorder criteria by shifting away from overlap with the

Using personality neuroscience to study personality disorder.

PubMed

Abram, Samantha V; DeYoung, Colin G

2017-01-01

Personality neuroscience integrates techniques from personality psychology and neuroscience to elucidate the neural basis of individual differences in cognition, emotion, motivation, and behavior. This endeavor is pertinent not only to our understanding of healthy personality variation, but also to the aberrant trait manifestations present in personality disorders and severe psychopathology. In the current review, we focus on the advances and limitations of neuroimaging methods with respect to personality neuroscience. We discuss the value of personality theory as a means to link specific neural mechanisms with various traits (e.g., the neural basis of the "Big Five"). Given the overlap between dimensional models of normal personality and psychopathology, we also describe how researchers can reconceptualize psychopathological disorders along key dimensions, and, in turn, formulate specific neural hypotheses, extended from personality theory. Examples from the borderline personality disorder literature are used to illustrate this approach. We provide recommendations for utilizing neuroimaging methods to capture the neural mechanisms that underlie continuous traits across the spectrum from healthy to maladaptive. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Predicting Personality Disorder Functioning Styles by the Five-Factor Nonverbal Personality Questionnaire in Healthy Volunteers and Personality Disorder Patients.

PubMed

Gao, Qianqian; Ma, Guorong; Zhu, Qisha; Fan, Hongying; Wang, Wei

2016-01-01

Detecting personality disorders in the illiterate population is a challenge, but nonverbal tools measuring personality traits such as the Five-Factor Nonverbal Personality Questionnaire (FFNPQ) might help. We hypothesized that FFNPQ traits are associated with personality disorder functioning styles in a predictable way, especially in a sample of personality disorder patients. We therefore invited 106 personality disorder patients and 205 healthy volunteers to answer the FFNPQ and the Parker Personality Measure (PERM) which measures 11 personality disorder functioning styles. Patients scored significantly higher on the FFNPQ neuroticism and conscientiousness traits and all 11 PERM styles. In both groups, the 5 FFNPQ traits displayed extensive associations with the 11 PERM styles, respectively, and the associations were more specific in patients. Associations between neuroticism, extraversion and agreeableness traits and most PERM styles were less exclusive, but conscientiousness was associated with antisocial (-) and obsessive-compulsive styles, and openness to experience with schizotypal and dependent (-) styles. Our study has demonstrated correlations between FFNPQ traits and PERM styles, and implies the nonverbal measure of personality traits is capable of aiding the diagnoses of personality disorders in the illiterate population. Enlarging sample size and including the illiterate might make for more stable results. © 2016 S. Karger AG, Basel.

[Psychopathy and associated personality disorders: searching for a particular effect of the borderline personality disorder?].

PubMed

Nioche, A; Pham, T H; Ducro, C; de Beaurepaire, C; Chudzik, L; Courtois, R; Réveillère, C

2010-06-01

Recent clinical and empirical works are based on Cleckley's clinical observations in which psychopathy is viewed as a personality disorder, characterised by a lack of emotions, callousness, unreliability and superficiality. Hare operationalised Cleckley's concept of psychopathy by developing the Psychopathy Checklist-Revised composed of 20 items that load on two factors in majority: factor 1 (personality aspects of psychopathy) and factor 2 (behavioural manifestations), close to the antisocial personality disorder (DSM-IV criteria). Comorbidity is strong with antisocial personality disorder but also with histrionic, narcissistic and borderline disorders. As results of categorical studies relative to comorbidity suggest a strong comorbidity between psychopathy and other personality disorders, and particularly cluster B disorders (axis II, DSM-IV), this study assesses the relationships between psychopathy (dimensional approach) and personality disorders (categorical approach) and particularly with the borderline personality disorder. The aim of this study is also to underline the complementarity of categorical (SCID-II) and dimensional approaches (PCL-R), and the utility of the standardised clinical examination. We hypothesised positive associations between psychopathy and other personality disorders, mainly with the cluster B axis II (narcissistic, antisocial, histrionic, and borderline). Among those disorders, a particular link exists with the borderline personality disorder, considering that their association may attenuate the pathological level of the psychopathy. The sample included 80 male inmates from French prisons (age: M=31.48; SD=11.06). Each participant was evaluated with the PCL-R to assess the level of psychopathy and the SCID-II to assess the possible presence of personality disorders. The MINI and the WAIS-III were used to exclude respectively those who presented an axis I comorbidity (mood disorders and psychotic disorders established at the moment

The frequency of personality disorders in patients with gender identity disorder.

PubMed

Meybodi, Azadeh Mazaheri; Hajebi, Ahmad; Jolfaei, Atefeh Ghanbari

2014-01-01

Co-morbid psychiatric disorders affect prognosis, psychosocial adjustment and post-surgery satisfaction in patients with gender identity disorder. In this paper, we assessed the frequency of personality disorders in Iranian GID patients. Seventy- three patients requesting sex reassignment surgery (SRS) were recruited for this crosssectional study. Of the participants, 57.5% were biologically male and 42.5% were biologically female. They were assessed through the Millon Clinical Multiaxial Inventory II (MCMI- II). The frequency of personality disorders was 81.4%. The most frequent personality disorder was narcissistic personality disorder (57.1%) and the least was borderline personality disorder. The average number of diagnoses was 3.00 per patient. The findings of this study revealed that the prevalence of personality disorders was higher among the participants, and the most frequent personality disorder was narcissistic personality disorder (57.1%), and borderline personality disorder was less common among the studied patients.

The treatment of personality disorder in Jamaica with psychohistoriographic brief psychotherapy.

PubMed

Hickling, F W

2013-01-01

To assess the clinical outcome of patients with personality disorder, receiving treatment with psychohistoriographic brief psychotherapy (PBP). Patients seen in the author's private practice from 1974-2010 with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) personality disorder diagnosis were treated with PBP. Demographic, clinical responses and one-year clinical outcome measures were disaggregated and analysed, using SPSS, version 17. One hundred patients completed treatment with PBP, male:female 34:64; mean age of 35.86 ± 10.28 (range 16 - 66) years. Forty-five per cent were married, 73% were of predominantly African racial origin, with 59% from socio-economic class (SEC) I and 39% from SEC II and III. The presenting complaints were interpersonal conflict (35%), anxiety (21%) and depressed mood (20%). Major depression (30%), substance abuse disorder (18%) and generalized anxiety disorder (13%) were the most common Axis I diagnoses. Histrionic personality disorder (39%) and avoidant personality disorder (35%) were the main Axis II diagnoses. Psychohistoriography was completed with all patients, and charted by 96%. Transference variants were experienced by all patients and worked through with 87%. The quadranting process was completed by 42% with goal setting instituted by 96% and actualization scoring fully completed by 34%. A continuous exercise programme was instituted by all patients, and was maintained by 56% at one-year follow-up. Ninety-four per cent reported fair (10%), good (68%) to very good/excellent (16%) improvement on completion of PBP, with 72% assessed as maintaining fair to good clinical improvement by the therapist at one-year follow-up. Patients with personality disorders showed clinical improvement one year after being treated with psychohistoriographic brief psychotherapy.

Associations linking parenting styles and offspring personality disorder are moderated by parental personality disorder, evidence from China.

PubMed

Cheng, Hui Green; Huang, Yueqin; Liu, Zhaorui; Liu, Baohua

2011-08-30

The aim of the study is to examine the association linking parenting and personality disorder controlling for parental personality disorder, and whether this association is moderated by parental PD. Data were from community-dwelling high school students aged 18 and above and their parents living in Beijing, China. A total of 181 cases and 2,605 controls were included in this study. Personality disorder in students was assessed via a two-stage approach, Personality Diagnostic Questionnaire as a screening tool and International Personality Disorder Examination as the diagnostic tool. Information about parenting was collected from students using Egna Minnen av. Betraffande Uppfostran. Negative parenting styles, e.g. rejective or over-protective parenting, were found to be associated with the occurrence of personality disorder. Conflictive parenting styles were also found to be associated with personality disorder. Generally stronger associations were found for students with parental personality disorder as compared to students without parental personality disorder. Findings from this study support the role of parenting in the occurrence of PD, especially for children with family history of personality disorder. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

The relation between attachment, personality, internalizing, and externalizing dimensions in adolescents with borderline personality disorder.

PubMed

Ramos, Vera; Canta, Guilherme; de Castro, Filipa; Leal, Isabel

2016-01-01

The relation between attachment and personality features is an important field to explore in adolescent borderline personality disorder (BPD), and previous research has shown that personality features may be conceptualized within latent internalizing and externalizing dimensions. This cross-sectional study used a structural equation model to examine the association between the BPD participants' perception of attachment and personality features, mediated by the underlying internalizing/externalizing personality dimensions. Data were analyzed for 60 adolescents, ages 15 to 18 years, diagnosed with BPD who completed attachment and personality self-report measures. The authors' results showed a good fit of the model, suggesting a significant association between attachment and the internalizing/externalizing dimensions, which simultaneously congregate and influence personality traits. The perception of attachment anxiety was positively related to the internalizing dimension and at the same time negatively related to the externalizing dimension. However, the perception of attachment avoidance was not related to internalizing or externalizing personality dimensions.

GENDER ROLE AND PERSONALITY DISORDERS

PubMed Central

Klonsky, E. David; Jane, J. Serrita; Turkheimer, Eric; Oltmanns, Thomas F.

2015-01-01

Many researchers have hypothesized relationships between personality disorders and gender role (i.e., masculinity and femininity). However, research has not addressed if people who are masculine or feminine more often meet the criteria for personality disorders. The present study examined whether college students (N = 665, 60% women) higher in masculinity or femininity more often exhibited features of the 10 DSM-IV personality disorders. Feminine men exhibited more features of all the personality disorders except antisocial. Dependent traits were associated with higher femininity and lower masculinity. Antisocial traits were associated with masculinity. Both men and women who typically behaved consistent with their gender had more narcissistic and histrionic features, whereas participants who typically behaved unlike their gender had more features of the Cluster A personality disorders. PMID:12489312

Stressful life events as predictors of functioning: findings from the Collaborative Longitudinal Personality Disorders Study

PubMed Central

Pagano, M. E.; Skodol, A. E.; Stout, R. L.; Shea, M. T.; Yen, S.; Grilo, C. M.; Sanislow, C. A.; Bender, D. S.; McGlashan, T. H.; Zanarini, M. C.; Gunderson, J. G.

2008-01-01

Objective Although much attention has been given to the effects of adverse childhood experiences on the development of personality disorders (PDs), we know far less about how recent life events influence the ongoing course of functioning. We examined the extent to which PD subjects differ in rates of life events and the extent to which life events impact psychosocial functioning. Method A total of 633 subjects were drawn from the Collaborative Longitudinal Personality Disorders Study (CLPS), a multi-site study of four personality disorders – schizotypal (STPD), borderline (BPD), avoidant (AVPD), obsessive-compulsive (OCPD) – and a comparison group of major depressive disorders (MDD) without PD. Results Borderline personality disorder subjects reported significantly more total negative life events than other PDs or subjects with MDD. Negative events, especially interpersonal events, predicted decreased psychosocial functioning over time. Conclusion Our findings indicate higher rates of negative events in subjects with more severe PDs and suggest that negative life events adversely impact multiple areas of psychosocial functioning. PMID:15521826

Assessing competition avoidance as a basic personality dimension.

PubMed

Ryckman, Richard M; Thornton, Bill; Gold, Joel A

2009-03-01

The lack of an adequate psychometric instrument has impeded personality theory testing in the area of competition avoidance. The authors conducted 6 studies in an attempt to remedy this deficiency by constructing an individual-difference measure of competition avoidance. In line with K. Horney's (1937) interpersonal theory of neurosis, participants who were higher in competition avoidance showed higher levels of neuroticism, greater fears of both success and failure, a lower desire to prove themselves in competitive situations, higher levels of self-handicapping, and more maladaptiveness than those participants who were lower in competition avoidance. Also, they were more modest and willing to conform to group standards than were those lower in competition avoidance. The authors discuss the measure's potential usefulness as a diagnostic and assessment tool in academic, athletic, and clinical settings.

Avoiding cumulative trauma disorders in shops and offices.

PubMed

Kroemer, K H

1992-09-01

Cumulative trauma disorders have been medically described for about 100 yr and have been related to physical activities for nearly 300 yr. Yet, avoiding these disorders in the shop and office is becoming of urgent concern only now, particularly because of the Occupational Safety and Health Administration's (OSHA's) investigation and enforcement program. Such disorders occur most often in soft tissues of the body, particularly at tendons and their sheaths. They may irritate or damage nerves and impede blood flow. They are frequent in the hand/wrist/forearm area; for example, in the carpal tunnel and in the shoulder and neck. Although controversy exists, occupational and leisure activities are generally believed to cause or aggravate cumulative trauma disorders. The major activity-related factors are rapid repetitive movements, forceful movements, static muscle loading, inappropriate body postures, vibrations, and cold. Yet, the quantitative thresholds above which cumulative trauma disorders are expected to occur are largely unknown and need to be researched. Furthermore, certain health conditions may make individuals predisposed to cumulative disorders. For most cumulative trauma disorders, physical activities and job procedures can be identified that are related to the occurrence of cumulative trauma disorders. This allows the establishment of generic and specific recommendations for the avoidance of conditions that may lead to cumulative trauma disorders in the workshop or the office.

Clinical status of comorbid bipolar disorder and borderline personality disorder.

PubMed

Parker, Gordon; Bayes, Adam; McClure, Georgia; Del Moral, Yolanda Romàn Ruiz; Stevenson, Janine

2016-09-01

The status and differentiation of comorbid borderline personality disorder and bipolar disorder is worthy of clarification. To determine whether comorbid borderline personality disorder and bipolar disorder are interdependent or independent conditions. We interviewed patients diagnosed with either a borderline personality disorder and/or a bipolar condition. Analyses of participants grouped by DSM diagnoses established that those with comorbid conditions scored similarly to those with a borderline personality disorder alone on all key variables (i.e. gender, severity of borderline personality scores, developmental stressors, illness correlates, self-injurious behaviour rates) and differed from those with a bipolar disorder alone on nearly all non-bipolar item variables. Similar findings were returned for groups defined by clinical diagnoses. Comorbid bipolar disorder and borderline personality disorder is consistent with the formal definition of comorbidity in that, while coterminous, individuals meeting such criteria have features of two independent conditions. © The Royal College of Psychiatrists 2016.

Mood disorder history and personality assessment in premenstrual dysphoric disorder.

PubMed

Critchlow, D G; Bond, A J; Wingrove, J

2001-09-01

Menstrually related dysphoria is known to be associated with other affective disorders, notably major depressive disorder and puerperal depression. The relationship between premenstrual dysphoric disorder (PMDD) and maladaptive personality disorders and traits, however, is less established, at least in part because of the methodological and nosologic difficulties in the diagnosis of both PMDD and personality disorders. This study seeks to address this problem to elucidate the relationship between PMDD, other affective disturbances commonly experienced by women, and maladaptive personality. Axis I and II disorders were examined using standardized instruments and stringent diagnostic criteria (DSM-IV and the International Personality Disorders Examination) in 34 women with DSM-IV PMDD and 22 healthy women without severe premenstrual mood changes. Seventy-seven percent of the PMDD group had suffered from a past Axis I disorder in comparison with 17% of the control group. Two thirds of the parous women with PMDD had suffered from major depressive disorder in the puerperium. Personality disorder diagnoses were not highly represented in either group of women. The women with PMDD had significantly more obsessional personality traits (p < .001 ) but not absolute personality disorder diagnoses. Obsessional symptoms are known to cluster with the affective disorders and may reflect underlying temperamental and biological vulnerability. This study provides further evidence of the link between serotonergic dysregulation, personality vulnerability, and mood changes related to the female reproductive cycle.

Avoidance of Affect Mediates the Effect of Invalidating Childhood Environments on Borderline Personality Symptomatology in a Non-Clinical Sample

ERIC Educational Resources Information Center

Sturrock, Bonnie A.; Francis, Andrew; Carr, Steven

2009-01-01

The aim of this study was to test the Linehan (1993) proposal regarding associations between invalidating childhood environments, distress tolerance (e.g., avoidance of affect), and borderline personality disorder (BPD) symptoms. The sample consisted of 141 non-clinical participants (51 men, 89 women, one gender unknown), ranging in age from 18 to…

Psychobiology and treatment of borderline personality disorder.

PubMed

Cloninger, C Robert

2002-04-01

Borderline personality disorder can be characterized in terms of a profile of abnormal deviations on multiple personality dimensions using the temperament and character inventory (TCI). Borderline patients show poor character development, including low TCI self-directedness (irresponsible, blaming) and low TCI cooperativeness (hostile, intolerant). Their temperament is explosive or unstable due to a combination of high TCI harm avoidance (anxious, shy), high TCI novelty seeking (impulsive, quick-tempered), and low reward dependence (cold, aloof). Consequently they are usually dysthymic with an admixture of anxiety and anger, and regulate their social problems and intense emotions in immature ways. Genetic and psychobiological studies have led to identification of biological correlates of each of the TCI dimensions of personality, including individual differences in regional brain activity, psychophysiological variables, neuroendocrine abnormalities and specific gene polymorphisms. Each dimension of personality involves complex non-linear interaction of multiple genetic and environmental factors and, in turn, each personality dimension interacts with the others in influencing the way an individual directs and adapts to his or her life experiences. Systematic clinical trials have shown that these personality variables predict the response to pharmacological and psychotherapeutic treatments. For example, high harm avoidance and low self-directedness predict slower response and more rapid relapse with both antidepressants and cognitive-behavioral therapy. Treatment with drugs and/or psychotherapy can be individually matched to the patient's profile of temperament and character traits, rather than treating a heterogeneous group of patients as if they had a discrete, homogeneous illness. Fundamental change in cognitive schemas depends on attention to all aspects of character, especially self-transcendence, which has previously been neglected in cognitive

Childhood antecedents of adolescent personality disorders.

PubMed

Bernstein, D P; Cohen, P; Skodol, A; Bezirganian, S; Brook, J S

1996-07-01

The purpose of this study was to investigate the childhood antecedents of personality disorders that are diagnosed in adolescence. A randomly selected community sample of 641 youths was assessed initially in childhood and followed longitudinally over 10 years. Childhood behavior ratings were based on maternal report; diagnoses of adolescent personality disorders were based on data obtained from both maternal and youth informants. Four composite measures of childhood behavior problems were used: conduct problems, depressive symptoms, anxiety/fear, and immaturity. Adolescent personality disorders were considered present only if the disorders persisted over a 2-year period. For all analyses, personality disorders were grouped into the three clusters (A, B, and C) of DSM-III-R. Logistic regression analyses indicated that all four of the putative childhood antecedents were associated with greater odds of an adolescent personality disorder 10 years later. Childhood conduct problems remained an independent predictor of personality disorders in all three clusters, even when other childhood problems were included in the same regression model. Additionally, depressive symptoms emerged as an independent predictor of cluster A personality disorders in boys, while immaturity was an independent predictor of cluster B personality disorders in girls. No moderating effects of age at time of childhood assessment were found. These results support the view that personality disorders can be traced to childhood emotional and behavioral disturbances and suggest that these problems have both general and specific relationships to adolescent personality functioning.

The continuum between Bipolar Disorder and Borderline Personality Disorder.

PubMed

Elisei, Sandro; Anastasi, Serena; Verdolini, Norma

2012-09-01

Several studies have been carried out regarding the possible overlap between Bipolar Disorder and borderline personality disorder. Up to now, it is not possible to provide a definitive picture. In fact, there is currently significant debate about the relationship between Borderline Personality Disorder and Bipolar Disorder. MEDLINE searches were performed to identify the latest studies of these disorders, considering psychodynamic aspects. Bipolar disorder and borderline personality disorder share common clinical features, namely affective instability and impulsivity which however differ in quality. Consequently, to better understand these aspects, it is necessary to trace the stages of childhood psychological development. It has been claimed that Bipolar Disorder Type II can be divided into two subtypes: one stable and functional between episodes and one unstable between episodes which is related to Borderline Personality Disorder. However, better diagnostic theories, psychiatrist's empathy and patience remain the essential tool to understand and to face human suffering.

The centrality of affective instability and identity in Borderline Personality Disorder: Evidence from network analysis.

PubMed

Richetin, Juliette; Preti, Emanuele; Costantini, Giulio; De Panfilis, Chiara

2017-01-01

We argue that the series of traits characterizing Borderline Personality Disorder samples do not weigh equally. In this regard, we believe that network approaches employed recently in Personality and Psychopathology research to provide information about the differential relationships among symptoms would be useful to test our claim. To our knowledge, this approach has never been applied to personality disorders. We applied network analysis to the nine Borderline Personality Disorder traits to explore their relationships in two samples drawn from university students and clinical populations (N = 1317 and N = 96, respectively). We used the Fused Graphical Lasso, a technique that allows estimating networks from different populations separately while considering their similarities and differences. Moreover, we examined centrality indices to determine the relative importance of each symptom in each network. The general structure of the two networks was very similar in the two samples, although some differences were detected. Results indicate the centrality of mainly affective instability, identity, and effort to avoid abandonment aspects in Borderline Personality Disorder. Results are consistent with the new DSM Alternative Model for Personality Disorders. We discuss them in terms of implications for therapy.

The centrality of affective instability and identity in Borderline Personality Disorder: Evidence from network analysis

PubMed Central

Costantini, Giulio; De Panfilis, Chiara

2017-01-01

We argue that the series of traits characterizing Borderline Personality Disorder samples do not weigh equally. In this regard, we believe that network approaches employed recently in Personality and Psychopathology research to provide information about the differential relationships among symptoms would be useful to test our claim. To our knowledge, this approach has never been applied to personality disorders. We applied network analysis to the nine Borderline Personality Disorder traits to explore their relationships in two samples drawn from university students and clinical populations (N = 1317 and N = 96, respectively). We used the Fused Graphical Lasso, a technique that allows estimating networks from different populations separately while considering their similarities and differences. Moreover, we examined centrality indices to determine the relative importance of each symptom in each network. The general structure of the two networks was very similar in the two samples, although some differences were detected. Results indicate the centrality of mainly affective instability, identity, and effort to avoid abandonment aspects in Borderline Personality Disorder. Results are consistent with the new DSM Alternative Model for Personality Disorders. We discuss them in terms of implications for therapy. PMID:29040324

Prototypicality ratings of DSM-III criteria for personality disorders.

PubMed

Livesley, W J; Reiffer, L I; Sheldon, A E; West, M

1987-07-01

Although DSM-III personality disorder criteria have demonstrated acceptable reliability, the question of validity has not been adequately addressed. A first step in establishing the validity of diagnoses is to establish the validity of the criteria used to assess each diagnosis. The content validity of diagnostic criteria was investigated in relation to the larger set of potential criteria culled from the psychiatric literature. For each DSM-III axis II diagnosis, a panel of clinicians rated how prototypical each potential criterion was of the diagnosis in question. The results reveal problems with the organization and content of the criteria for most diagnoses. Many DSM-III criteria are composed of several statements linked by conjunctions or disjunctions. These component statements often received markedly different ratings, suggesting that criteria should be single statements. For most diagnoses, traits not included in DSM-III received higher ratings than did some DSM-III criteria. Suggestions are made to improve the distinctiveness and content validity of paranoid, schizoid, antisocial, borderline, avoidant, dependent, and compulsive personality disorders. The results for schizotypal personality disorder suggest that many clinicians are uncertain about this diagnosis. These findings provide a systematic way to modify definitions that contrasts with the more arbitrary ways in which diagnoses have previously been defined and redefined.

Associations Between Personality Disorder Characteristics, Psychological Symptoms, and Sexual Functioning in Young Women.

PubMed

Grauvogl, Andrea; Pelzer, Britt; Radder, Veerle; van Lankveld, Jacques

2018-02-01

Recently, the etiology of sexual dysfunctions in women has been approached from different angles. In clinical practice and in previous studies, it has been observed that women with sexual problems experience anxiety problems and express more rigid and perfectionistic personality traits than women without these problems. To investigate whether personality disorder characteristics according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) and psychological symptoms are associated with sexual problems in women. 188 women 18 to 25 years old participated in this cross-sectional study. Questionnaires measuring sexual functioning (Female Sexual Function Index), personality disorder characteristics (Assessment of DSM-IV-TR Personality Disorders Questionnaire), and psychological symptoms (Brief Symptom Inventory and Center for Epidemiological Studies Depression Scale) were used. The main outcome measure used was sexual functioning assessed by self-report. Results, using analysis of variance, indicated that women with sexual problems report significantly more cluster A (specifically schizoid) and C (specifically avoidant and obsessive-compulsive) personality disorder characteristics than women without sexual problems. Furthermore, using multiple regression analyses, higher cluster A (specifically schizoid) and lower cluster B (specifically borderline and antisocial) personality disorder characteristics indicated lower levels of sexual functioning. Psychological symptoms partly mediated the effect of cluster A personality disorder characteristics on sexual functioning. The results of this study indicate that clinical practice should extend its scope by focusing more on improving adaptive personality characteristics, such as extraversion and individualism seen in cluster B personality characteristics, and decreasing the perfectionistic, introvert, and self-doubting characteristics seen in cluster C personality characteristics

Is low affect consciousness related to the severity of psychopathology? A cross-sectional study of patients with avoidant and borderline personality disorder.

PubMed

Normann-Eide, Eivind; Johansen, Merete Selsbakk; Normann-Eide, Tone; Egeland, Jens; Wilberg, Theresa

2013-02-01

This study examined the relationships between affect consciousness (AC) and symptom distress, interpersonal problems, low self-esteem, and the number of PD traits in patients with avoidant personality disorder (APD) and borderline personality disorder (BPD). Within the setting of a treatment trial, 52 patients with APD or BPD were examined with structured interviews and self-report questionnaires before treatment and at 3-year follow-up. The evaluations included the Affect Consciousness Interview, the SCID-II interview, the Symptom Checklist 90-R, the Circumplex of Interpersonal Problems, and the Index of Self-esteem. A low global level of AC was expected to be associated with the severity of psychopathology; a low AC for interest, joy, and tenderness was expected to be associated with social detachment; and a low AC for anger, contempt, and disgust was expected to be associated with nonassertiveness. A low AC was associated with interpersonal problems and low self-esteem, but not symptom distress or the number of fulfilled SCID-II criteria. Despite a significant reduction in the psychopathology based on most clinical variables, the associations measured at baseline were maintained after 3years. Examination of specific affect categories showed a pattern of convergent and discriminative relationships with different types of interpersonal problems. A low AC for pleasant affects was specifically related to communion problems, like cold, detached behavior, both at baseline and follow-up. In contrast, a low AC for self-boundary affects was specifically related to agency problems, like non-assertiveness, at follow-up. Our results showed that a low AC was associated with central domains of psychopathology in patients with PDs. This suggested that AC would be an important focus for treatment and further research in PDs. Future studies are needed to examine how AC is related to various forms of personality pathology. Copyright © 2013 Elsevier Inc. All rights reserved.

Relationship of drug-addicted patients' personality disorders to social problem-solving changes during the rehabilitation process.

PubMed

Kolesnikova, Jelena; Miezitis, Solveiga; Osis, Guntars

2013-08-01

Drug-addicted patients exhibit various personality disorders that interfere with their adaptation to society, as well as their ability to participate in the rehabilitation process. The Latvian Rehabilitation Programme for drug addicts includes social problem-solving training to help patients reintegrate into society. However, the role of personality disorders has not been investigated in relation to this process. The aim of the study is to assess whether personality disorders predict changes in dimensions of social problem-solving after 6 months of rehabilitation for drug-addicted patients. The sample of this study consists of 31 drug-addicted patients from the Latvian rehabilitation centres aged 21-35 (females 21%, males 79%). Two inventories are used: the Social Problem-Solving Inventory--Revised (SPSI-R) and Millon(TM) Clinical Multiaxial Inventory--III (MCMI-III) adapted into Russian. Results of the study indicated that some MCMI-III personality disorders (Schizoid and Histrionic) negatively predicted SPSI-R Positive problem orientation, and narcissistic disorder positively predicted SPSI-R Avoidance style after 6 months in the Latvian Rehabilitation Programme. The other personality disorders did not predict social problem-solving dimensions. The results of the study suggest that some personality disorders are related to changes in social problem-solving dimensions for drug-addicted patients. Hence, it is important to consider the implications of particular personality disorders to facilitate the implementation of social problem-solving rehabilitation programmes.

The MCP-1, CCL-5 and SDF-1 chemokines as pro-inflammatory markers in generalized anxiety disorder and personality disorders.

PubMed

Ogłodek, Ewa A; Szota, Anna M; Just, Marek J; Moś, Danuta M; Araszkiewicz, Aleksander

2015-02-01

The co-occurrence of generalized anxiety disorder and personality disorders suggests the existence of association between the neurobiological predispositions leading to the development of these disorders and activation of cytokine system. Pro-inflammatory chemokines such as CCL-5/RANTES (regulated upon activation normal T cell expressed and secreted) and CXCL12/SDF-1 (stromal derived factor) play an important role in immune response. A total of 160 participants were enrolled in the study, 120 of whom comprised the study group (people with the dual diagnosis of personality disorder and generalized anxiety disorder). The mean age was 41.4 ± 3.5 years (range: 20-44 years). The control group consisted of 40 healthy individuals in the mean age of 40.8 ± 3.1 years (range: 20-43 years). A blood sample was collected from each participant and the plasma levels of the CCL-2/MCP-1 (monocyte chemoattractant protein-1), RANTES and SDF-1 chemokines were determined by ELISA. Increased levels of MCP-1 and SDF-1 were found both in women and in men versus the control group for all types of personality disorders. The levels of CCL-5 in men were significantly increased versus the control group and significantly higher in women than in men. Neither women nor men with avoidant or obsessive-compulsive personality disorder showed any significant differences in MCP-1 or SFD-1 levels. In subjects with borderline personality disorder, the levels of the study chemokines were higher in women than in men. Our study has shown the need for determination of proinflammatory interleukins which are considered as biomarkers of personality disorders and generalized anxiety disorders. Copyright © 2014 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Pattern destabilization and emotional processing in cognitive therapy for personality disorders

PubMed Central

Hayes, Adele M.; Yasinski, Carly

2015-01-01

Clinical trials of treatments for personality disorders can provide a medium for studying the process of therapeutic change with particularly entrenched and self-perpetuating systems and might reveal important principles of system transition. We examined the extent to which maladaptive personality patterns were destabilized in a trial of cognitive therapy personality disorders (CT-PD) and how destabilization was associated with emotional processing and treatment outcomes. Dynamic systems theory was used as a theoretical framework for studying change. Method: Participants were 27 patients diagnosed with Avoidant or Obsessive Compulsive Personality Disorder (AVPD or OCPD), who completed an open trial of CT-PD. Raters coded treatment sessions using a coding system that operationalizes emotional processing, as well as cognitive, affective, behavioral, and somatic components of pathological (negative) and more adaptive (positive) patterns of functioning. Pattern destabilization (dispersion) scores during the early phase of treatment (phase 1: session 1–10) and the schema-focused phase (phase 2: session 11–34) were calculated using a program called GridWare. Results: More pattern destabilization and emotional processing in the schema-focused phase of CT-PD predicted more improvement in personality disorder symptoms and positive pattern strength at the end of treatment, whereas these variables in phase 1 did not predict outcome. Conclusion: In addition to illustrating a quantitative method for studying destabilization and change of patterns of psychopathology, we present findings that are consistent with recent updates of emotional processing theory and with principles from dynamic systems theory. PMID:25755647

Pattern destabilization and emotional processing in cognitive therapy for personality disorders.

PubMed

Hayes, Adele M; Yasinski, Carly

2015-01-01

Clinical trials of treatments for personality disorders can provide a medium for studying the process of therapeutic change with particularly entrenched and self-perpetuating systems and might reveal important principles of system transition. We examined the extent to which maladaptive personality patterns were destabilized in a trial of cognitive therapy personality disorders (CT-PD) and how destabilization was associated with emotional processing and treatment outcomes. Dynamic systems theory was used as a theoretical framework for studying change. Participants were 27 patients diagnosed with Avoidant or Obsessive Compulsive Personality Disorder (AVPD or OCPD), who completed an open trial of CT-PD. Raters coded treatment sessions using a coding system that operationalizes emotional processing, as well as cognitive, affective, behavioral, and somatic components of pathological (negative) and more adaptive (positive) patterns of functioning. Pattern destabilization (dispersion) scores during the early phase of treatment (phase 1: session 1-10) and the schema-focused phase (phase 2: session 11-34) were calculated using a program called GridWare. More pattern destabilization and emotional processing in the schema-focused phase of CT-PD predicted more improvement in personality disorder symptoms and positive pattern strength at the end of treatment, whereas these variables in phase 1 did not predict outcome. In addition to illustrating a quantitative method for studying destabilization and change of patterns of psychopathology, we present findings that are consistent with recent updates of emotional processing theory and with principles from dynamic systems theory.

Identifying Latent Trajectories of Personality Disorder Symptom Change: Growth Mixture Modeling in the Longitudinal Study of Personality Disorders

PubMed Central

Hallquist, Michael N.; Lenzenweger, Mark F.

2013-01-01

Although previous reports have documented mean-level declines in personality disorder (PD) symptoms over time, little is known about whether personality pathology sometimes emerges among nonsymptomatic adults, or whether rates of change differ qualitatively among symptomatic persons. Our study sought to characterize heterogeneity in the longitudinal course of PD symptoms with the goal of testing for and describing latent trajectories. Participants were 250 young adults selected into two groups using a PD screening measure: those who met diagnostic criteria for a DSM-III-R PD (PPD, n = 129), and those with few PD symptoms (NoPD, n = 121). PD symptoms were assessed three times over a four-year study using semistructured interviews. Total PD symptom counts and symptoms of each DSM-III-R PD were analyzed using growth mixture modeling. In the NoPD group, latent trajectories were characterized by stable, minor symptoms; the rapid or gradual remission of subclinical symptoms; or the emergence of symptoms of Avoidant, Obsessive-Compulsive, or Paranoid PD. In the PPD group, three latent trajectories were evident: rapid symptom remission, slow symptom decline, or a relative absence of symptoms. Rapid remission of PD symptoms was associated with fewer comorbid disorders, lower negative emotionality, and greater positive emotionality and constraint, whereas emergent personality dysfunction was associated with comorbid PD symptoms and lower positive emotionality. In most cases, symptom change for one PD was associated with concomitant changes in other PDs, depressive symptoms, and anxiety. These results indicate that the longitudinal course of PD symptoms is heterogeneous, with distinct trajectories evident for both symptomatic and nonsymptomatic individuals. The prognosis of PD symptoms may be informed by an assessment of personality and comorbid psychopathology. PMID:23231459

Predictors of comorbid personality disorders in patients with panic disorder with agoraphobia.

PubMed

Latas, M; Starcevic, V; Trajkovic, G; Bogojevic, G

2000-01-01

The aim of this study was to ascertain predictors of comorbid personality disorders in patients with panic disorder with agoraphobia (PDAG). Sixty consecutive outpatients with PDAG were administered the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) for the purpose of diagnosing personality disorders. Logistic regressions were used to identify predictors of any comorbid personality disorder, any DSM-IV cluster A, cluster B, and cluster C personality disorder. Independent variables in these regressions were gender, age, duration of panic disorder (PD), severity of PDAG, and scores on self-report instruments that assess the patient's perception of their parents, childhood separation anxiety, and traumatic experiences. High levels of parental protection on the Parental Bonding Instrument (PBI), indicating a perception of the parents as overprotective and controlling, emerged as the only statistically significant predictor of any comorbid personality disorder. This finding was attributed to the association between parental overprotection and cluster B personality disorders, particularly borderline personality disorder. The duration of PD was a significant predictor of any cluster B and any cluster C personality disorder, suggesting that some of the cluster B and cluster C personality disorders may be a consequence of the long-lasting PDAG. Any cluster B personality disorder was also associated with younger age. In conclusion, despite a generally nonspecific nature of the relationship between parental overprotection in childhood and adult psychopathology, the findings of this study suggest some specificity for the association between parental overprotection in childhood and personality disturbance in PDAG patients, particularly cluster B personality disorders.

Schizoid personality disorder

MedlinePlus

... disorder is unknown. It may be related to schizophrenia and shares many of the same risk factors. Schizoid personality disorder is not as disabling as schizophrenia. It doesn't cause the disconnection from reality ( ...

Childhood abuse, alexithymia and personality disorder.

PubMed

Berenbaum, H

1996-12-01

I examined the relationships among childhood abuse, alexithymia, and personality disorder. Participants were 60 adults who were receiving outpatient psychotherapy. Both the participants and their therapists used the Toronto Alexithymia Scale to provide independently information concerning the client's level of alexithymia. The therapists provided information concerning DSM-III-R personality disorder diagnoses, and participants completed portions of the Personality Diagnostic Questionnaire-Revised. Information concerning childhood abuse history was obtained from the therapists. As expected, childhood abuse, alexithymia, and personality disorder were all associated with each other. The abilities to identify and communicate emotions were differentially associated with childhood abuse and personality disorder.

Establishing the severity of personality disorder.

PubMed

Tyrer, P; Johnson, T

1996-12-01

The authors developed a simplified method of rating the severity of personality disorder. The new rating method is based on four levels of severity: no personality disorder, personality difficulty, simple personality disorder, and diffuse personality disorder. The new method was applied to different diagnostic systems and was then compared with an old rating system based on six severity levels. Data were derived from a longitudinal study in which 163 patients with anxiety and depressive disorders had initial assessments of personality status and were followed up over 2 years. Ratings of psychiatric symptoms were made by using the Comprehensive Psychopathological Rating Scale over this period. The results were analyzed with special attention to linear and quadratic trends. The new system was clinically useful in separating patients' initial assessments and outcomes. Patients with no personality disorder had the lowest initial symptom scores and the best outcomes, and those with diffuse personality disorder had the highest initial levels of symptoms and improved least over the 2 years. When the patients were separated by the old classification system, 72% of the variation between groups was accounted for by linear and quadratic trends; the comparable percentage was 97% when the patients were categorized by the new system. The new system of rating severity of personality disturbance is an improvement on existing methods and allows ratings to be made easily from DSM-IV and ICD-10.

[The efficacy and tolerability of pericyazine in the treatment of patients with schizotypal disorder, organic personality disorders and pathocharacterological changes within personality disorders].

PubMed

Danilov, D S

To assess the efficacy and tolerability of pericyazine in the treatment of patients with mental disorders manifesting with psychopathic-like symptoms and correction of pathocharacterological disorders in patients with personality disorders during the short-term admission to the hospital or the long-term outpatient treatment. Sixty-three patients with schizotypal personality disorder and organic personality disorder with psychopathic-like symptoms and pathocharacterological changes within the diagnosis of dissocial personality disorder and borderline personality disorder were examined. Patients received pericyazine during the short-term admission to the hospital (6 weeks) or the long-term outpatient treatment (6 month). Efficacy, tolerability and compliance were assessed in the study. Treatment with pricyazine was effective in all patients. The improvement was seen in patients with organic personality disorders and patients with personality disorders (psychopathy). The maximal effect was observed in inpatients and this effect remained during outpatient treatment. The improvement of mental state of patients with schizotypal personality disorder achieved during inpatient treatment with pericyazine continued during the long-term outpatient treatment. Side-effects were restricted to extrapyramidal symptoms, the frequency of metabolic syndrome was low. During outpatient treatment, the compliance was higher if the patient was managed by the same psychiatrist during inpatient- and outpatient treatment.

Theodore Millon's Contributions to Conceptualizing Personality Disorders.

PubMed

Pincus, Aaron L; Krueger, Robert F

2015-01-01

We review Theodore Millon's contributions to conceptualizing personality disorders in contemporary clinical science and practice. Millon worked tirelessly across professional domains and theoretical orientations, developing a rich integrative theory of personality and its pathology, directly and indirectly impacting the evolving iterations of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III through DSM-5), and advocating for the personality disorders through his contributions to cofounding the International Society for the Study of Personality Disorders and the Journal of Personality Disorders. We conclude with a closer look at Millon's final major contributions to conceptualizing personality disorders as well as the strengths and limitations of his approach.

Reward Dependence and Harm Avoidance among Patients with Binge-Purge Type Eating Disorders.

PubMed

Gat-Lazer, Sigal; Geva, Ronny; Gur, Eitan; Stein, Daniel

2017-05-01

The Cloninger's Psychobiological Model of Temperament and Character includes temperamental dimensions such as reward dependence (RD) and harm avoidance (HA). Studies of RD differentiate between sensitivity to reward (SR) versus to punishment (SP). We investigated the interrelationship between HA and RD in acutely ill patients with binge/purge (B/P) type eating disorders (EDs) and following symptomatic stabilization. Fifty patients with B/P EDs were assessed at admission to inpatient treatment, 36 of whom were reassessed at discharge. Thirty-six controls were similarly assessed. Participants completed Tridimensional Personality Questionnaire (TPQ), Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), and took the Gambling Task. Patients with B/P EDs had higher TPQ-RD and lower TPQ-HA accompanied by lower SPSRQ-SR and SPSRQ-SP. SPSRQ-SP correlated positively and negatively with TPQ-HA and TPQ-RD, respectively. Combination of lower TPQ-HA, lower SPSRQ-SP, and greater risk-taking inclination may maintain disordered eating in patients with B/P EDs. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Personality and Psychiatric Disorders in Women Affected by Polycystic Ovary Syndrome

PubMed Central

Scaruffi, Elisabetta; Gambineri, Alessandra; Cattaneo, Stefania; Turra, Jenni; Vettor, Roberto; Mioni, Roberto

2014-01-01

Background: Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder among fertile women. Studies show reduced quality of life, anxiety, depression, body dissatisfaction, eating disorder, and sexual dysfunction, but the etiology of these disturbs remains still debated. The aim of our study is to verify whether this hyperandrogenic syndrome characterizes a strong psycho(patho)logical personality. Method: Sixty PCOS subjects (mean age 25.8 ± 4.7 years) were evaluated by anthropometric, metabolic, hormonal, clinical, and psychological parameters. After the certainty of the diagnosis of PCOS, the Rorschach test, according to Exner’s comprehensive system (CS) and the Millon Clinical Multiaxial Inventory-III (MCMI-III) were administered to each patient. The control group, on which the comparison was carried out, was composed by 40 healthy and aged compared women who were exclusively administered the Rorschach test according to CS. Results: MCMI-III evidenced axis II DSM-IV personality disorders [4.1% schizoid, depressive, sadistic, negativistic (passive–aggressive), and masochistic, 6.1% avoiding, 12.2% dependent, 20.4% histrionic, 16.3% narcissistic, 2.0% obsessive–compulsive], and axis I DSM-IV psychiatric disorders: 10.2% anxiety, 2.0% somatoform disorder and bipolar disorder, 16.3% major depressive disorder. Finally, we found 44.9% delusional disorder and 4.1% thought disorder. Rorschach test’s results show 53.1% reduced coping abilities and social skills, 55.1% depression, 30.6% perceptual distortion and cognitive slippage, 24.5% constantly alert and worry, 8.1% at risk for suicide, and finally about 50% of our patients had chronic stress. Conclusion: PCOS women have relevant personality and psychiatric disorders, when compared with normal subjects. PMID:25429283

Severe avoidant/restrictive food intake disorder and coexisting stimulant treated attention deficit hyperactivity disorder.

PubMed

Pennell, Alexandra; Couturier, Jennifer; Grant, Christina; Johnson, Natasha

2016-11-01

There is a growing body of literature describing the development, clinical course, and treatment of avoidant/restrictive food intake disorder (ARFID), a diagnostic category introduced in the DSM-5. However, information surrounding complex cases of ARFID involving coexisting medical and/or psychiatric disorders remains scarce. Here we report on two cases of young patients diagnosed concurrently with ARFID and attention deficit hyperactivity disorder (ADHD) who both experienced significant growth restriction following initiation of stimulant medication. The appetite suppressant effect of stimulants exacerbated longstanding avoidant and restrictive eating behaviors resulting in growth restriction and admission to an inpatient eating disorders unit. The implications of ARFID exacerbated by stimulant-treated ADHD are explored, as well as the treatment delivered. These cases suggest that further research is needed to explore management options to counteract the appetite suppression effects of stimulants, while simultaneously addressing attention deficit symptoms and oppositional behavior. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1036-1039). © 2016 Wiley Periodicals, Inc.

The General Assessment of Personality Disorder (GAPD) as an instrument for assessing the core features of personality disorders.

PubMed

Berghuis, Han; Kamphuis, Jan H; Verheul, Roel; Larstone, Roseann; Livesley, John

2013-01-01

This study presents a psychometric evaluation of the General Assessment of Personality Disorder (GAPD), a self-report questionnaire for assessing the core components of personality dysfunction on the basis of Livesley's (2003) adaptive failure model. Analysis of samples from a general (n = 196) and a clinical population (n = 280) from Canada and the Netherlands, respectively, found a very similar two-component structure consistent with the two core components of personality dysfunction proposed by the model, namely, self-pathology and interpersonal dysfunction. Moreover, the GAPD discriminated between patients diagnosed with and without Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) personality disorder(s) and demonstrated discriminative power in detecting the severity of personality pathology. Correlations with a DSM-IV symptom measure and a pathological traits model suggest partial conceptual overlap. Although further testing is indicated, the present findings suggest the GAPD is suitable for assessing the core components of personality dysfunction. It may contribute to a two-step integrated assessment of personality pathology that assesses both personality dysfunction and personality traits. The core features of personality disorder can be defined as disorders in the self and in the capacity for interpersonal functioning. A clinically useful operationalization of disordered functioning of personality is needed to determine the maladaptivity of personality traits. An integrated assessment of personality (dys)functioning and personality traits provides a more comprehensive clinical picture of the patient, which may aid treatment planning. Copyright © 2012 John Wiley & Sons, Ltd.

Pathological narcissism and narcissistic personality disorder in Axis I disorders.

PubMed

Ronningstam, E

1996-01-01

This paper presents available information on the comorbidity of narcissistic personality disorder (NPD) and pathological narcissism with major mental illness. A review of empirical studies reporting on the prevalence of NPD in Axis I disorders, and of theoretical and clinical literature on narcissistic pathology in major mental illness, forms the basis for an analysis of this interface. The results show that prevalence rates of NPD in Axis I disorders rarely exceed those found in the general psychiatric or personality disorder populations (i.e., less than 22%). NPD was found at high rates in individuals with a substance use disorder (12-38%) or bipolar disorder (4-47%); it was present at very low rates or absent in persons with obsessive-compulsive disorder. Higher prevalence rates were reported in the studies that used the Millon Clinical Multiaxial Inventory I or II than in those that employed the Structured interview for DSM-III Personality Disorders or the Structured Interview for DSM-III-R Personality Disorders--Revised. There is no evidence implicating a significant relationship between NPD and any specific Axis I disorder. A comparison of theoretical and clinical studies with empirical ones reveals major differences in the views regarding the presence and significance of NPD in Axis I disorders. However, the results highlight trends of interacting comorbidity between NPD and substance use disorders, bipolar disorder, depression, and anorexia nervosa.

Seeking to understand lived experiences of personal recovery in personality disorder in community and forensic settings - a qualitative methods investigation.

PubMed

Shepherd, Andrew; Sanders, Caroline; Shaw, Jenny

2017-08-01

Understandings of personal recovery have emerged as an alternative framework to traditional ideas of clinical progression, or symptom remission, in clinical practice. Most research in this field has focussed on the experience of individuals suffering with psychotic disorders and little research has been conducted to explore the experience of individuals with a personality disorder diagnosis, despite the high prevalence of such difficulties. The nature of the personality disorder diagnosis, together with high prevalence rates in forensic settings, renders the understanding of recovery in these contexts particularly problematic. The current study seeks to map out pertinent themes relating to the recovery process in personality disorder as described by individuals accessing care in either community or forensic settings. Individual qualitative interviews were utilised to explore the lived experience of those receiving a personality disorder diagnosis and accessing mental health care in either community or forensic settings. A thematic analysis was conducted to identify shared concepts and understanding between participants. Fourty-one individual participant interviews were conducted across forensic and community settings. Recovery was presented by participants as a developing negotiated understanding of the self, together with looked for change and hope in the future. Four specific themes emerged in relation to this process: 1. Understanding early lived experience as informing sense of self 2. Developing emotional control 3. Diagnosis as linking understanding and hope for change 4. The role of mental health services. Through considering personal recovery in personality disorder as a negotiated understanding between the individual, their social networks and professionals this study illustrates the complexity of working through such a process. Clarity of understanding in this area is essential to avoid developing resistance in the recovery process. Understanding of

Child development and personality disorder.

PubMed

Cohen, Patricia

2008-09-01

The evidence is surprisingly strong that even early adolescent personality disorders or elevated personality disorder symptoms have a broad range of negative effects well into adulthood, for the most part comparable to or even larger than those of Axis I disorders. Current evidence suggests that the most severe long-term prognosis is associated with borderline and schizotypal PDs and elevated symptoms. And of course, childhood conduct disorder is in a peculiar status, disappearing in adulthood to be manifest as a very severe disorder-antisocial PD-in a minority of those with the adolescent disorder.

DSM-5 Personality Traits and DSM-IV Personality Disorders

PubMed Central

Hopwood, Christopher J.; Thomas, Katherine M.; Markon, Kristian E.; Wright, Aidan G.C.; Krueger, Robert F.

2014-01-01

Two issues pertinent to the DSM-5 proposal for personality pathology, the recovery of DSM-IV personality disorders (PDs) by proposed DSM-5 traits and the validity of the proposed DSM-5 hybrid model which incorporates both personality pathology symptoms and maladaptive traits, were evaluated in a large undergraduate sample (N = 808). Proposed DSM-5 traits as assessed with the Personality Inventory for DSM-5 explained a substantial proportion of variance in DSM-IV PDs as assessed with the Personality Diagnostic Questionnaire-4+, and trait indicators of the six proposed DSM-5 PDs were mostly specific to those disorders with some exceptions. Regression analyses support the DSM-5 hybrid model in that pathological traits and an indicator of general personality pathology severity provided incremental information about PDs. Findings are discussed in the context of broader issues around the proposed DSM-5 model of personality disorders. PMID:22250660

Long-term outcome of hypochondriacal personality disorder.

PubMed

Tyrer, P; Seivewright, N; Seivewright, H

1999-02-01

Hypochondriacal personality disorder diagnosed according to the Personality Assessment Schedule, a structured clinical interview, was related to outcome after 2 years and 5 years in a randomized, controlled trial of treatment of generalized anxiety, panic, and dysthymic disorders. Seventeen individuals (9%) from a population of 181 patients had hypochondriacal personality disorder and they experienced a significantly worse outcome than other patients, including those with other personality disorders, in terms of symptomatic change and health service utilization. This lack of improvement was associated with persistent somatization in hypochondriacal personality disorder. The results give further support to the belief that hypochondriacal personality disorder is a valid clinical diagnosis that has important clinical correlates, but further work is needed to establish the extent of its overlap with hypochondriasis as a mental state disorder.

Personality Disorders

MedlinePlus

... personality disorder are unstable in several areas, including interpersonal relationships, behavior, mood, and self-image. Abrupt and extreme mood changes, stormy interpersonal relationships, an unstable and fluctuating self-image, unpredictable ...

Personality disorder across the life course.

PubMed

Newton-Howes, Giles; Clark, Lee Anna; Chanen, Andrew

2015-02-21

The pervasive effect of personality disorder is often overlooked in clinical practice, both as an important moderator of mental state and physical disorders, and as a disorder that should be recognised and managed in its own right. Contemporary research has shown that maladaptive personality (when personality traits are extreme and associated with clinical distress or psychosocial impairment) is common, can be recognised early in life, evolves continuously across the lifespan, and is more plastic than previously believed. These new insights offer opportunities to intervene to support more adaptive development than before, and research shows that such intervention can be effective. Further research is needed to improve classification, assessment, and diagnosis of personality disorder across the lifespan; to understand the complex interplay between changes in personality traits and clinical presentation over time; and to promote more effective intervention at the earliest possible stage of the disorder than is done at present. Recognition of how personality disorder relates to age and developmental stage can improve care of all patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

Temperament and personality in eating disorders.

PubMed

Rotella, Francesco; Fioravanti, Giulia; Ricca, Valdo

2016-01-01

In the last decades, three main different personality domains have been investigated in the field of eating disorders: personality traits, temperament, and personality disorders. The use of a wide range of instruments and the presence of many different approaches in the definition of personality dimensions make it difficult to summarize the emerging results from different studies. The aim of this narrative review is to critically highlight and discuss all interesting developments in this field, as reflected in the recent literature. The study of personality and temperament in eating disorders seems to be in line with the recently suggested dimensional approach, which highlights the importance of symptoms aggregation, rather than the categorical diagnoses. Recent literature seems to confirm that specific personality and temperamental profiles can be drawn for patients with eating disorders, which can discriminate different eating disorders' diagnoses/symptoms. These observations have relevant clinical implications as treatment of eating disorders is largely based on psychotherapeutic interventions. However, large longitudinal studies are needed to better clarify the suggested relationships and to identify more defined therapeutic strategies.

Identifying latent trajectories of personality disorder symptom change: growth mixture modeling in the longitudinal study of personality disorders.

PubMed

Hallquist, Michael N; Lenzenweger, Mark F

2013-02-01

Although previous reports have documented mean-level declines in personality disorder (PD) symptoms over time, little is known about whether personality pathology sometimes emerges among nonsymptomatic adults, or whether rates of change differ qualitatively among symptomatic persons. Our study sought to characterize heterogeneity in the longitudinal course of PD symptoms with the goal of testing for and describing latent trajectories. Participants were 250 young adults selected into two groups using a PD screening measure: those who met diagnostic criteria for a DSM-III-R PD (PPD, n = 129), and those with few PD symptoms (NoPD, n = 121). PD symptoms were assessed three times over a 4-year study using semistructured interviews. Total PD symptom counts and symptoms of each DSM-III-R PD were analyzed using growth mixture modeling. In the NoPD group, latent trajectories were characterized by stable, minor symptoms; the rapid or gradual remission of subclinical symptoms; or the emergence of symptoms of avoidant, obsessive-compulsive, or paranoid PD. In the PPD group, three latent trajectories were evident: rapid symptom remission, slow symptom decline, or a relative absence of symptoms. Rapid remission of PD symptoms was associated with fewer comorbid disorders, lower Negative Emotionality, and greater Positive Emotionality and Constraint, whereas emergent personality dysfunction was associated with comorbid PD symptoms and lower Positive Emotionality. In most cases, symptom change for one PD was associated with concomitant changes in other PDs, depressive symptoms, and anxiety. These results indicate that the longitudinal course of PD symptoms is heterogeneous, with distinct trajectories evident for both symptomatic and nonsymptomatic individuals. The prognosis of PD symptoms may be informed by an assessment of personality and comorbid psychopathology. 2013 APA, all rights reserved

Neuroscience and approach/avoidance personality traits: a two stage (valuation-motivation) approach.

PubMed

Corr, Philip J; McNaughton, Neil

2012-11-01

Many personality theories link specific traits to the sensitivities of the neural systems that control approach and avoidance. But there is no consensus on the nature of these systems. Here we combine recent advances in economics and neuroscience to provide a more solid foundation for a neuroscience of approach/avoidance personality. We propose a two-stage integration of valuation (loss/gain) sensitivities with motivational (approach/avoidance/conflict) sensitivities. Our key conclusions are: (1) that valuation of appetitive and aversive events (e.g. gain and loss as studied by behavioural economists) is an independent perceptual input stage--with the economic phenomenon of loss aversion resulting from greater negative valuation sensitivity compared to positive valuation sensitivity; (2) that valuation of an appetitive stimulus then interacts with a contingency of presentation or omission to generate a motivational 'attractor' or 'repulsor', respectively (vice versa for an aversive stimulus); (3) the resultant behavioural tendencies to approach or avoid have distinct sensitivities to those of the valuation systems; (4) while attractors and repulsors can reinforce new responses they also, more usually, elicit innate or previously conditioned responses and so the perception/valuation-motivation/action complex is best characterised as acting as a 'reinforcer' not a 'reinforcement'; and (5) approach-avoidance conflict must be viewed as activating a third motivation system that is distinct from the basic approach and avoidance systems. We provide examples of methods of assessing each of the constructs within approach-avoidance theories and of linking these constructs to personality measures. We sketch a preliminary five-element reinforcer sensitivity theory (RST-5) as a first step in the integration of existing specific approach-avoidance theories into a coherent neuroscience of personality. Copyright © 2012 Elsevier Ltd. All rights reserved.

Obsessive-compulsive personality disorder traits and personality dimensions in parents of children with obsessive-compulsive disorder.

PubMed

Calvo, Rosa; Lázaro, Luisa; Castro-Fornieles, Josefina; Font, Elena; Moreno, Elena; Toro, J

2009-04-01

To compare patterns of temperament and character and the prevalence of Obsessive-Compulsive Personality Disorder (OCPD) and OCPD traits in parents of children with OCD and parents of healthy controls. TCI and SCID-II were administered to 63 parents of 32 children with OCD and 63 parents of age- and sex-matched controls with no psychiatric diagnosis. Interviewers were not blind to proband status. Personality dimension scores and frequencies of OCPD criteria in both groups were compared after excluding parents with a diagnosis of OCD. Relationships between TCI dimensions and OCPD symptoms in parents and the clinical characteristics of OCD children were also studied. Parents of OCD children presented significantly higher scores in harm avoidance and lower scores in self-directedness, cooperativeness and reward dependence than parents of healthy children. A higher incidence of OCPD was found in parents of probands (p<0.02). Hoarding, perfectionism and preoccupation with details were significantly more frequent in parents of OCD children. Counting, ordering and cleaning compulsions in OCD children predicted elevated odds of perfectionism and rigidity in their parents. The existence of the dimensional personality profile associated with OCD in parents of children with OCD and the higher number of OCPD criteria in these parents in comparison to parents of healthy children highlight the importance of the role of personality factors in familial OCD.

Avoidant/Restrictive Food Intake Disorder (ARFID).

PubMed

Zimmerman, Jacqueline; Fisher, Martin

2017-04-01

Avoidant/restrictive food intake disorder (ARFID) is an entirely new diagnosis in the DSM-5. ARFID replaces "feeding disorder of infancy or early childhood," which was a diagnosis in the DSM-IV restricted to children 6 years of age or younger; ARFID has no such age limitations and it is distinct from anorexia nervosa and bulimia nervosa in that there is no body image disturbance. ARFID involves a complex and heterogenous etiology, which is reviewed herein. What is known to date regarding the characteristics and medical and psychiatric comorbidities of this patient population are described and compared to other eating disorders. Evaluation and management strategies are also discussed. No data yet exist regarding ARFID׳s prognosis and prevention; however, recommendations to guide parents in establishing appropriate infant and child feeding practices are provided. Copyright © 2017 Mosby, Inc. All rights reserved.

Parental social anxiety disorder prospectively predicts toddlers' fear/avoidance in a social referencing paradigm.

PubMed

Aktar, Evin; Majdandžić, Mirjana; de Vente, Wieke; Bögels, Susan M

2014-01-01

Anxiety runs in families. Observational learning of anxious behavior from parents with anxiety disorders plays an important role in the intergenerational transmission of anxiety. We investigated the link between parental anxiety (parental lifetime anxiety disorders and expressed parental anxiety) and toddler fear/avoidance during social referencing (SR) situations. Toddlers (N = 117) participated with both parents (with lifetime social anxiety disorder, other nonsocial anxiety disorders, lifetime comorbid social and other anxiety disorders, or without anxiety disorders) in a longitudinal study. Behavioral inhibition (BI) was measured at 12 months via observational tasks. At 30 months, children were confronted with a stranger and a remote-control robot in SR situations, separately with each parent. Children's fear and avoidance, and parents' expressions of anxiety, encouragement, and overcontrol were observed. Toddlers of parents with lifetime social anxiety disorder (alone and comorbid with other anxiety disorders) showed more fear/avoidance in SR situations than toddlers of parents without anxiety disorders, while the effect of other anxiety disorders alone was not significant. Although expressed parental anxiety at 30 months in SR situations did not significantly predict toddlers' fear/avoidance, higher levels of expressed anxiety at 12 months in SR situations by parents with comorbid social and other anxiety disorders predicted higher levels of fear/avoidance. BI at 12 months predicted toddlers' fear/avoidance only with mothers, but not with fathers. Parental lifetime social anxiety disorders may be a stronger predictor of children's fear/avoidance than parents' expressions of anxiety in SR situations in toddlerhood. End of infancy may be a sensitive time for learning of anxiety from parents with comorbid lifetime social and nonsocial anxiety disorders in SR situations. Fathers are as important as mothers in the transmission of anxiety via SR. Furthermore

Risk profiles of personality traits for suicidality among mood disorder patients and community controls.

PubMed

Su, M-H; Chen, H-C; Lu, M-L; Feng, J; Chen, I-M; Wu, C-S; Chang, S-W; Kuo, P-H

2018-01-01

To examine the associations between personality traits and suicidal ideation (SI) and attempt (SA) in mood disorder patients and community controls. We recruited 365 bipolar, 296 major depressive disorder patients, and 315 community controls to assess their lifetime suicidality. Participants filled out self-reported personality questionnaires to collect data of personality traits, including novelty seeking (NS), harm avoidance (HA), extraversion (E), and neuroticism (N). We used logistic regression models adjusted for diagnoses to analyze combinational effects of personality traits on the risk of suicide. Additionally, radar charts display personality profiles for suicidal behaviours by groups. All personality traits were associated with the risk of suicidality with various effect size, except for E that showed protective effect. High N or HA had prominent and independent risk effects on SI and SA. Combinations of high N and low E, or high HA and NS were the risk personality profiles for suicidality. Higher N scores further distinguished SA from SI in mood disorder patients. Introvert personality traits showed independent risk effects on suicidality regardless of diagnosis status. Among high-risk individuals with suicidal thoughts, higher neuroticism tendency is further associated with increased risk of suicide attempt. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Personality disorder functioning styles are associated with the effects of the cognitive-behavioral therapy for panic disorder: a preliminary study.

PubMed

Chen, Wanzhen; Hu, Jing; Xu, Shaofang; Shen, Mowei; Chai, Hao; Wang, Wei

2014-06-01

The effect of the cognitive behavioral therapy (CBT) for panic disorder varies, but how personality disorder functioning style influences it remains unclear. In 30 healthy volunteers and 44 patients with panic disorder (22 treated and 22 waiting list), we administered the Parker Personality Measure (PERM) and the Plutchik-van Praag Depression Inventory (PVP). Before and during the CBT or waiting period, patients were asked to record their panic attacks using the Panic Attack Record (PAR). Patients scored significantly higher on PERM Antisocial, Borderline, Histrionic, Avoident, Dependent, and Passive-aggressive styles and on depression. After CBT, all PAR parameters were significantly reduced in the treated group. The Obsessive-compulsive style was positively correlated with the panic attack duration and the total-thought before CBT or waiting period in all patients. In treated patients, the decreased panic attack duration was positively correlated with Histrionic, Obsessive-compulsive and Passive-aggressive; the decreased total symptom number was positively correlated with Antisocial and Histrionic; the decreased total-sensation was positively correlated with antisocial; and the total-thought was positively correlated with Narcissistic style. The length and duration of CBT was short and mainly with behavioral strategies, how personality influenced the related cognition per se remains unknown here. However, our preliminary results indicate that personality disorder functioning styles related to the externalized behaviors and the Obsessive-compulsive style have positive effects on CBT for panic disorder, implying that CBT practitioners should note their personality styles when treating these patients.

The social-cognitive basis of personality disorders.

PubMed

Herpertz, Sabine C; Bertsch, Katja

2014-01-01

The review summarizes recent results on abnormalities in social cognition in patients with personality disorders that predispose them to develop dysfunctional interaction with others. The review starts with more basic social cognition processes, such as emotion recognition and reactions to social exclusion that are followed by more complex processes such as cognitive and affective empathy. The deficits in social cognition depend on the particular function that is investigated and is strongly associated with characteristic symptoms of particular personality disorders. Thus, patients with borderline personality disorder are hypersensitive for social threat, they show deficits in cognitive empathy and high emotion contagion, that is, they share emotions of others without properly discriminating between one's own feelings and those of others. Psychopaths are characterized by deficiency in facial fear recognition and emotional empathy similar to patients with narcissistic personality disorder. Studies on social cognition in cluster A and C personality disorders are sparse. Research indicates deficits in social cognition in patients with personality disorders, but more research is needed to investigate social cognition in cluster A and C personality disorders and to compare deficits in social cognitive functions across personality disorders.

Obsessive compulsive personality disorder and Parkinson's disease.

PubMed

Nicoletti, Alessandra; Luca, Antonina; Raciti, Loredana; Contrafatto, Donatella; Bruno, Elisa; Dibilio, Valeria; Sciacca, Giorgia; Mostile, Giovanni; Petralia, Antonio; Zappia, Mario

2013-01-01

To evaluate the frequency of personality disorders in Parkinson's disease (PD) patients and in a group of healthy controls. Patients affected by PD diagnosed according to the United Kingdom Parkinson's disease Society Brain Bank diagnostic criteria and a group of healthy controls were enrolled in the study. PD patients with cognitive impairment were excluded from the study. Structured Clinical Interview for Personality Disorders-II (SCID-II) has been performed to evaluate the presence of personality disorders. Presence of personality disorders, diagnosed according to the DSM-IV, was confirmed by a psychiatric interview. Clinical and pharmacological data were also recorded using a standardized questionnaire. 100 PD patients (57 men; mean age 59.0 ± 10.2 years) and 100 healthy subjects (52 men; mean age 58.1 ± 11.4 years) were enrolled in the study. The most common personality disorder was the obsessive-compulsive personality disorder diagnosed in 40 PD patients and in 10 controls subjects (p-value<0.0001) followed by the depressive personality disorder recorded in 14 PD patients and 4 control subjects (p-value 0.02). Obsessive-compulsive personality disorder was also found in 8 out of 16 de novo PD patients with a short disease duration. PD patients presented a high frequency of obsessive-compulsive personality disorder that does not seem to be related with both disease duration and dopaminergic therapy.

[Personality disorders, psychopathy and serial killers].

PubMed

Morana, Hilda C P; Stone, Michael H; Abdalla-Filho, Elias

2006-10-01

To illustrate the basic characteristics of several specific personality disorders, focusing mainly in antisocial personality disorder. The differences between antisocial personality disorder and psychopathy are highlighted. Serial killers and its psychopathic aspects are also discussed. A bibliographic review was completed in order to outline convergences and divergences among different authors about this controversial issue, especially those concerning the possibility of treatment. While anti-social personality disorder is a medical diagnosis, the term "psychopathy" (which belongs to the sphere of forensic psychiatry) may be understood as a "legal diagnosis". It is not still possible to identify an effective treatment for serial killers. Personality disorders, especially of the antisocial type, still represent a formidable challenge to forensic psychiatry today. Questions as yet unanswered include the best and most humane place for patients with this condition and the nature of a standardised treatment recommendation.

Modified crisis intervention for personality disorder.

PubMed

Rudnick, A

1998-01-01

This study proposes that the goal of crisis intervention for persons with personality disorders should be to return them to their pre-crisis level of functioning, even though this is maladaptive. This is contrasted with standard crisis intervention, which aims to return normal or neurotic persons to their pre-crisis normal or neurotic functioning, usually by means of few and short-term therapeutic encounters. The modification proposed costs more time and resources in persons with personality disorders in crisis and fits the intervention to the personality type. This is illustrated by the case of Eve, a patient in crisis, whose pre-crisis functioning was maladaptive because of a dependent personality disorder. The goal of (modified) crisis intervention in this case was to return the patient to her dependent lifestyle, by means of pharmacotherapy combined with intensive supportive psychotherapy during 3-4 months of partial (day) hospitalization. The special nature of crisis in personality disorders is discussed.

[Psychiatric disorders and childhood trauma in prisoners with antisocial personality disorder].

PubMed

Kopp, D; Spitzer, C; Kuwert, P; Barnow, S; Orlob, S; Lüth, H; Freyberger, H J; Dudeck, M

2009-03-01

Previous studies indicate high prevalence rates of mental disorders and trauma among prisoners. Based on a sample of 102 male German prisoners, the comorbidity and childhood trauma experiences in 72 criminals with antisocial personality disorder were investigated. Furthermore, associations of antisocial personality disorder and early traumatic experiences with the age at first conviction and the lifetime months of imprisonment were examined. Subjects had high rates of comorbid lifetime and current disorders as well as childhood trauma experiences. Physical abuse in childhood and adolescence was identified as a predictor for lifetime months of imprisonment, antisocial personality disorder was found to be a predictor for the age at first conviction. Our findings confirm the hypothesis of prisoners with antisocial personality disorder being a severely traumatized population with serious mental disorders. Traumatic childhood experiences and antisocial personality disorder are associated with criminality variables. This has important implications on preventive treatments as well as on how prison services are addressing these problems.

Borderline personality disorder: study in adolescence.

PubMed

James, A; Berelowitz, M; Vereker, M

1996-04-01

The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile.

Personality trait interactions in parents of patients with borderline personality disorder: a controlled study using the Temperament and Character Inventory.

PubMed

Fassino, Secondo; Amianto, Federico; Gastaldi, Filippo; Abbate-Daga, Giovanni; Brambilla, Francesca; Leombruni, Paolo

2009-01-30

Family environment is a pathogenic factor of borderline personality disorder (BPD). However, the personality traits of patients with BPD and their parents have never been assessed using the same instrument and then examined for relationships. In the present study, we explored the temperament and character traits of BPD patients and their parents to investigate possible interactions. In total, 56 patients with BPD and their parents were evaluated with the Temperament and Character Inventory (TCI) and compared with 53 control families. Discriminant and correlation analyses indicated that subjects with BPD displayed higher levels of novelty seeking, harm avoidance, and self-transcendence and lower levels of self-directedness than control subjects. Their fathers displayed higher levels of novelty seeking and lower levels of persistence and self-directedness, and their mothers displayed lower levels of self-directedness compared with levels in control parents. In BPD families, temperament and character traits displayed high levels of discriminatory power. Novelty seeking in offspring with borderline personality disorder was significantly correlated with their mothers' novelty seeking and their fathers' self-transcendence. Self-directedness in borderline offspring was significantly correlated with both their mothers' and fathers' novelty seeking, and their self-transcendence was significantly correlated with their mothers' novelty seeking and harm avoidance. The different correlational pattern for borderline and control families is discussed. Characteristic personality patterns were found in BPD offspring and in both parents. The relationship between personality traits of borderline offspring and those of their parents may be related to both genetic transmission and family dynamics. Ramifications for treatment are discussed.

Compulsive buying disorder clustering based on sex, age, onset and personality traits.

PubMed

Granero, Roser; Fernández-Aranda, Fernando; Baño, Marta; Steward, Trevor; Mestre-Bach, Gemma; Del Pino-Gutiérrez, Amparo; Moragas, Laura; Mallorquí-Bagué, Núria; Aymamí, Neus; Goméz-Peña, Mónica; Tárrega, Salomé; Menchón, José M; Jiménez-Murcia, Susana

2016-07-01

In spite of the revived interest in compulsive buying disorder (CBD), its classification into the contemporary nosologic systems continues to be debated, and scarce studies have addressed heterogeneity in the clinical phenotype through methodologies based on a person-centered approach. To identify empirical clusters of CBD employing personality traits, as well as patients' sex, age and the age of CBD onset as indicators. An agglomerative hierarchical clustering method defining a combination of the Schwarz Bayesian Information Criterion and log-likelihood was used. Three clusters were identified in a sample of n=110 patients attending a specialized CBD unit a) "male compulsive buyers" reported the highest prevalence of comorbid gambling disorder and the lowest levels of reward dependence; b) "female low-dysfunctional" mainly included employed women, with the highest level of education, the oldest age of onset, the lowest scores in harm avoidance and the highest levels of persistence, self-directedness and cooperativeness; and c) "female highly-dysfunctional" with the youngest age of onset, the highest levels of comorbid psychopathology and harm avoidance, and the lowest score in self-directedness. Sociodemographic characteristics and personality traits can be used to determine CBD clusters which represent different clinical subtypes. These subtypes should be considered when developing assessment instruments, preventive programs and treatment interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

The relationship between borderline personality disorder and bipolar disorder

PubMed Central

Zimmerman, Mark; Morgan, Theresa A.

2013-01-01

It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum. PMID:24174890

Relationship between personality traits and panic disorder.

PubMed

Navarro, Bárbara; Sánchez, Mónica; Herrán, Andrés; Sierra-Biddle, Deirdre

2013-01-01

Panic disorder is a chronic course disorder that causes important distress and impaired social function. The relationship between personality disorders and panic disorder has been studied, and determines its severity, course and treatment, but it has not been studied the relationship between personality traits and outcome of panic disorder. 82 patients with a first episode of panic disorder are selected and followed during 1 year, to analyze the existence and kind of relationship between their personality traits and the outcome of their disorder.

Personality Pathology of Adults With Autism Spectrum Disorder Without Accompanying Intellectual Impairment in Comparison to Adults With Personality Disorders.

PubMed

Strunz, Sandra; Westphal, Linda; Ritter, Kathrin; Heuser, Isabella; Dziobek, Isabel; Roepke, Stefan

2015-12-01

Differentiating autism spectrum disorders (ASDs) without accompanying intellectual impairment from personality disorders is often challenging. Identifying personality traits and personality pathology specific to ASD might facilitate diagnostic procedure. We recruited a sample of 59 adults with ASD without accompanying intellectual impairment, 62 individuals with narcissistic personality disorder, 80 individuals with borderline personality disorder, and 106 nonclinical controls. Personality traits, measured with the neo-personality inventory-revised (NEO-PI-R), and personality pathology, measured with the dimensional assessment of personality pathology (DAPP-BQ), were assessed. Personality traits and personality pathology specific to ASD could be identified. ASD individuals scored significantly lower on the NEO-PI-R scales extraversion and openness to experience and significantly higher on the DAPP-BQ scales inhibitedness and compulsivity relative to all other groups. Diagnostic implications are discussed.

Ethical aspects of personality disorders.

PubMed

Bendelow, Gillian

2010-11-01

To review recent literature around the controversial diagnosis of personality disorder, and to assess the ethical aspects of its status as a medical disorder. The diagnostic currency of personality disorder as a psychiatric/medical disorder has a longstanding history of ethical and social challenges through critiques of the medicalization of deviance. More recently controversies by reflexive physicians around the inclusion of the category in the forthcoming revisions of International Classification of Diseases and Diagnostic and Statistical Manual of Mental Disorders classifications reflect the problems of value-laden criteria, with the diagnostic category being severely challenged from within psychiatry as well as from without. The clinical diagnostic criteria for extremely value-laden psychiatric conditions such as personality disorder need to be analyzed through the lens of values-based medicine, as well as through clinical evidence, as the propensity for political and sociolegal appropriation of the categories can render their clinical and diagnostic value meaningless.

Mind, brain, and personality disorders.

PubMed

Gabbard, Glen O

2005-04-01

The use of the terms "mind" and "brain" in psychiatry is often associated with a set of polarities. Concepts such as environment, psychosocial, and psychotherapy are linked with "mind," while genes, biology, and medication are often associated with "brain." The author examines these dichotomies as they apply to personality disorders. Research on antisocial and borderline personality disorders that is relevant to these dichotomies is evaluated. The implications of the findings for the understanding of pathogenesis and treatment are reconsidered. In the clinical setting, it is problematic to lump together terms such as "genes," "brain," and "biological" as though they are separate and distinct from terms such as "environment," "mind," and "psychosocial." These dichotomies are problematic, because genes and environment are inextricably intertwined in the pathogenesis of personality disorders, psychosocial experiences may result in permanent changes in the brain, and psychotherapy may have its effect by altering brain structure and function. The "theory of mind" is a useful construct for bridging "mind" and "brain" in the treatment of personality disorders. Severe personality disorders are best understood and treated without "either-or" dichotomies of brain and mind. Each domain has a different language, however, and the language of the mind is necessary to help the patient develop a theory of mind.

An exploration of links between early parenting experiences and personality disorder type and disordered personality functioning.

PubMed

Parker, G; Roy, K; Wilhelm, K; Mitchell, P; Austin, M P; Hadzi-Pavlovic, D

1999-01-01

Reports of early parenting were assessed using two measures, the Parental Bonding Index (PBI) and the Measure of Parenting Style (MOPS), in a sample of 265 patients with DSM-defined major depressive disorder. Psychiatrists then rated the extent to which sample members evidenced the personality "styles" underpinning 15 separate personality disorders, returning personality vignette scores. The extent of disordered functioning was also assessed across "parameters" and "domains" by psychiatrists, referrers, and family members, using a range of measures. Those with higher scores on vignettes measuring borderline, anxious, depressive, and self-defeating personality style rated parents as uncaring, overcontrolling, and abusive. When vignettes were consolidated into scores akin to the DSM clusters, the most consistent links between perceived dysfunctional parenting were with the Cluster C (anxious), and Cluster B (dramatic) styles and were nonsignificant for Cluster A (eccentric) style. Meeting criteria for an increasing number of personality disorder clusters was associated with increasing levels of adverse parenting. Multiple regression analyses indicated that disordered functioning (as assessed by the three independent rater groups) was most distinctly associated with paternal indifference and maternal overcontrol.

Avoidance symptoms and assessment of posttraumatic stress disorder in Arab immigrant women.

PubMed

Norris, Anne E; Aroian, Karen J

2008-10-01

This study investigates whether the avoidance symptom criterion required for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) diagnosis of posttraumatic stress disorder (PTSD) is overly conservative. Arab immigrant women (N = 453), many of whom reported experiencing multiple traumatic events, completed the Posttraumatic Diagnostic Scale in Arabic as part of a face to face interview. Analyses indicated all but one avoidance symptom was reported less frequently than reexperiencing and arousal symptoms. However, those who fully met reexperiencing, avoidance, and arousal symptom criteria had worse symptom severity and functioning than those who fully met reexperiencing and arousal symptom criteria, but only partially met avoidance symptom criterion. Study findings support importance of the PTSD avoidance symptom criterion.

Mechanisms shaping the development of personality and personality disorders in children and adolescents.

PubMed

Lenkiewicz, Kamila; Srebnicki, Tomasz; Bryńska, Anita

2016-01-01

Until the end of the nineties last century personality disorders could not be diagnosed before the age of eighteen. Nevertheless, the results of studies published in the last decade have revealed that personality disorders can be observed in children and adolescents and that personality disorders diagnosed in adult patients had been present as early as in childhood. The knowledge of possible mechanisms shaping personality disorders in childhood is unsatisfactory and needs to be expanded. Developmental psychology explains the development of abnormal personality through inappropriate attachment patterns and abnormal transitions between developmental phases. Genetic and temperamental factors are also important in the aetiology of personality disorders as well as early maladaptive schemas resulting from personal experiences and interactions with others. The aim of this article is to review the current knowledge on the mechanisms shaping the development of personality and personality disorders in childhood and adolescence.

The General Assessment of Personality Disorder (GAPD): factor structure, incremental validity of self-pathology, and relations to DSM-IV personality disorders.

PubMed

Hentschel, Annett G; Livesley, W John

2013-01-01

Recent developments in the classification of personality disorder, especially moves toward more dimensional systems, create the need to assess general personality disorder apart from individual differences in personality pathology. The General Assessment of Personality Disorder (GAPD) is a self-report questionnaire designed to evaluate general personality disorder. The measure evaluates 2 major components of disordered personality: self or identity problems and interpersonal dysfunction. This study explores whether there is a single factor reflecting general personality pathology as proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), whether self-pathology has incremental validity over interpersonal pathology as measured by GAPD, and whether GAPD scales relate significantly to Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]) personality disorders. Based on responses from a German psychiatric sample of 149 participants, parallel analysis yielded a 1-factor model. Self Pathology scales of the GAPD increased the predictive validity of the Interpersonal Pathology scales of the GAPD. The GAPD scales showed a moderate to high correlation for 9 of 12 DSM-IV personality disorders.

Endophenotypes in the personality disorders

PubMed Central

Siever, Larry J.

2005-01-01

The identification of endophenotypes in the personality disorders may provide a basis for the identification of underlying genotypes that influence the traits and dimensions of the personality disorders, as well as susceptibility to major psychiatric illnesses. Clinical dimensions of personality disorders that lend themselves to the study of corresponding endophenotypes include affective instability impulsiwity aggression, emotional information processing, cognitive disorganization, social deficits, and psychosis. For example, the propensity to aggression can be evaluated by psychometric measures, interview, laboratory paradigms, neurochemical imaging, and pharmacological studies. These suggest that aggression is a measurable trait that may be related to reduced serotonergic activity. Hyperresponsiveness of amygdala and other limbic structures may be related to affective instability, while structural and functional brain alterations underlie the cognitive disorganization in psychoticlike symptoms of schizotypal personality disorder. Thus, an endophenotypic approach not only provides clues to underlying candidate genes contributing to these behavioral dimensions, but may also point the way to a better understanding of pathophysiological mechanisms. PMID:16262209

Attachment and Personality Disorders

ERIC Educational Resources Information Center

Sinha, Preeti; Sharan, Pratap

2007-01-01

Personality disorders (PDs) arise from core psychopathology of interpersonal relationships and understanding of self and others. The distorted representations of self and others, as well as unhealthy relationships that characterize persons with various PDs, indicate the possibility that persons with PDs have insecure attachment. Insecure…

Severity of personality disorders and domains of general personality dysfunction related to attachment.

PubMed

Hengartner, Michael P; von Wyl, Agnes; Tanis, Thachell; Halmi, Winter; Galynker, Igor; Cohen, Lisa J

2015-08-01

This is the first study to link attachment to both severity of total DSM-IV personality disorder (PD) traits and domains of general personality dysfunction, using a sample of 72 inpatients from New York City. We assessed a measure of global PD severity and the core domains of personality functioning using the severity indices of personality problems (SIPP-118). Attachment was measured with the experience in close relationships-revised (ECR-R) and the relationship style questionnaire (RSQ). Global PD severity correlated most strongly with attachment anxiety (r = 0.65). Regression of the SIPP-118 domains on attachment produced models that accounted for a substantial proportion of variance in those scales (R(2) ranging from 28.2 to 54.2%). SIPP-118 relational capacities were the strongest predictor of ECR-R avoidance (β = -0.88) and anxiety (β = -0.58), as well as RSQ secure (β = 0.53) and fearful (β = -0.65). In conclusion, insecure attachment strongly related to the severity of global PD traits and specifically to relational capacities, which are a higher-order domain of general personality dysfunction. These findings provide further evidence that interpersonal problems are at the core of PDs and that attachment could constitute an important mediator of the social dysfunction in persons with personality pathology. Copyright © 2015 John Wiley & Sons, Ltd.

Modeling Avoidance in Mood and Anxiety Disorders Using Reinforcement Learning.

PubMed

Mkrtchian, Anahit; Aylward, Jessica; Dayan, Peter; Roiser, Jonathan P; Robinson, Oliver J

2017-10-01

Serious and debilitating symptoms of anxiety are the most common mental health problem worldwide, accounting for around 5% of all adult years lived with disability in the developed world. Avoidance behavior-avoiding social situations for fear of embarrassment, for instance-is a core feature of such anxiety. However, as for many other psychiatric symptoms the biological mechanisms underlying avoidance remain unclear. Reinforcement learning models provide formal and testable characterizations of the mechanisms of decision making; here, we examine avoidance in these terms. A total of 101 healthy participants and individuals with mood and anxiety disorders completed an approach-avoidance go/no-go task under stress induced by threat of unpredictable shock. We show an increased reliance in the mood and anxiety group on a parameter of our reinforcement learning model that characterizes a prepotent (pavlovian) bias to withhold responding in the face of negative outcomes. This was particularly the case when the mood and anxiety group was under stress. This formal description of avoidance within the reinforcement learning framework provides a new means of linking clinical symptoms with biophysically plausible models of neural circuitry and, as such, takes us closer to a mechanistic understanding of mood and anxiety disorders. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Imagery Rescripting for Personality Disorders

ERIC Educational Resources Information Center

Arntz, Arnoud

2011-01-01

Imagery rescripting is a powerful technique that can be successfully applied in the treatment of personality disorders. For personality disorders, imagery rescripting is not used to address intrusive images but to change the implicational meaning of schemas and childhood experiences that underlie the patient's problems. Various mechanisms that may…

Parents' personality clusters and eating disordered daughters' personality and psychopathology.

PubMed

Amianto, Federico; Ercole, Roberta; Marzola, Enrica; Abbate Daga, Giovanni; Fassino, Secondo

2015-11-30

The present study explores how parents' personality clusters relate to their eating disordered daughters' personality and psychopathology. Mothers and fathers were tested with the Temperament Character Inventory. Their daughters were assessed with the following: Temperament and Character Inventory, Eating Disorder Inventory-2, Symptom Checklist-90, Parental Bonding Instrument, Attachment Style Questionnaire, and Family Assessment Device. Daughters' personality traits and psychopathology scores were compared between clusters. Daughters' features were related to those of their parents. Explosive/adventurous mothers were found to relate to their daughters' borderline personality profile and more severe interoceptive awareness. Mothers' immaturity was correlated to their daughters' higher character immaturity, inadequacy, and depressive feelings. Fathers who were explosive/methodic correlated with their daughters' character immaturity, severe eating, and general psychopathology. Fathers' character immaturity only marginally related to their daughters' specific features. Both parents' temperament clusters and mothers' character clusters related to patients' personality and eating psychopathology. The cluster approach to personality-related dynamics of families with an individual affected by an eating disorder expands the knowledge on the relationship between parents' characteristics and daughters' illness, suggesting complex and unique relationships correlating parents' personality traits to their daughters' disorder. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Increased Treatment Complexity for Major Depressive Disorder for Inpatients With Comorbid Personality Disorder.

PubMed

Wiegand, Hauke F; Godemann, Frank

2017-05-01

The study examined inpatient treatment for major depressive disorder (MDD) when it is complicated by comorbid personality disorder. In this descriptive analysis of a large data sample from 2013 (German VIPP data set) of 58,913 cases from 75 hospitals, three groups were compared: patients with MDD, patients with MDD and a comorbid personality disorder, and patients with a main diagnosis of personality disorder. Compared with MDD patients, those with comorbid personality disorder had higher rates of recurrent depression and nearly twice as many readmissions within one year, despite longer mean length of stay. Records of patients with comorbidities more often indicated accounting codes for "complex diagnostic procedures," "crisis intervention," and "constant observation." Patients with comorbid disorders differed from patients with a main diagnosis of personality disorder in treatment indicator characteristics and distribution of personality disorder diagnoses. Personality disorder comorbidity made MDD treatment more complex, and recurrence of MDD episodes and hospital readmission occurred more often than if patients had a sole MDD diagnosis.

DSM-IV personality disorders and associations with externalizing and internalizing disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

PubMed

Harford, Thomas C; Chen, Chiung M; Saha, Tulshi D; Smith, Sharon M; Ruan, W June; Grant, Bridget F

2013-11-01

Although associations between personality disorders and psychiatric disorders are well established in general population studies, their association with liability dimensions for externalizing and internalizing disorders has not been fully assessed. The purpose of this study is to examine associations between personality disorders (PDs) and lifetime externalizing and internalizing Axis I disorders. Data were obtained from the total sample of 34,653 respondents from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drawing on the literature, a 3-factor exploratory structural equation model was selected to simultaneously assess the measurement relations among DSM-IV Axis I substance use and mood and anxiety disorders and the structural relations between the latent internalizing-externalizing dimensions and DSM-IV PDs, adjusting for gender, age, race/ethnicity, and marital status. Antisocial, histrionic, and borderline PDs were strong predictors for the externalizing factor, while schizotypal, borderline, avoidant, and obsessive-compulsive PDs had significantly larger effects on the internalizing fear factor when compared to the internalizing misery factor. Paranoid, schizoid, narcissistic, and dependent PDs provided limited discrimination between and among the three factors. An overarching latent factor representing general personality dysfunction was significantly greater on the internalizing fear factor followed by the externalizing factor, and weakest for the internalizing misery factor. Personality disorders offer important opportunities for studies on the externalizing-internalizing spectrum of common psychiatric disorders. Future studies based on panic, anxiety, and depressive symptoms may elucidate PD associations with the internalizing spectrum of disorders. Published by Elsevier Ltd.

DSM-IV Personality Disorders and Associations with Externalizing and Internalizing Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

PubMed Central

Harford, Thomas C.; Chen, Chiung M.; Saha, Tulshi D.; Smith, Sharon M.; Ruan, W. June; Grant, Bridget F.

2013-01-01

Background Although associations between personality disorders and psychiatric disorders are well established in general population studies, their association with liability dimensions for externalizing and internalizing disorders has not been fully assessed. The purpose of this study is to examine associations between personality disorders (PDs) and lifetime externalizing and internalizing Axis I disorders. Methods Data were obtained from the total sample of 34,653 respondents from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drawing on the literature, a 3-factor exploratory structural equation model was selected to simultaneously assess the measurement relations among DSM-IV Axis I substance use and mood and anxiety disorders and the structural relations between the latent internalizing-externalizing dimensions and DSM-IV PDs, adjusting for gender, age, race/ethnicity, and marital status. Results Antisocial, histrionic, and borderline PDs were strong predictors for the externalizing factor, while schizotypal, borderline, avoidant, and obsessive-compulsive PDs had significantly larger effects on the internalizing fear factor when compared to the internalizing misery factor. Paranoid, schizoid, narcissistic, and dependent PDs provided limited discrimination between and among the three factors. An overarching latent factor representing general personality dysfunction was significantly greater on the internalizing fear factor followed by the externalizing factor, and weakest for the internalizing misery factor. Conclusion Personality disorders offer important opportunities for studies on the externalizing-internalizing spectrum of common psychiatric disorders. Future studies based on panic, anxiety, and depressive symptoms may elucidate PD associations with the internalizing spectrum of disorders. PMID:23932575

Linking Career Counseling to Personality Disorders.

ERIC Educational Resources Information Center

Kjos, Diane

1995-01-01

Relates personality disorders to career development issues and counseling interventions. Case examples suggesting career-focused treatment interventions for dependent, borderline, obsessive-compulsive, and passive-aggressive personality disorders are presented. (Author/JBJ)

Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders.

PubMed

Mueser, Kim T; Crocker, Anne G; Frisman, Linda B; Drake, Robert E; Covell, Nancy H; Essock, Susan M

2006-10-01

Conduct disorder (CD) and antisocial personality disorder (ASPD) are established risk factors for substance use disorders in both the general population and among persons with schizophrenia and other severe mental illnesses. Among clients with substance use disorders in the general population, CD and ASPD are associated with more severe problems and criminal justice involvement, but little research has examined their correlates in clients with dual disorders. To address this question, we compared the demographic, substance abuse, clinical, homelessness, sexual risk, and criminal justice characteristics of 178 dual disorder clients living in 2 urban areas between 4 groups: No CD/ASPD, CD Only, Adult ASPD Only, and Full ASPD. Clients in the Adult ASPD Only group tended to have the most severe drug abuse severity, the most extensive homelessness, and the most lifetime sexual partners, followed by the Full ASPD group, compared with the other 2 groups. However, clients with Full ASPD had the most criminal justice involvement, especially with respect to violent charges and convictions. The results suggest that a late-onset ASPD subtype may develop in clients with severe mental illness secondary to substance abuse, but that much criminal behavior in clients with dual disorders may be due to the early onset of the full ASPD syndrome in this population and not the effects of substance use disorders.

Personality factors and weight preoccupation: a continuum approach to the association between eating disorders and personality disorders.

PubMed

Davis, C; Claridge, G; Cerullo, D

1997-01-01

Evidence shows a high comorbidity of eating disorders and some forms of personality disorder. Adopting a dimensional approach to both, our study explored their connection among a non-clinical sample. 191 young women completed personality scales of general neuroticism, and of borderline, schizotypal, obsessive-compulsive, and narcissistic (both adjustive and maladaptive) traits. Weight preoccupation (WP), as a normal analogue of eating disorders, was assessed with scales from the Eating Disorder Inventory, and height and weight measured. The data were analysed with multiple regression techniques, with WP as the dependent variable. In low to normal weight subjects, after controlling for the significant influence of body mass, the specific predictors of WP in the regression model were borderline personality and maladaptive narcissism, in the positive direction, and adjustive narcissism and obsessive-compulsiveness in the negative direction. In heavier women, narcissism made no contribution--nor, more significantly, did body mass. Patterns of association between eating pathology and personality disorder, especially borderline and narcissism, can be clearly mapped across to personality traits in the currently non-clinical population. This finding has important implications for understanding dynamics of, and identifying individuals at risk for, eating disorders.

[Categorical and dimensional diagnosis in schizoid and narcissistic personality disorders: critical interpretation of literature cases].

PubMed

Coccanari De Fornari, Maria Antonietta; Piccione, Michele; Giampà, Alessio

2010-01-01

In the general reflection inherent categorical and dimensional diagnosis and the opportunity to put neurotic and psychotic personality in the various chapters of the discipline, a never-ending discussion on the similarities and differences between clinical pictures classified in separate entries (think of the comings and goings from one cluster to another between schizoid and avoidant personality disorder). Other cogent discussion focused on the nosographical criteria, targeted to a modified classification that takes into account dimensional rather than descriptive criteria. About personality disorders think of the debate on their degree of severity, as assessed by criteria such dissimilar from various authors, as to be very different in this sense a ranking according to the variables considered (eg, classifications by Kernberg and Millon). As an established tradition that a contribution to psychological studies derives also from the literary and artistic forms in general, we propose, through the interpretation of literary cases, the dimensional affinity between schizoid and narcissistic disorders. The dimensions taken into account are those of affectivity and intersubjectivity, impaired in both disorders.

Ten-Year Course of Borderline Personality Disorder

PubMed Central

Gunderson, John G.; Stout, Robert L.; McGlashan, Thomas H.; Shea, M. Tracie; Morey, Leslie C.; Grilo, Carlos M.; Zanarini, Mary C.; Yen, Shirley; Markowitz, John C.; Sanislow, Charles; Ansell, Emily; Pinto, Anthony; Skodol, Andrew E.

2011-01-01

Context Borderline personality disorder (BPD) is traditionally considered chronic and intractable. Objective To compare the course of BPD’s psychopathology and social function with that of other personality disorders and with major depressive disorder (MDD) over 10 years. Design A collaborative study of treatment-seeking, 18-to 45-year-old patients followed up with standardized, reliable, and repeated measures of diagnostic remission and relapse and of both global social functioning and subtypes of social functioning. Setting Nineteen clinical settings (hospital and outpatient) in 4 northeastern US cities. Participants Three study groups, including 175 patients with BPD, 312 with cluster C personality disorders, and 95 with MDD but no personality disorder. Main Outcome Measures The Diagnostic Interview for DSM-IV Personality Disorders and its follow-along version (the Diagnostic Interview for DSM-IV Personality Disorders–Follow-Along Version) were used to diagnose personality disorders and assess changes in them. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Longitudinal Interval Follow-up Evaluation were used to diagnose MDD and assess changes in MDD and in social function. Results Eighty-five percent of patients with BPD remitted. Remission of BPD was slower than for MDD (P<.001) and minimally slower than for other personality disorders (P<.03). Twelve percent of patients with BPD relapsed, a rate less frequent and slower than for patients with MDD (P<.001) and other personality disorders (P=.008). All BPD criteria declined at similar rates. Social function scores showed severe impairment with only modest albeit statistically significant improvement; patients with BPD remained persistently more dysfunctional than the other 2 groups (P<.001). Reductions in criteria predicted subsequent improvements in DSM-IV Axis V Global Assessment of Functioning scores (P<.001). Conclusions The 10-year course of BPD is characterized by high rates of

Validity aspects of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, narcissistic personality disorder construct.

PubMed

Karterud, Sigmund; Øien, Maria; Pedersen, Geir

2011-01-01

The Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, narcissistic personality disorder (NPD) construct has been criticized for being too narrowly defined, for example, by focusing on overt grandiosity at the expense of exhibitionism and narcissistic vulnerability and thus covering only parts of the domain of narcissism. The purpose of this study was to elucidate several validity aspects of the NPD construct. The material consisted of data from 2277 patients (80% of whom had a personality disorder [PD]) who were admitted to units connected to The Norwegian Network of Psychotherapeutic Day Hospitals. The Axis II diagnoses were assessed by Structured Clinical Interview for DSM, Fourth Edition, Axis II Personality Disorders. The frequency of NPD was very low (0.8%). Male patients were overrepresented both on a diagnostic level and on criteria levels. The NPD category was positively associated with other cluster B disorders and negatively associated with avoidant PD. The criteria "demands excessive admiration" and "fantasies of unlimited success" correlated almost as highly with the histrionic PD category and loaded primarily on a histrionic factor. The dominant NPD factor also included the antisocial criterion of "showing no regret having injured others." The major part of the patients' personality pathology could be attributed to other PD criteria. The results challenge the notion of NPD as a distinct diagnostic category. Rather, narcissism should be conceived as personality dimensions pertinent to the whole range of PDs. The results support the views put forward by Russ et al (Refining the construct of narcissistic personality disorder: diagnostic criteria and subtypes. Am J Psychiatry 2008;11:1473-1481) that what clinicians conceive as narcissism consists of several subtypes (dimensions). Our data support the existence of a grandiose/malignant type and an exhibitionistic type. Unfortunately, there was no measure of hypersensitivity. The

Aspects of depression associated with borderline personality disorder.

PubMed

Rogers, J H; Widiger, T A; Krupp, A

1995-02-01

Shared symptoms between borderline personality disorder and depression have resulted in inherent difficulties in evaluating the relationship between these disorders. Some theorists have argued that depression in patients with borderline personality disorder is qualitatively distinct from depression in nonborderline patients. The purpose of this study was to empirically identify aspects of depression most associated with borderline personality disorder. Through interview and self-report measures, the authors studied depression in 50 inpatients, 21 of whom had borderline personality disorder. The aspects of depression most associated with borderline personality disorder were self-condemnation, emptiness, abandonment fears, self-destructiveness, and hopelessness; boredom and somatic complaints exhibited no association. Depression associated with borderline pathology appears to be in some respects unique, as well as distinct from nonborderline depression. The study's implications delineate the importance of considering the phenomenological aspects of depression in borderline personality disorder.

[Personality and somatic disorders].

PubMed

Darves-Bornoz, J-M

2018-06-08

In the title of this text, by somatic disorders we mean those physical illnesses clearly related to a non-psychiatric medical field, frequently termed psychosomatic illnesses and somatoform disorders. For forty years, a trend of thought has focused with pertinence on the psychological peculiarities in patients with severe somatic diseases. Moreover, causality was often supposed in the regularly mentioned association between personality features and somatoform disorders. However, the revival of the study of the earlier field of relationships between mind and body by Briquet, Charcot, Janet and Freud in his first period has led to the reassessment of the meaning of these observations. This reexamination is marked out by several assertions. Two of them work as preliminaries to argumentation: 1. existential wounds may produce long-lasting personality alterations; 2. existential wounds may produce somatoform disorders. These phenomena have been rediscovered over the last few years among assaulted subjects as well as war veterans in whom a frequent occurrence of somatizations has been, in addition, closely linked to the incidence of behavior or personality disorders. Two theses then emerge: 1. somatic diseases may produce long-lasting personality alterations; 2. until now no premorbid personality univocally predisposing to somatic diseases could be found. Indeed, during the 1980s a growing body of negative results coming from retrospective and prospective studies as well as anatomical comparisons have accumulated upon the potential role of certain personality factors in the incidence of somatic illnesses. This dialectic leads to the connection of two corollary assertions: 1. "pensée opératoire" and "alexithymia" in patients with somatic diseases may represent only an effect of the announcement or chronicity of the organic disease; 2. the old "dissociative hysteria" with somatic manifestations finds its substratum in existential wounds and not in pre-trauma personality

The Coraline Effect: The Misdiagnosis of Personality Disorders in College Students Who Grew up with a Personality Disordered Parent

ERIC Educational Resources Information Center

Donatone, Brooke

2016-01-01

College students may be misdiagnosed as personality disordered when in fact their problems are better explained by their upbringing. Growing up with a personality disordered parent may cause them to initially present with what appear to be personality disordered traits due to issues such as not learning adequate coping skills. Accurate diagnosis…

Pattern of comorbidity among anxious and odd personality disorders: the case of obsessive-compulsive personality disorder.

PubMed

Rossi, A; Marinangeli, M G; Butti, G; Kalyvoka, A; Petruzzi, C

2000-09-01

The aim of this study was to examine the pattern of comorbidity among obsessive-compulsive personality disorder (OCPD) and other personality disorders (PDs) in a sample of 400 psychiatric inpatients. PDs were assessed using the Semistructured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Odds ratios (ORs) were calculated to determine significant comorbidity among OCPD and other axis II disorders. The most elevated odds ratios were found for the cooccurrence of OCPD with cluster A PDs (the "odd" PDs, or paranoid and schizoid PDs). These results are consistent with those of previous studies showing a higher cooccurrence of OCPD with cluster A than with cluster C ("anxious") PDs. In light of these observations, issues associated with the nosologic status of OCPD within the Diagnostic and Statistical Manual of Mental Disorders clustering system remain unsettled.

[High-conflict-divorce and personality disorder].

PubMed

Spindler, Manfred

2009-01-01

We tried to identify clues related to personality disorders - especially related to borderline personality--in parents of high-conflict divorce. We compared n = 34 high-conflict clients of psychological counselling to n = 45 clients not related to high-conflict divorce. Parents of high-conflict divorce did not show significantly more hints related to personality disorder. Parents who live separated scored higher than parents living together. Extreme-group-analyses over all clients revealed in 20% definitely evidence of personality disorders or very low resiliency. Psychological counselling in the realm of Child care units also addresses clients who rate themselves as seriously impaired or non-resilient.

Antisocial personality disorder and anxiety disorder: a diagnostic variant?

PubMed

Coid, Jeremy; Ullrich, Simone

2010-06-01

Antisocial personality disorder (ASPD) with co-morbid anxiety disorder may be a variant of ASPD with different etiology and treatment requirements. We investigated diagnostic co-morbidity, ASPD criteria, and anxiety/affective symptoms of ASPD/anxiety disorder. Weighted analyses were carried out using survey data from a representative British household sample. ASPD/anxiety disorder demonstrated differing patterns of antisocial criteria, co-morbidity with clinical syndromes, psychotic symptoms, and other personality disorders compared to ASPD alone. ASPD criteria demonstrated specific associations with CIS-R scores of anxiety and affective symptoms. Findings suggest ASPD/anxiety disorder is a variant of ASPD, determined by symptoms of anxiety. Although co-morbid anxiety and affective symptoms are the same as in anxiety disorder alone, associations with psychotic symptoms require further investigation. Copyright 2010 Elsevier Ltd. All rights reserved.

An integrative dimensional classification of personality disorder.

PubMed

Widiger, Thomas A; Livesley, W John; Clark, Lee Anna

2009-09-01

Psychological assessment research concerns how to describe psychological dysfunction in ways that are both valid and useful. Recent advances in assessment research hold the promise of facilitating significant improvements in description and diagnosis. One such contribution is in the classification of personality disorder symptomatology. The American Psychiatric Association's diagnostic manual considers personality disorders to be categorically distinct entities. However, research assessing personality disorders has consistently supported a dimensional perspective. Recognition of the many limitations of categorical models of personality disorder classification has led to the development of a variety of alternative proposals, which further research has indicated can be integrated within a common hierarchical structure. This article offers an alternative integrated dimensional model of normal and abnormal personality structure, and it illustrates how such a model could be used clinically to describe patients' normal adaptive personality traits as well as their maladaptive personality traits that could provide the basis for future assessments of personality disorder. The empirical support, feasibility, and clinical utility of the proposal are discussed. Points of ambiguity and dispute are highlighted, and suggestions for future research are provided. Copyright 2009 APA, all rights reserved.

Personality disorders in heart failure patients requiring psychiatric management: comorbidity detections from a routine depression and anxiety screening protocol.

PubMed

Tully, Phillip J; Selkow, Terina

2014-12-30

Several international guidelines recommend routine depression screening in cardiac disease populations. No previous study has determined the prevalence and comorbidities of personality disorders in patients presenting for psychiatric treatment after these screening initiatives. In the first stage 404 heart failure (HF) patients were routinely screened and 73 underwent structured interview when either of the following criteria were met: (a) Patient Health Questionnaire ≥10; (b) Generalized Anxiety Disorder Questionnaire ≥7); (c) Response to one item panic-screener. Or (d) Suicidality. Patients with personality disorders were compared to the positive-screen patients on psychiatric comorbidities. The most common personality disorders were avoidant (8.2%), borderline (6.8%) and obsessive compulsive (4.1%), other personality disorders were prevalent in less than <3% of patients. Personality disorder patients had significantly greater risk of major depression (risk ratio (RR) 1.2; 95% confidence interval (CI) 1.2-13.3), generalized anxiety disorder (RR 3.2; 95% CI 1.0-10.0), social phobia (RR 3.8; 95% CI 1.3-11.5) and alcohol abuse/dependence (RR 3.2; 95% 1.0-9.5). The findings that HF patients with personality disorders presented with complex psychiatric comorbidity suggest that pathways facilitating the integration of psychiatric services into cardiology settings are warranted when routine depression screening is in place. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

Personality disorder: a new global perspective

PubMed Central

TYRER, PETER; MULDER, ROGER; CRAWFORD, MIKE; NEWTON-HOWES, GILES; SIMONSEN, ERIK; NDETEI, DAVID; KOLDOBSKY, NESTOR; FOSSATI, ANDREA; MBATIA, JOSEPH; BARRETT, BARBARA

2010-01-01

Personality disorder is now being accepted as an important condition in mainstream psychiatry across the world. Although it often remains unrecognized in ordinary practice, research studies have shown it is common, creates considerable morbidity, is associated with high costs to services and to society, and interferes, usually negatively, with progress in the treatment of other mental disorders. We now have evidence that personality disorder, as currently classified, affects around 6% of the world population, and the differences between countries show no consistent variation. We are also getting increasing evidence that some treatments, mainly psychological, are of value in this group of disorders. What is now needed is a new classification that is of greater value to clinicians, and the WPA Section on Personality Disorders is currently undertaking this task. PMID:20148162

High prevalence of personality disorders among circadian rhythm sleep disorders (CRSD) patients.

PubMed

Dagan, Y; Sela, H; Omer, H; Hallis, D; Dar, R

1996-10-01

The purpose of this study was to examine systematically our previous clinical impression regarding the prevalence of personality disorders in patients suffering from circadian rhythm sleep disorders (CRSD). We hypothesized that, in a group of patients suffering from CRSD, there would be a higher frequency of personality disorders than in a group of healthy controls. The experimental group consisted of CRSD patients diagnosed according to a clinical interview and actigraphic recordings. The control group consisted of healthy volunteers in whom CRSD had been ruled out by means of a self-administered questionnaire. Both groups were assessed for personality disorders using the MCMI, a diagnostic tool based on Millon's biopsychosocial theory of personality and the PRQ-R, a diagnostic tool based on the DMS-III-R. Both tests provided clear and significant support for the hypothesis that individuals suffering from CRSD are characterized to a greater extent by personality disorders than a control group. No specific characteristic pattern or profile of personality disorders was clearly detected. Correct early diagnosis and treatment of CRSD may improve afflicted individuals' adaptive capabilities and perhaps even prevent the development of a personality disorder. This suggests how important a greater awareness of CRSD on the part of the professional community may be.

Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Schizotypal Personality Disorder: Results From the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions

PubMed Central

Pulay, Attila J.; Stinson, Frederick S.; Dawson, Deborah A.; Goldstein, Risë B.; Chou, S. Patricia; Huang, Boji; Saha, Tulshi D.; Smith, Sharon M.; Pickering, Roger P.; Ruan, W. June; Hasin, Deborah S.; Grant, Bridget F.

2009-01-01

Objective: To present nationally representative findings on the prevalence, correlates, and comorbidity of and disability associated with DSM-IV schizotypal personality disorder (SPD). Method: This study used the 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, which targeted a nationally representative sample of the adult civilian population of the United States aged 18 years and older and residing in households and group quarters. In Wave 2, attempts were made to conduct face-to-face reinterviews with all respondents to the Wave 1 interview. Results: Lifetime prevalence of SPD was 3.9%, with significantly greater rates among men (4.2%) than women (3.7%) (p < .01). Odds for SPD were significantly greater among black women, individuals with lower incomes, and those who were separated, divorced, or widowed; odds were significantly lower among Asian men (all p < .01). Schizotypal personality disorder was associated with substantial mental disability in both sexes. Co-occurrence rates of Axis I and other Axis II disorders among respondents with SPD were much higher than rates of co-occurrence of SPD among respondents with other disorders. After adjustment for sociodemographic characteristics and additional comorbidity, associations remained significant in both sexes between SPD and 12-month and lifetime bipolar I disorder, social and specific phobias, and posttraumatic stress disorder, as well as 12-month bipolar II disorder, lifetime generalized anxiety disorder, and borderline and narcissistic personality disorders (all p < .01). Conclusions: Common and unique factors may underlie associations of SPD with narcissistic and borderline personality disorders, whereas much of the comorbidity between SPD and most mood and anxiety disorders appears to reflect factors common to these disorders. Some of the associations with SPD were sex specific. Schizotypal personality disorder and dependent, avoidant, and borderline personality disorders

Rumination, experiential avoidance, and dysfunctional thinking in eating disorders

PubMed Central

Rawal, Adhip; Park, Rebecca J.; Williams, J. Mark G.

2010-01-01

The majority of research in eating disorders (ED) has investigated the content of disorder-specific thoughts, while few studies have addressed underlying cognitive-affective processes. A better understanding of processes underpinning ED may have important implications for treatment development. Two studies were conducted that investigated levels of rumination, beliefs about rumination, experiential avoidance, and aspects of schematic thinking in individuals with eating pathology. The latter was assessed with a newly designed ED-Sentence Completion Task (ED-SCT). Study 1 (N = 177) examined relations between ED psychopathology and these variables in a student population. Extending this, Study 2 (N = 26) assessed differences between patients with anorexia nervosa and healthy control participants. The results showed that ED psychopathology was related to disorder-specific cognitions, experiential avoidance as well as ruminative brooding but not reflection. A follow-up of anorexia nervosa patients indicated that changes in ED psychopathology were associated with changes in dysfunctional attitudes and maladaptive cognitive-affective processes. These findings highlight cognitive processes that may play an important role in the maintenance of eating pathology. PMID:20598670

Childhood adversity, mental disorder comorbidity, and suicidal behavior in schizotypal personality disorder.

PubMed

Lentz, Vanessa; Robinson, Jennifer; Bolton, James M

2010-11-01

Schizotypal personality disorder (SPD) is a serious and relatively common psychiatric disorder, yet remains understudied among the personality disorders. The current study examines the psychiatric correlates of SPD in a representative epidemiologic sample, utilizing data from the National Epidemiological Survey on Alcohol and Related Conditions (N = 34,653). Multiple logistic regression compared people with SPD to the general population across a broad range of childhood adversities, comorbid psychiatric disorders, and suicidal behavior. SPD was strongly associated with many adverse childhood experiences. After adjusting for confounding factors, SPD was independently associated with major depression and several anxiety disorders, including post-traumatic stress disorder. Interestingly, SPD was more strongly associated with borderline and narcissistic personality disorders than cluster A personality disorders. Individuals with SPD were also more likely to attempt suicide. As a whole, these results suggest that individuals with SPD experience significant morbidity and may be at increased risk of mortality.

38 CFR 4.127 - Mental retardation and personality disorders.

Code of Federal Regulations, 2014 CFR

2014-07-01

... personality disorders. 4.127 Section 4.127 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... and personality disorders. Mental retardation and personality disorders are not diseases or injuries... superimposed upon mental retardation or a personality disorder may be service-connected. (Authority: 38 U.S.C...

38 CFR 4.127 - Mental retardation and personality disorders.

Code of Federal Regulations, 2012 CFR

2012-07-01

... personality disorders. 4.127 Section 4.127 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... and personality disorders. Mental retardation and personality disorders are not diseases or injuries... superimposed upon mental retardation or a personality disorder may be service-connected. (Authority: 38 U.S.C...

38 CFR 4.127 - Mental retardation and personality disorders.

Code of Federal Regulations, 2013 CFR

2013-07-01

... personality disorders. 4.127 Section 4.127 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... and personality disorders. Mental retardation and personality disorders are not diseases or injuries... superimposed upon mental retardation or a personality disorder may be service-connected. (Authority: 38 U.S.C...

38 CFR 4.127 - Mental retardation and personality disorders.

Code of Federal Regulations, 2011 CFR

2011-07-01

... personality disorders. 4.127 Section 4.127 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... and personality disorders. Mental retardation and personality disorders are not diseases or injuries... superimposed upon mental retardation or a personality disorder may be service-connected. (Authority: 38 U.S.C...

Comorbidity of obsessive-compulsive disorder with obsessive-compulsive personality disorder: Does it imply a specific subtype of obsessive-compulsive disorder?

PubMed

Garyfallos, George; Katsigiannopoulos, Konstantinos; Adamopoulou, Aravela; Papazisis, Georgios; Karastergiou, Anastasia; Bozikas, Vasilios P

2010-05-15

The present study examined whether the comorbidity of obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD) constitute a specific subtype of OCD. The study sample consisted of 146 consecutive outpatients with a DSM-IV diagnosis of OCD. Diagnoses were established using MINI, IPDE, YBOCS and YBOCS-SC. OCD patients with comorbid OCPD were compared with OCD patients without OCPD on various sociodemographic and clinical variables. Almost one third of the OCD subjects met criteria for comorbid OCPD. OCD+OCPD patients had a significantly earlier age at onset of initial OC symptoms, earlier age at onset of OCD and more obsessions and compulsions than pure obsessions compared to the patients with OCDOCPD. OCD+OCPD patients also had a higher rate of comorbidity with avoidant personality disorder and showed more impairment in global functioning. There were not differences between the two sub-groups on severity of OCD symptoms and also on type of OCD onset. Our results indicate that the comorbidity of OCD with OCPD is associated with a number of specific clinical characteristics of OCD. These findings in conjunction with of current clinical, family and genetic studies provide some initial evidence that OCD comorbid with OCPD constitute a specific subtype of OCD. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Neurochemical alterations associated with borderline personality disorder.

PubMed

Atmaca, Murad; Karakoc, Tevfik; Mermi, Osman; Gurkan Gurok, M; Yildirim, Hanefi

2015-01-01

In neuroimaging on borderline personality disorder, prior studies focused on the hippocampus and amygdala, as mentioned above. However, no study investigated whether there were neurochemical changes in the patients with borderline personality disorder. Therefore, in the present study, we aimed to investigate neurochemical change of patients diagnosed with borderline disorder and hypothesized that neurochemicals would change in the hippocampus region of these patients. Seventeen patients and the same number of healthy control subjects were analyzed by using a 1.5 Tesla GE Signa Imaging System. N-acetylaspartate (NAA), choline compounds (CHO), and creatine (CRE) values of hippocampal region were measured. The mean NAA/CRE ratio in the hippocampus region was significantly reduced in the patients with borderline personality disorder compared to that of healthy control subjects, In addition, NAA/CHO ratio of the patients with borderline personality disorder was also significantly reduced when compared to that of healthy subjects. There was no difference in the ratio of CHO/CRE. In summary, we present evidence for reduced NAA in the patients with borderline personality disorder. © 2015, The Author(s).

On the role of oxytocin in borderline personality disorder.

PubMed

Brüne, Martin

2016-09-01

Interpersonal dysfunction is central to borderline personality disorder (BPD). Recent research has focused on the role of oxytocin (OT) in BPD, particularly regarding associations of OT activity with symptoms, genetic polymorphisms of the oxytocin receptor coding gene (OXTR) in BPD, and experimental modification of interpersonal core problems of patients with BPD such as hypervigilance towards threat detection, mistrust, and non-verbal behaviour during social interaction by intranasal application of OT. A literature ('medline') review was performed using the keywords 'oxytocin' and 'borderline personality disorder'. Secondary literature on trauma and attachment in relation to OT was also considered relevant. Together, findings suggest that in BPD OT is associated with enhanced defensive mechanisms and avoidance behaviour. Moreover, gene-environment interaction concerning polymorphic variations of the OXTR gene and childhood adversity in BPD suggests that these genes convey developmental flexibility or 'differential susceptibility' to environmental contingencies, whereby BPD resides at the poor outcome end of the spectrum. In view of the conflicting literature, it needs to be studied carefully whether OT can serve as a therapeutic agent given adjunct to psychotherapy in BPD. More research about the role of OT is also required with regard to the prevention of the non-genetic intergenerational transmission of BPD. Clarifying the role of OT in BPD may also benefit from research in non-human animals targeting the interaction between early adversity and OT availability more directly. The study of oxytocin can contribute to the understanding of the neurobiology of borderline personality disorder. Oxytocin is critically involved in attachment security, and methylation of the oxytocin receptor may play a role in the epigenetic modulation of early adversity. The intranasal application of oxytocin may be a useful therapeutic adjunct to psychotherapy. Insecure attachment and

Socioeconomic-status and mental health in a personality disorder sample: The importance of neighbourhood factors

PubMed Central

Walsh, Zach; Shea, M. Tracie; Yen, Shirley; Ansell, Emily B.; Grilo, Carlos M.; McGlashan, Thomas H.; Stout, Robert L.; Bender, Donna S.; Skodol, Andrew E.; Sanislow, Charles A.; Morey, Lesley C.; Gunderson, John G.

2015-01-01

This cross-sectional study examined the associations between neighbourhood-level socioeconomic-status, and psychosocial functioning and personality pathology among 335 adults drawn from the Collaborative Longitudinal Personality Disorders Study. Participants belonged to four personality disorder (PD) diagnostic groups: Avoidant, Borderline, Schizotypal, and Obsessive Compulsive. Global functioning, social adjustment, and PD symptoms were assessed following a minimum two-year period of residential stability. Residence in higher-risk neighbourhoods was associated with more PD symptoms and lower levels of functioning and social adjustment. These relationships were consistent after controlling for individual-level socioeconomic-status and ethnicity; however, the positive association between neighbourhood-level socio-economic risk and PD symptoms was evident only at higher levels of individual-level socio-economic risk. Our findings identify NSES as a candidate for explaining some of the variability in symptoms and functioning among PD individuals. PMID:22984860

Personality Disorders (and Their Relation to Syndromal Disorders).

ERIC Educational Resources Information Center

Beck, Aaron T.

Personality disorders and their syndromal disorders may be considered in terms of their distal, phylogenetic origins, and their structures and functions. From an evolutionary standpoint, the syndromal disorders such as anxiety and depression may be viewed as preprogrammed reactions to a perceived threat or a perceived depletion of the individual's…

Personality Disorders and the 3-Year Course of Alcohol, Drug, and Nicotine Use Disorders

PubMed Central

Hasin, Deborah; Fenton, Miriam C.; Skodol, Andrew; Krueger, Robert; Keyes, Katherine; Geier, Timothy; Greenstein, Eliana; Blanco, Carlos; Grant, Bridget

2012-01-01

Context Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD), and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions. Objective To determine the association between the ten DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample. Design Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (N=1,172), cannabis use disorder (N=454) or nicotine dependence (N=4,017) at baseline and who were re-interviewed three years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration. Main outcome measure Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period. Results Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis and nicotine use disorders (adjusted odds ratios: 2.46-3.51), as was borderline personality disorder (adjusted odds ratios: 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios: 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence. Conclusions The consistent findings on the association of antisocial, borderline and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional

Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders.

PubMed

Hasin, Deborah; Fenton, Miriam C; Skodol, Andrew; Krueger, Robert; Keyes, Katherine; Geier, Timothy; Greenstein, Eliana; Blanco, Carlos; Grant, Bridget

2011-11-01

Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD) and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions. To determine the association between the 10 DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample. Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (n = 1172), cannabis use disorder (n = 454), or nicotine dependence (n = 4017) at baseline and who were reinterviewed 3 years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration. Main Outcome Measure  Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period. Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis, and nicotine use disorders (adjusted odds ratios, 2.46-3.51), as was borderline personality disorder (adjusted odds ratios, 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios, 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence. The consistent findings on the association of antisocial, borderline, and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional representations of personality

Demographic features and premorbid personality disorder traits in relation to age of onset and sex in paranoid schizophrenia.

PubMed

Skokou, Maria; Gourzis, Philippos

2014-03-30

Personality disorders in the premorbid period of schizophrenia and particularly in relation to age of onset and sex, seem to be a rather under-researched area. In the present study, 88 patients with paranoid schizophrenia were examined, regarding demographic characteristics and premorbid personality disorder traits, in order to investigate for differences in the premorbid period of the disease, in relation to age of onset and sex. Age cutoff points were set at <30 years and ≥35 years of age for young and late onset groups, respectively. The Structured Clinical Interview for DSM-IV-Patient Edition for Axis I disorders (SCID-P) was used prospectively for diagnoses. Premorbid personality disorder traits were retrospectively assessed by using the Structured Clinical Interview for DSM-IV-Patient Edition for Axis II disorders (SCID-II). Comparisons were performed by applying the two-tailed Wilcoxon rank-sum and the χ(2) statistical tests. Young onset patients were characterized by significantly higher proportion of urban birth, single status, more avoidant premorbid personality disorder traits, and less passive-aggressive premorbid personality disorder traits, than late onset counterparts. Differences were more prominently shown in men. Earlier age of onset seems to be associated to increased social inhibition and worse psychosocial adaptation in the premorbid period of paranoid schizophrenia. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Subjective and Objective Binge Eating in Relation to Eating Disorder Symptomatology, Negative Affect, and Personality Dimensions

PubMed Central

Brownstone, Lisa M.; Bardone-Cone, Anna M.; Fitzsimmons-Craft, Ellen E.; Printz, Katherine S.; Le Grange, Daniel; Mitchell, James E.; Crow, Scott J.; Peterson, Carol B.; Crosby, Ross D.; Klein, Marjorie H.; Wonderlich, Stephen A.; Joiner, Thomas E.

2013-01-01

Objective The current study explored the clinical meaningfulness of distinguishing subjective (SBE) from objective binge eating (OBE) among individuals with threshold/subthreshold bulimia nervosa (BN). We examined relations between OBEs and SBEs and eating disorder symptoms, negative affect, and personality dimensions using both a group comparison and a continuous approach. Method Participants were 204 adult females meeting criteria for threshold/subthreshold BN who completed questionnaires related to disordered eating, affect, and personality. Results Group comparisons indicated that SBE and OBE groups did not significantly differ on eating disorder pathology or negative affect, but did differ on two personality dimensions (cognitive distortion and attentional impulsivity). Using the continuous approach, we found that frequencies of SBEs (not OBEs) accounted for unique variance in weight/shape concern, diuretic use frequency, depressive symptoms, anxiety, social avoidance, insecure attachment, and cognitive distortion. Discussion SBEs in the context of BN may indicate broader areas of psychopathology. PMID:23109272

Clinical Components of Borderline Personality Disorder and Personality Functioning.

PubMed

Ferrer, Marc; Andión, Óscar; Calvo, Natalia; Hörz, Susanne; Fischer-Kern, Melitta; Kapusta, Nestor D; Schneider, Gudrun; Clarkin, John F; Doering, Stephan

2018-01-01

Impairment in personality functioning (PF) represents a salient criterion of the DSM-5 alternative diagnostic model for personality disorders (AMPD). The main goal of this study is to analyze the relationship of the borderline personality disorder (BPD) clinical components derived from the DSM-5 categorical diagnostic model (affective dysregulation, behavioral dysregulation, and disturbed relatedness) with personality organization (PO), i.e., PF, assessed by the Structured Interview of Personality Organization (STIPO). STIPO and the Structured Clinical Interviews for DSM-IV (SCID-I and -II) were administered to 206 BPD patients. The relationship between PO and BPD components were studied using Spearman correlations and independent linear regression analyses. Significant positive correlations were observed between STIPO scores and several DSM-5 BPD criteria and comorbid psychiatric disorders. STIPO dimensions mainly correlated with disturbed relatedness and, to a lesser extent, affective dysregulation components. Each BPD clinical component was associated with specific STIPO dimensions. Both diagnostic models, DSM-5 BPD criteria and PO, are not only related but complementary concepts. The results of this study particularly recommend STIPO for the assessment of relational functioning, which is a major domain of the Personality Functioning Scale Levels of the DSM-5 AMPD. © 2018 S. Karger AG, Basel.

Personality Pathology of Adults with Autism Spectrum Disorder without Accompanying Intellectual Impairment in Comparison to Adults with Personality Disorders

ERIC Educational Resources Information Center

Strunz, Sandra; Westphal, Linda; Ritter, Kathrin; Heuser, Isabella; Dziobek, Isabel; Roepke, Stefan

2015-01-01

Differentiating autism spectrum disorders (ASDs) without accompanying intellectual impairment from personality disorders is often challenging. Identifying personality traits and personality pathology specific to ASD might facilitate diagnostic procedure. We recruited a sample of 59 adults with ASD without accompanying intellectual impairment, 62…

The Worry Behaviors Inventory: Assessing the behavioral avoidance associated with generalized anxiety disorder.

PubMed

Mahoney, Alison E J; Hobbs, Megan J; Newby, Jill M; Williams, Alishia D; Sunderland, Matthew; Andrews, Gavin

2016-10-01

Understanding behavioral avoidance associated with generalized anxiety disorder (GAD) has implications for the classification, theoretical conceptualization, and clinical management of the disorder. This study describes the development and preliminary psychometric evaluation of a self-report measure of avoidant behaviors associated with GAD: the Worry Behaviors Inventory (WBI). The WBI was administered to treatment-seeking patients (N=1201). Convergent validity was assessed by correlating the WBI with measures of GAD symptom severity. Divergent validity was assessed by correlating the WBI with measures of general disability and measures of depression, social anxiety and panic disorder symptom severity. Exploratory and confirmatory factor analyses supported a two-factor structure (Safety Behaviors and Avoidance). Internal reliability was acceptable for the 10-item WBI scale (α=.86), Safety Behaviors (α=.85) and Avoidance subscales (α=.75). Evidence of convergent, divergent, and discriminant validity is reported. WBI subscales demonstrated differential associations with measures of symptom severity. The Safety Behaviors subscale was more strongly associated with GAD symptoms than symptoms of other disorders, whereas the Avoidance subscale was as strongly correlated with GAD severity as it was with depression, social anxiety and panic disorder severity. Structured diagnostic interviews were not conducted therefor validity analyses are limited to probable diagnoses based on self-report. The cross-sectional design precluded examination of the WBI's temporal stability and treatment sensitivity. Preliminary evidence supports the use of the WBI in research and clinical settings and may assist clinicians to identify behaviors that are theorized to maintain GAD and that can be targeted during psychological treatment. Copyright © 2016 Elsevier B.V. All rights reserved.

Survey of psychotherapeutic approaches to narcissistic personality disorder.

PubMed

Nurnberg, H G

1984-01-01

The spectrum of Narcissistic Personality Disorder extends from severe impairment to high levels of success, fame, power, and wealth. Several treatment frameworks are available. The therapist must be flexible to choose and shift between libidinal and narcissistic issues to those of ambivalence or ego syntonic character defenses or to focus on ego defense mechanisms or object relationships (Esmiol, 1974). A curative process requires enduring corrective structural changes within distorted intrapsychic configurations manifesting themselves as psychopathology (Horowitz, 1976). These structural changes come about by completion of the working through process. Recurrences will occur, even with insight, but self-mastery enables the patient to take on new functions formerly avoided. In Kohut's view, more cohesive reorganized personality is characterized by (Goldberg, 1973): increased empathy within interpersonal relationships and toward the self; previous rebuffs, failures, and separations of fragmenting consequences and turmoil are experienced with minimal reversible regression; object relations improvement without evidence of extreme narcissistic sensitivity; improved sense of humor indicating a capacity for flexible detachment and distance from the self; emergence and proliferation of satisfying creative talents; increased capacity to work alone and achieve personal gratification; capacity to give without contingencies of anticipated personal gain; and capacity to genuinely recognize and mourn the loss of an important real other.

Psychoanalytic-Interactional Therapy versus Psychodynamic Therapy by Experts for Personality Disorders: A Randomized Controlled Efficacy-Effectiveness Study in Cluster B Personality Disorders.

PubMed

Leichsenring, Falk; Masuhr, Oliver; Jaeger, Ulrich; Rabung, Sven; Dally, Andreas; Dümpelmann, Michael; Fricke-Neef, Christian; Steinert, Christiane; Streeck, Ulrich

2016-01-01

With regard to cluster B personality disorders, most psychotherapeutic treatments focus on borderline personality disorder. Evidence-based treatments for patients with other cluster B personality disorders are not yet available. Psychoanalytic-interactional therapy (PIT) represents a transdiagnostic treatment for severe personality disorders. PIT has been applied in clinical practice for many years and has proven effective in open studies. In a randomized controlled trial, we compared manual-guided PIT to nonmanualized pychodynamic therapy by experts in personality disorders (E-PDT) in patients with cluster B personality disorders. In an inpatient setting, patients with cluster B personality disorders were randomly assigned to manual-guided PIT (n = 64) or nonmanualized E-PDT (n = 58). In addition, a quasi-experimental control condition was used (n = 46) including both patients receiving treatment as usual and patients waiting for treatment. Primary outcomes were level of personality organization and overall psychological distress. As secondary outcomes, depression, anxiety and interpersonal problems were examined. No significant improvements were found in the control patients. Both PIT and E-PDT achieved significant improvements in all outcome measures and were superior to the control condition. No differences were found between PIT and E-PDT in any outcome measure at the end of treatment. The type of cluster B personality disorder had no impact on the results. In an inpatient setting, both PIT and E-PDT proved to be superior to a control condition in cluster B personality disorders. In a head-to-head comparison, both treatments appeared to be equally effective. Further research on the treatment of cluster B personality disorders is required. © 2016 S. Karger AG, Basel.

Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder.

PubMed

Aymamí, N; Jiménez-Murcia, S; Granero, R; Ramos-Quiroga, J A; Fernández-Aranda, F; Claes, L; Sauvaget, A; Grall-Bronnec, M; Gómez-Peña, M; Savvidou, L G; Fagundo, A B; del Pino-Gutierrez, A; Moragas, L; Casas, M; Penelo, E; Menchón, J M

2015-01-01

(1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18-35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits.

[Personality disorders in the elderly].

PubMed

Saarela, Tuula; Stenberg, Jan-Henry

2011-01-01

The diagnostic assessment of old age personality disorders is challenging. Medical illnesses and cognitive impairment may influence the clinical symptoms. Common elements of effective approaches such as building a collaborative relationship and maintaining consistency as well as structured framework of treatment can be tailored to the problems of a patient. Pharmacological treatment guidelines of personality disorders need to be individually applied to elderly persons. Comorbid depression is often the primary symptom seen and needs to be treated. Psychiatry should take steps to promote effective treatments and provide support and clinical supervision to health staff treating these individuals.

Personality disorders in women with severe premenstrual syndrome.

PubMed

Sassoon, Stephanie A; Colrain, Ian M; Baker, Fiona C

2011-06-01

Premenstrual syndrome (PMS) and its more severe form, premenstrual dysphoric disorder, affect up to 18% of women. Both are commonly associated with other mood-related disorders such as major depression, and cause significant life impairment, but their relationship with personality disorders is less clear. After completing the Structured Clinical Interview for DSM-IV-TR disorders, 33 women with severe PMS and 26 asymptomatic women, counterbalanced for menstrual cycle phase, were administered the Structured Interview for DSM-IV Personality Disorders, a diagnostic interview with low transparency, strong inter-rater reliability, and good diagnostic clarity. Women with severe PMS had a higher prevalence of personality disorders (p = 0.003) than asymptomatic women (27% versus 0%), and were more likely to have odd-eccentric, dramatic-erratic, and anxious-fearful personality disorder traits (p < 0.05). Obsessive-compulsive personality disorder (OCPD) was the most common character pathology in the PMS group (n = 6, 18%). OCPD, although not necessarily associated with greater severity of premenstrual symptoms, was related to poorer life functioning in women with PMS. The comorbidity of a personality disorder and severe PMS places an additive burden on general life functioning and may have implications for psychiatric treatment or medication given to those with severe premenstrual symptoms.

Personality risk profile for conduct disorder and substance use disorders in youth.

PubMed

Anderson, Kristen G; Tapert, Susan F; Moadab, Ida; Crowley, Thomas J; Brown, Sandra A

2007-10-01

The five factor model of personality is a useful metric to describe personality profiles associated with maladaptive functioning. Using the NEO-Five Factor Inventory (NEO-FFI), we examined a conceptually based profile of high neuroticism, low agreeableness and low conscientiousness among 243 youth (aged 13-18 years) with varying degrees of conduct disorder (CD) and substance use disorders (SUD). Comparisons of the NEO-FFI personality dimensions between CD/SUD youth and adolescent siblings (N=173), and relations between the personality dimensions and behavioral indicators of conduct disorder and substance involvement were examined. Youth with CD and SUD had greater neuroticism, lower agreeableness, and lower conscientiousness than siblings of a similar age. The NEO-FFI scales predicted aggression and substance involvement for both probands and siblings in this cross-sectional investigation. These findings support the role for personality in models of the etiology and persistence of conduct disorder and substance use disorders.

Avoidant personality disorder

MedlinePlus

... Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

Dreams and Nightmares in Personality Disorders.

PubMed

Schredl, Michael

2016-02-01

Although the relationship between dreaming and psychopathology has been studied quite extensively, research on dreaming in patients with personality disorders has been very scarce. In patients with borderline personality disorder, negatively toned dreams and heightened nightmare frequency have been found-characteristics not determined by co-morbid depression or posttraumatic stress disorder. The review includes suggestions for future studies as the existing results clearly indicate that this line of research is most interesting. Lastly, clinical recommendations especially regarding the treatment of the often found co-morbid nightmare disorder will be given.

[Antisocial personality disorder].

PubMed

Repo-Tiihonen, Eila; Hallikainen, Tero

2016-01-01

Antisocial personality disorder (ASP), especially psychopathy as its extreme form, has provoked fear and excitement over thousands of years. Ruthless violence involved in the disorder has inspired scientists, too.The abundance of research results concerning epidemiology, physiology, neuroanatomy, heritability, and treatment interventions has made ASP one of the best documented disorders in psychiatry. Numerous interventions have been tested, but there is no current treatment algorithm. Biological and sociological parameters indicate the importance of early targeted interventions among the high risk children. Otherwise, as adults they cause the greatest harm. The use of medications or psychotherapy for adults needs careful consideration.

An assessment of the Standardized Assessment of Personality as a screening instrument for the International Personality Disorder Examination: a comparison of informant and patient assessment for personality disorder.

PubMed

Mann, A H; Raven, P; Pilgrim, J; Khanna, S; Velayudham, A; Suresh, K P; Channabasavanna, S M; Janca, A; Sartorius, N

1999-07-01

The International Personality Disorder Examination (IPDE) has been developed as a standardized interview for personality disorders. While it has good psychometric properties, its length makes it difficult to use in the community in population research, particularly outside psychiatric settings. The informant-based Standard Assessment of Personality (SAP), which has been in use since 1981, could serve as a valid screen to detect likely personality disordered individuals who would then receive a definitive diagnosis by IPDE. This study aimed to compare the two instruments in their capacity to detect personality disorder according to ICD-10 taxonomy and to estimate the efficiency of the use of the two together in a case-finding exercise. Ninety psychiatric out-patients in Bangalore, India, were assessed for personality disorder using the two methods. Assessment was conducted by a pair of trained interviewers in random order and by random allocation to interviewer. Overall agreement between the two instruments in the detection of ICD-10 personality disorder was modest (kappa = 0.4). The level of agreement varied according to personality category, ranging from kappa 0.66 (dependent) to kappa 0.09 (dyssocial). The SAP proved to have a high negative predictive value (97%) for IPDE as the gold standard, suggesting its potential as a screen in samples where the expected prevalence of personality disorder is low. A two-stage approach to epidemiological studies of personality disorder may be practicable.

Specific personality traits and general personality dysfunction as predictors of the presence and severity of personality disorders in a clinical sample.

PubMed

Berghuis, Han; Kamphuis, Jan H; Verheul, Roel

2014-01-01

This study examined the associations of specific personality traits and general personality dysfunction in relation to the presence and severity of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) personality disorders in a Dutch clinical sample. Two widely used measures of specific personality traits were selected, the Revised NEO Personality Inventory as a measure of normal personality traits, and the Dimensional Assessment of Personality Pathology-Basic Questionnaire as a measure of pathological traits. In addition, 2 promising measures of personality dysfunction were selected, the General Assessment of Personality Disorder and the Severity Indices of Personality Problems. Theoretically predicted associations were found between the measures, and all measures predicted the presence and severity of DSM-IV personality disorders. The combination of general personality dysfunction models and personality traits models provided incremental information about the presence and severity of personality disorders, suggesting that an integrative approach of multiple perspectives might serve comprehensive assessment of personality disorders.

The relationship of social anxiety disorder symptoms with probable attention deficit hyperactivity disorder in Turkish university students; impact of negative affect and personality traits of neuroticism and extraversion.

PubMed

Evren, Cuneyt; Dalbudak, Ercan; Ozen, Secil; Evren, Bilge

2017-08-01

The aim of the present study was to evaluate relationship of social anxiety disorder symptoms with probable attention deficit hyperactivity disorder (ADHD) while controlling the personality traits of neuroticism and extraversion, anxiety and depression symptoms in a sample of Turkish university students (n=455). Participants were evaluated with the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Eysenck Personality Questionnaire Revised-Abbreviated Form (EPQR-A), the Adult ADHD Self-Report Scale (ASRS-v1.1) and the Liebowitz Social Anxiety Scale (LSAS). Severity of social anxiety, depression, anxiety and neuroticism were higher among those with probable ADHD, whereas extraversion score did not differ between the groups. The severity of ADHD score, particularly hyperactivity/impulsivity score, was related with the "fear or anxiety" together with low extraversion (introversion) and high neuroticism dimensions of personality, whereas the severity of ADHD score, both inatentiveness and hyperactivity/impulsivity scores, was related with "avoidence" together with low extraversion (introversion) dimension of personality. These findings suggest that probable ADHD and severity of ADHD symptoms are related with both "fear or anxiety" and "avoidance" of social anxiety, while personality dimensions of low extraversion (introversion) and high neuroticism may have an effect on this relationships among young adults. Copyright © 2017. Published by Elsevier B.V.

Early-onset obsessive-compulsive disorder and personality disorders in adulthood.

PubMed

Maina, Giuseppe; Albert, Umberto; Salvi, Virginio; Pessina, Enrico; Bogetto, Filippo

2008-03-15

Obsessive-compulsive disorder (OCD) often emerges in childhood or adolescence. The aim of the present study was to evaluate whether adult patients with prepuberal onset differ from subjects with later onset in terms of personality disorder comorbidity. The Structured Clinical Interview for DSM-IV Axis II Disorders was used to assess 148 patients with a principal diagnosis of OCD according to the Structured Clinical Interview for DSM-IV Axis I Disorders. The following two subgroups of subjects were selected according to the age at onset of symptomatology: patients with an early-onset (< or =10 years), and patients with a later onset (> or =17 years). Of the 148 patients screened for the present study, 33 (22.3%) had an early onset and 1369 (46.6%) had a later onset. With regard to personality disorders, early-onset patients showed more OC personality disorders (OCPD) than later onset patients. Our finding suggests that OCD in childhood increases the risk for developing OCPD in adulthood, or that early-onset OCD and OCPD share a common pathogenesis.

Normal personality, personality disorder and psychosis: current views and future perspectives.

PubMed

Balaratnasingam, Sivasankaran; Janca, Aleksandar

2015-01-01

The purpose of this article is to review recent literature examining the occurrence of psychotic experiences in normal population and those with personality disorders. Up to 15% of individuals in the general population report some type or degree of psychotic experience. Most of these individuals function adequately, do not require psychiatric treatment and do not receive diagnosis of a psychotic illness. A significant number of individuals diagnosed with borderline personality disorder (25-50%) also report psychotic symptoms. These are not easily differentiated from the psychotic symptoms reported by individuals with schizophrenia, nor are they always transient. However, emerging research has confirmed that individuals with schizotypal personality disorder are dimensionally related to those with schizophrenia and are at an increased risk of transition to psychosis. Psychotic symptoms are best considered as 'trans-diagnostic' entities on a continuum from normal to pathological. There is a large body of evidence for a dimensional relationship between schizotypal personality disorder and schizophrenia. There is also a significant amount of research showing that psychotic symptoms in borderline personality disorder are frequent, nontransient and represent a marker of illness severity. This review highlights the need to move beyond traditional assumptions and categorical boundaries when evaluating psychotic experiences and psychopathological phenomena.

Personality disorders as maladaptive, extreme variants of normal personality: borderline personality disorder and neuroticism in a substance using sample.

PubMed

Samuel, Douglas B; Carroll, Kathleen M; Rounsaville, Bruce J; Ball, Samuel A

2013-10-01

Although the current diagnostic manual conceptualizes personality disorders (PDs) as categorical entities, an alternative perspective is that PDs represent maladaptive extreme versions of the same traits that describe normal personality. Existing evidence indicates that normal personality traits, such as those assessed by the five-factor model (FFM), share a common structure and obtain reasonably predictable correlations with the PDs. However, very little research has investigated whether PDs are more extreme than normal personality traits. Utilizing item-response theory analyses, the authors of the current study extend previous research to demonstrate that the diagnostic criterion for borderline personality disorder and FFM neuroticism could be fit along a single latent dimension. Furthermore, the authors' findings indicate that the borderline criteria assessed the shared latent trait at a level that was more extreme (d = 1.11) than FFM neuroticism. This finding provides further evidence for dimensional understanding of personality pathology and suggests that a trait model in DSM-5 should span normal and abnormal personality functioning, but focus on the extremes of these common traits.

Personality Traits and Comorbidity in Adults With ADHD.

PubMed

Instanes, Johanne Telnes; Haavik, Jan; Halmøy, Anne

2016-10-01

To assess personality traits using the Temperament and Character Inventory (TCI) in a group of 63 previously diagnosed ADHD patients and 68 population controls and investigate the impact of common comorbid psychiatric disorders on these personality measures. Psychiatric comorbidity was assessed with the Mini International Neuropsychiatric Interview Plus and personality traits by the TCI. The patient group had significantly higher scores on the TCI dimensions Harm avoidance and Novelty seeking compared with the control group. However, when adjusting for comorbid anxiety and depressive disorder, the ADHD group no longer showed higher Harm avoidance than the control group. The difference in Novelty seeking between the patient and control groups was correlated with lifetime diagnosis of antisocial personality disorder (ASPD). It is important to take comorbid psychiatric disorders into account while investigating personality traits in ADHD. © The Author(s) 2013.

A study of chemokines, chemokine receptors and interleukin-6 in patients with panic disorder, personality disorders and their co-morbidity.

PubMed

Ogłodek, Ewa A; Szota, Anna M; Just, Marek J; Szromek, Adam R; Araszkiewicz, Aleksander

2016-08-01

Stress may induce inflammatory changes in the immune system and activate pro-inflammatory cytokines and their receptors by activating the hypothalamic-pituitary-adrenal axis. 460 hospitalized patients with panic disorders (PD) and/or personality disorders (P) were studied. The study group comprised subjects with PD, avoidant personality disorder (APD), borderline personality disorder (BPD), obsessive-compulsive personality disorder (OCPD), and concomitant (PD+APD; PD+BPD; PD+OCPD). Each study group consisted of 60 subjects (30 females and 30 males). The control group included 20 females and 20 males without any history of mental disorder. ELISA was used to assess the levels of chemokines: CCL-5/RANTES (regulated on activation, normal T-cell expressed and secreted), CXCL-12/SDF-1 (stromal derived factor), their receptors CXCR-5 (C-C chemokine receptor type-5), CXCR-4 (chemokine C-X-C motif receptor-4), and IL-6. Statistically significant differences in the levels of CCL-5 and CCR-5 were revealed between all study groups. The greatest differences were found between the groups with PD+OCPD and PD+APD. Moreover, concomitance of PD with P significantly increased the level of chemokines and their receptors in all study groups versus the subjects with P alone. The results of the study show differences between the groups. To be specific, inflammatory markers were more elevated in the study groups than the controls. Therefore, chemokines and chemokine receptors may be used as inflammatory markers in patients with PD co-existent with P to indicate disease severity. PD was found to be a factor in maintaining inflammatory activity in the immune system in patients with P. Copyright © 2016 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

CONTINUITY OF AXES I AND II: TOWARD A UNIFIED MODEL OF PERSONALITY, PERSONALITY DISORDERS, AND CLINICAL DISORDERS

PubMed Central

Krueger, Robert F.

2008-01-01

In the current standard psychiatric nomenclature, the DSM–IV–TR (APA, 2000), mental disorders are divided into two groups: Clinical Disorders (CDs) and Personality Disorders (PDs), and CD and PD diagnoses are recorded on two separate axes (Axes I and II, respectively). This article considers evidence regarding putative bases for distinguishing between CDs and PDs, and finds that these constructs are more similar than distinct. Links between the domains may be better understood by focusing on how personality connects CDs and PDs. This perspective underlines the need to work toward a more unified model of personality, PDs, and CDs in research and in future editions of the DSM. PMID:16175735

Development of an integrated model of personality, personality disorders and severe axis I disorders, with special reference to major affective disorders.

PubMed

von Zerssen, Detlev

2002-04-01

A unidimensional model of the relationships between normal temperament, psychopathic variants of it and the two main forms of so-called endogenous psychoses (major affective disorders and schizophrenia) was derived from Kretschmer's constitutional typology. It was, however, not confirmed by means of a biometric approach nor was Kretschmer's broad concept of cyclothymia as a correlate of physical stoutness on the one hand and major affective disorders on the other supported by empirical data. Yet the concept of the 'melancholic type' of personality of patients with severe unipolar major depression (melancholia) which resembles descriptions by psychoanalysts could be corroborated. This was also true for the 'manic type' of personality as a (premorbid) correlate of predominantly manic forms of a bipolar I disorder. As predicted from a spectrum concept of major affective disorders, the ratio of traits of either type co-varied with the ratio of the depressive and the manic components in the long-term course of such a disorder. The two types of premorbid personality and a rare variant of the 'manic type', named 'relaxed, easy-going type', were conceived as 'affective types' dominating in major affective disorders. They are opposed to three 'neurotoid types' prevailing in so-called neurotic disorders as well as in schizophrenic psychoses. The similarity among the types can be visualized as spatial relationships in a circular, i.e. a two-dimensional, model (circumplex). Personality disorders as maladapted extreme variants of personality are, by definition, located outside the circle, mainly along its 'neurotoid' side. However, due to their transitional nature, axis I disorders cannot be represented adequately within the plane which represents (adapted as well as maladapted) forms of habitual behaviour (personality types and disorders, respectively). To integrate them into the spatial model of similarity interrelations, a dimension of actual psychopathology has to be added

Mental disorder and violence: personality dimensions and clinical features.

PubMed

Nestor, Paul G

2002-12-01

This review examines the role of personality dimensions in the greater rates of violence that have now been established to accompany certain classes of mental disorders. Empirical studies are reviewed that have often used objective measures of personality and epidemiological samples with low levels of subject selection biases. The risk of violence may be understood in terms of four fundamental personality dimensions: 1) impulse control, 2) affect regulation, 3) narcissism, and 4) paranoid cognitive personality style. Low impulse control and affect regulation increase the risk for violence across disorders, especially for primary and comorbid substance abuse disorders. By contrast, paranoid cognitive personality style and narcissistic injury increase the risk for violence, respectively, in persons with schizophrenia spectrum disorders and in samples of both college students and individuals with personality disorders. This review supports the hypothesis that these four fundamental personality dimensions operate jointly, and in varying degrees, as clinical risk factors for violence among groups with these classes of mental disorders.

Using the mood disorder questionnaire and bipolar spectrum diagnostic scale to detect bipolar disorder and borderline personality disorder among eating disorder patients

PubMed Central

2013-01-01

Background Screening scales for bipolar disorder including the Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) have been plagued by high false positive rates confounded by presence of borderline personality disorder. This study examined the accuracy of these scales for detecting bipolar disorder among patients referred for eating disorders and explored the possibility of simultaneous assessment of co-morbid borderline personality disorder. Methods Participants were 78 consecutive female patients who were referred for evaluation of an eating disorder. All participants completed the mood and eating disorder sections of the SCID-I/P and the borderline personality disorder section of the SCID-II, in addition to the MDQ and BSDS. Predictive validity of the MDQ and BSDS was evaluated by Receiver Operating Characteristic analysis of the Area Under the Curve (AUC). Results Fifteen (19%) and twelve (15%) patients fulfilled criteria for bipolar II disorder and borderline personality disorder, respectively. The AUCs for bipolar II disorder were 0.78 (MDQ) and 0.78 (BDSD), and the AUCs for borderline personality disorder were 0.75 (MDQ) and 0.79 (BSDS). Conclusions Among patients being evaluated for eating disorders, the MDQ and BSDS show promise as screening questionnaires for both bipolar disorder and borderline personality disorder. PMID:23443034

Rating of personality disorder features in popular movie characters.

PubMed

Hesse, Morten; Schliewe, Sanna; Thomsen, Rasmus R

2005-12-08

Tools for training professionals in rating personality disorders are few. We present one such tool: rating of fictional persons. However, before ratings of fictional persons can be useful, we need to know whether raters get the same results, when rating fictional characters. Psychology students at the University of Copenhagen (N = 8) rated four different movie characters from four movies based on three systems: Global rating scales representing each of the 10 personality disorders in the DSM-IV, a criterion list of all criteria for all DSM-IV personality disorders in random order, and the Ten Item Personality Inventory for rating the five-factor model. Agreement was estimated based on intraclass-correlation. Agreement for rating scales for personality disorders ranged from 0.04 to 0.54. For personality disorder features based on DSM-IV criteria, agreement ranged from 0.24 to 0.89, and agreement for the five-factor model ranged from 0.05 to 0.88. The largest multivariate effect was observed for criteria count followed by the TIPI, followed by rating scales. Raters experienced personality disorder criteria as the easiest, and global personality disorder scales as the most difficult, but with significant variation between movies. Psychology students with limited or no clinical experience can agree well on the personality traits of movie characters based on watching the movie. Rating movie characters may be a way to practice assessment of personality.

Identifying Personality Disorders that are Security Risks: Field Test Results

DTIC Science & Technology

2011-09-01

clinical personality disorders, namely psychopathy, malignant narcissism , and borderline personality organization, can increase the likelihood of...ratings indicated that three personality disorders, psychopathy, malignant narcissism , and borderline personality organization, were associated with...certain clinical personality disorders and unreliable and unsafe behavior in the workplace, disorders such as psychopathy and malignant narcissism

Antisocial personality disorder with and without antecedent childhood conduct disorder: does it make a difference?

PubMed

Walters, Glenn D; Knight, Raymond A

2010-04-01

The purpose of this study was to test whether prior conduct disorder increased deviance in persons diagnosed with antisocial personality disorder. One hundred and three male inmates satisfying adult antisocial and conduct disorder criteria for antisocial personality disorder achieved significantly higher scores on self-report measures of criminal thinking and antisocial attitudes than 137 male inmates satisfying only the adult criteria for antisocial personality disorder and 87 male nonantisocial inmates. Inmates satisfying adult antisocial and conduct disorder criteria for antisocial personality disorder were also more likely to receive disciplinary infractions for misconduct than inmates in the other two conditions. The theoretical, diagnostic, and practical implications of these results are discussed.

Effects of Personality Disorders on Functioning and Well-Being in Major Depressive Disorder

PubMed Central

SKODOL, ANDREW E.; GRILO, CARLOS M.; PAGANO, MARIA E.; BENDER, DONNA S.; GUNDERSON, JOHN G.; SHEA, M. TRACIE; YEN, SHIRLEY; ZANARINI, MARY C.; MCGLASHAN, THOMAS H.

2008-01-01

Background Patients with depressive disorders have limitations in physical and emotional functioning comparable to patients with chronic medical conditions. Personality disorders (PDs) are also known to be associated with functional impairment. Aims To determine the effects of PDs on the functioning and well-being of patients with major depressive disorder (MDD). Method In the Collaborative Longitudinal Personality Disorders Study, 668 patients who met criteria for schizotypal, borderline, avoidant, or obsessive-compulsive PDs or for MDD and no PD were assessed with semi-structured interviews at baseline, 6, 12, 24, and 36 months. In this study, 151 patients who met criteria for current MDD at the 36-month follow-up were compared on the basis of the presence (n = 118) or absence (n = 33) of persistent PD. Physical and social/emotional functioning and well-being were assessed using the Medical Outcomes Study (MOS) Short-Form Health Survey (SF-36). These results were compared with those of a sample of patients with MDD seen in the mental health specialty sector who were followed in the Medical Outcomes Study. Results Patients with MDD and co-occurring PD had significantly more impairment on scales measuring role limitations due to emotional problems, social functioning, and general health perceptions than patients with MDD and no PD. Although patients with MDD and no PD were found to have levels of functioning and well-being that were lower in several domains than those previously reported in depressed patients recruited from mental health settings, patients with MDD and co-occurring PD were found to have much lower levels of functioning in all areas than reported samples. Conclusions Co-occurring PDs contribute significantly to impairment in social and emotional functioning and reduced well-being in patients with MDD. PMID:16304504

The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence.

PubMed

McGlashan, T H; Grilo, C M; Skodol, A E; Gunderson, J G; Shea, M T; Morey, L C; Zanarini, M C; Stout, R L

2000-10-01

To describe baseline diagnostic co-occurrence in the Collaborative Longitudinal Personality Disorders Study. Six hundred and sixty-eight patients were reliably assessed with diagnostic interviews for DSM-IV Axis I and II disorders to create five groups: Schizotypal (STPD), Borderline (BPD), Avoidant (AVPD), Obsessive-Compulsive (OCPD) and Major Depressive Disorder (MDD) without personality disorder (PD). Mean number of Axis I lifetime diagnoses was 3.4; STPD and BPD groups had more diagnoses than AVPD, OCPD, and MDD groups. Significant Axis I co-occurrences emerged for Social Phobia/ AVPD, PTSD/BPD and Substance Use/BPD. Mean number of co-occurring PDs was 1.4; STPD had more than BPD group which had more than AVPD and OCPD groups. Significant PD co-occurrence emerged for: STPD/ Paranoid and Schizoid PDs, BPD with Antisocial and Dependent PDs, and lower frequency for OCPD/Antisocial PD. Diagnostic co-occurrences generally followed base rates, while significant departures resemble those of controlled literature.

Everyday Strivings in War Veterans With Posttraumatic Stress Disorder: Suffering From a Hyper-Focus on Avoidance and Emotion Regulation

PubMed Central

Kashdan, Todd B.; Breen, William E.; Julian, Terri

2014-01-01

This research investigated whether combat veterans' daily strivings are related to the presence of post-traumatic stress disorder (PTSD) and well-being. Veterans created a list of their most important strivings, which were content-analyzed for emotion regulation and approach or avoidance themes. It was hypothesized that veterans pursuing strivings with themes of emotion regulation or avoidance experience deleterious consequences compared with other veterans. For all veterans, devoting finite time and energy in daily life to regulating emotions was associated with less purpose, meaning, and joy compared with other strivings. Veterans with PTSD endorsed more strivings related to emotion regulation and devoted considerable effort to emotion regulation and avoidance strivings. Yet, these efforts failed to translate into any discernible benefits; veterans without PTSD derived greater joy and meaning from strivings focusing on approac- oriented behavior and themes other than emotion regulation. The presence of PTSD and a high rate of emotion regulation strivings led to the lowest global well-being and daily self-esteem during a 14-day assessment period. The presence of PTSD and a high rate of avoidance strivings also led to lower emotional well-being. Results indicate that strivings devoted to regulating emotions or avoidance efforts influence the mental health of veterans with and without PTSD. Studying personality at different levels of analysis—traits, strivings, and life narratives—allows for a fine-grained understanding of emotional disorders. PMID:20569784

Culture and personality disorder: a focus on Indigenous Australians.

PubMed

Balaratnasingam, Sivasankaran; Janca, Aleksandar

2017-01-01

To examine the validity of concept and diagnosis of personality disorder in transcultural settings using Indigenous Australian people as an example. There are significant deficits in comparative research on personality disorders across cultures. There is also a dearth of information regarding Indigenous Australians, and cultural applicability and clinical utility of the diagnosis of personality disorder in this group. The concept of culture is generally ignored when making a diagnosis of personality disorder. A valid diagnosis should incorporate what would be considered understandable and adaptive behavior in a person's culture. In Indigenous Australian culture, making diagnosis of a personality disorder is complicated by historical trauma from colonization, disruption of kinship networks, and ongoing effects of poverty and social marginalization.

Eating disorders in children: is avoidant-restrictive food intake disorder a feeding disorder or an eating disorder and what are the implications for treatment?

PubMed

Kennedy, Grace A; Wick, Madeline R; Keel, Pamela K

2018-01-01

Avoidant-restrictive food intake disorder (ARFID) is a current diagnosis in the "Feeding and Eating Disorders" section of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) and captures a heterogeneous presentation of eating disturbances. In recent years, ARFID has been studied primarily within the context of eating disorders despite having historical roots as a feeding disorder. The following review examines ARFID's similarities with and differences from feeding disorders and eating disorders, focusing on research published within the last three years. Implications of this differentiation for treatment are discussed.

Integrative Treatment of Personality Disorder. Part I: Psychotherapy.

PubMed

Jovanovic, Mirjana Divac; Svrakic, Dragan

2017-03-01

In this paper, we outline the concept of integrative therapy of borderline personality, also referred to as fragmented personality, which we consider to be the core psychopathology underlying all clinical subtypes of personality disorder. Hence, the terms borderline personality, borderline disorder, fragmented personality, and personality disorder are used interchangeably, as synonyms. Our integrative approach combines pharmacotherapy and psychotherapy, each specifically tailored to accomplish a positive feedback modulation of their respective effects. We argue that pharmacotherapy and psychotherapy of personality disorder complement each other. Pharmacological control of disruptive affects clears the stage, in some cases builds the stage, for the psychotherapeutic process to take place. In turn, psychotherapy promotes integration of personality fragments into more cohesive structures of self and identity, ultimately establishing self-regulation of mood and anxiety. We introduce our original method of psychotherapy, called reconstructive interpersonal therapy (RIT). The RIT integrates humanistic-existential and psychodynamic paradigms, and is thereby designed to accomplish a deep reconstruction of core psychopathology within the setting of high structure. We review and comment the current literature on the strategies, goals, therapy process, priorities, and phases of psychotherapy of borderline disorders, and describe in detail the fundamental principles of RIT.

Enhanced Avoidance Habits in Obsessive-Compulsive Disorder

PubMed Central

Gillan, Claire M.; Morein-Zamir, Sharon; Urcelay, Gonzalo P.; Sule, Akeem; Voon, Valerie; Apergis-Schoute, Annemieke M.; Fineberg, Naomi A.; Sahakian, Barbara J.; Robbins, Trevor W.

2014-01-01

Background Obsessive-compulsive disorder (OCD) is a psychiatric condition that typically manifests in compulsive urges to perform irrational or excessive avoidance behaviors. A recent account has suggested that compulsivity in OCD might arise from excessive stimulus-response habit formation, rendering behavior insensitive to goal value. We tested if OCD patients have a bias toward habits using a novel shock avoidance task. To explore how habits, as a putative model of compulsivity, might relate to obsessions and anxiety, we recorded measures of contingency knowledge, explicit fear, and physiological arousal. Methods Twenty-five OCD patients and 25 control subjects completed a shock avoidance task designed to induce habits through overtraining, which were identified using goal-devaluation. The relationship between habitual behavior, erroneous cognitions, and physiological arousal was assessed using behavior, questionnaires, subjective report, and skin conductance responses. Results A devaluation sensitivity test revealed that both groups could inhibit unnecessary behavioral responses before overtraining. Following overtraining, OCD patients showed greater avoidance habits than control subjects. Groups did not differ in conditioned arousal (skin conductance responses) at any stage. Additionally, groups did not differ in contingency knowledge or explicit ratings of shock expectancy following the habit test. Habit responses were associated with a subjective urge to respond. Conclusions These data indicate that OCD patients have a tendency to develop excessive avoidance habits, providing support for a habit account of OCD. Future research is needed to fully characterize the causal role of physiological arousal and explicit fear in habit formation in OCD. PMID:23510580

Behavioral avoidance mediates the relationship between anxiety and depressive symptoms among social anxiety disorder patients.

PubMed

Moitra, Ethan; Herbert, James D; Forman, Evan M

2008-10-01

This study investigated the relationship between social anxiety, depressive symptoms, and behavioral avoidance among adult patients with Social Anxiety Disorder (SAD). Epidemiological literature shows SAD is the most common comorbid disorder associated with Major Depressive Disorder (MDD), though the relationship between these disorders has not been investigated. In most cases, SAD onset precedes MDD, suggesting symptoms associated with SAD might lead to depression in some people. The present study addressed this question by investigating the mediational role of behavioral avoidance in this clinical phenomenon, using self-report data from treatment-seeking socially anxious adults. Mediational analyses were performed on a baseline sample of 190 individuals and on temporal data from a subset of this group. Results revealed behavioral avoidance mediated this relationship, and supported the importance of addressing such avoidance in the therapeutic setting, via exposure and other methods, as a possible means of preventing depressive symptom onset in socially anxious individuals.

Depressive Personality Disorder: A Review of the Literature.

ERIC Educational Resources Information Center

Sale, Beverley A.

The question of whether or not depressive personality disorder is a distinct disorder separate from mood disorders or other personality disorders has historically been debated by researchers and theorists and continues to be a topic of disagreement. Empirical studies reveal that only a modest relationship may exist between depressive personality…

Convergent validity of alternative MMPI-2 personality disorder scales.

PubMed

Hicklin, J; Widiger, T A

2000-12-01

The Morey, Waugh, and Blashfield (1985) MMPI (Hathaway et al., 1989) personality disorder scales provided a significant contribution to personality disorder research and assessment. However, the subsequent revisions to the MMPI and the multiple revisions to the diagnostic criteria sets that have since occurred may have justified comparable revisions to these scales. Somwaru and Ben-Porath (1995) selected a substantially different set of items from the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) to assess Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) personality disorder diagnostic criteria. In our study, we compared the convergent validity of these alternative MMPI-2 personality disorder scales with respect to 3 self-report measures of personality disorder symptomatology in a sample of 82 psychiatric outpatients. The results suggested that Somwaru and Ben-Porath's scales are as valid as the original Morey et al. scales and might be even more valid for the assessment of borderline, antisocial, and schizoid personality disorder symptomatology.

Personality Disorder in Adult Attention-Deficit/Hyperactivity Disorder: Attrition and Change During Long-term Treatment.

PubMed

Gift, Thomas E; Reimherr, Frederick W; Marchant, Barrie K; Steans, Tammy A; Wender, Paul H

2016-05-01

Personality disorders (PDs) are commonly found in adults with attention-deficit/hyperactivity disorder (ADHD) and are associated with increased ADHD symptoms and psychosocial impairment. To assess the impact of PDs or personality traits on retention rates in ADHD trials and whether treating ADHD affects the expression of PD, data were analyzed from 2 methylphenidate trials. Assessment of PDs and personality traits included using the Wisconsin Personality Disorders Inventory IV and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Personality Disorders. Attention-deficit/hyperactivity disorder symptoms were evaluated using the Wender-Reimherr Adult Attention Deficit Disorder Scale. Major findings were that subjects with cluster A, cluster B, passive-aggressive, or more than 1 PD showed more attrition. Subjects dropping out also had more schizoid and narcissistic traits. Attention-deficit/hyperactivity disorder symptoms (p < 0.001) and all personality traits (range, p = 0.03 to p = 0.001) improved, but there was almost no correlation between changes on these 2 measures. Conversely, of 11 Wisconsin Personality Disorders Inventory IV items that improved most, 8 resembled ADHD or oppositional defiant disorder symptoms.

Rating of personality disorder features in popular movie characters

PubMed Central

Hesse, Morten; Schliewe, Sanna; Thomsen, Rasmus R

2005-01-01

Background Tools for training professionals in rating personality disorders are few. We present one such tool: rating of fictional persons. However, before ratings of fictional persons can be useful, we need to know whether raters get the same results, when rating fictional characters. Method Psychology students at the University of Copenhagen (N = 8) rated four different movie characters from four movies based on three systems: Global rating scales representing each of the 10 personality disorders in the DSM-IV, a criterion list of all criteria for all DSM-IV personality disorders in random order, and the Ten Item Personality Inventory for rating the five-factor model. Agreement was estimated based on intraclass-correlation. Results Agreement for rating scales for personality disorders ranged from 0.04 to 0.54. For personality disorder features based on DSM-IV criteria, agreement ranged from 0.24 to 0.89, and agreement for the five-factor model ranged from 0.05 to 0.88. The largest multivariate effect was observed for criteria count followed by the TIPI, followed by rating scales. Raters experienced personality disorder criteria as the easiest, and global personality disorder scales as the most difficult, but with significant variation between movies. Conclusion Psychology students with limited or no clinical experience can agree well on the personality traits of movie characters based on watching the movie. Rating movie characters may be a way to practice assessment of personality. PMID:16336663

Where is the Personality in Personality Disorder Assessment? A Comparison Across Four Sets of Personality Disorder Scales

ERIC Educational Resources Information Center

Trobst, Krista K.; Ayearst, Lindsay E.; Salekin, Randall T.

2004-01-01

The present research examined the amount and kind of personality measured within four sets of personality disorder (PD) scales. Three samples of undergraduate students (Ns = 326, 537, and 617) completed at least one PD measure and a combined interpersonal circumplex model (ICM) and five-factor model (FFM) measure. The FFM dimensions were found to…

PDTRT special section: Methodological issues in personality disorder research.

PubMed

Widiger, Thomas A

2017-10-01

Personality Disorders: Theory, Research, and Treatment includes a rolling, ongoing Special Section concerned with methodological issues in personality disorder research. This third edition of this series includes two articles. The first is by Brian Hicks, Angus Clark, and Emily Durbin: "Person-Centered Approaches in the Study of Personality Disorders." The second article is by Steve Balsis: "Item Response Theory Applications in Personality Disorder Research." Both articles should be excellent resources for future research and certainly manuscripts submitted to this journal that use these analytic tools. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Eating disorders in children: is avoidant-restrictive food intake disorder a feeding disorder or an eating disorder and what are the implications for treatment?

PubMed Central

Kennedy, Grace A.; Wick, Madeline R.; Keel, Pamela K.

2018-01-01

Avoidant-restrictive food intake disorder (ARFID) is a current diagnosis in the “Feeding and Eating Disorders” section of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) and captures a heterogeneous presentation of eating disturbances. In recent years, ARFID has been studied primarily within the context of eating disorders despite having historical roots as a feeding disorder. The following review examines ARFID’s similarities with and differences from feeding disorders and eating disorders, focusing on research published within the last three years. Implications of this differentiation for treatment are discussed. PMID:29399331

Metacognition moderates the relationship of disturbances in attachment with severity of borderline personality disorder among persons in treatment of substance use disorders.

PubMed

Outcalt, Jared; Dimaggio, Giancarlo; Popolo, Raffaele; Buck, Kelly; Chaudoin-Patzoldt, Kelly A; Kukla, Marina; Olesek, Kyle L; Lysaker, Paul H

2016-01-01

Borderline personality disorder traits have been observed to be linked with both insecure attachment styles as well as deficits in mentalizing and metacognition. Less is known, however, about how attachment style does or does not interact with deficits in mentalizing and metacognition to create, sustain, or influence levels of borderline personality disorder traits. In this study, we examined the hypothesis that metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems, moderates the relationship of anxious attachment style with the severity of borderline personality disorder traits. Concurrent assessments were gathered of metacognitive mastery using the Metacognitive Assessment Scale Abbreviated, anxious attachment style using the Experiences of in Close Relationships Scale, and borderline personality disorder traits using the Structured Clinical Interview for DSM-IV Axis II Disorders. Participants were 59 adults in an early phase of recovery from substance use disorders in a residential setting. Multiple regression revealed that metacognitive mastery moderated the relationship of anxious attachment style with the number of borderline personality disorder traits. A median split of the anxious attachment and metacognitive mastery scores was performed yielding 4 groups. An analysis of covariance revealed that participants with higher levels of anxious attachment and poorer metacognitive mastery had more borderline personality disorder traits did than the other groups after controlling for levels of psychopathology. Insecure attachment may be associated with higher number of borderline personality disorder traits in the presence of deficits in metacognitive mastery. Patients with substance use and borderline personality disorder traits may benefit from treatment which addresses metacognitive mastery. Published by Elsevier Inc.

Heritability and linkage analysis of personality in bipolar disorder.

PubMed

Greenwood, Tiffany A; Badner, Judith A; Byerley, William; Keck, Paul E; McElroy, Susan L; Remick, Ronald A; Dessa Sadovnick, A; Kelsoe, John R

2013-11-01

The many attempts that have been made to identify genes for bipolar disorder (BD) have met with limited success, which may reflect an inadequacy of diagnosis as an informative and biologically relevant phenotype for genetic studies. Here we have explored aspects of personality as quantitative phenotypes for bipolar disorder through the use of the Temperament and Character Inventory (TCI), which assesses personality in seven dimensions. Four temperament dimensions are assessed: novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (PS). Three character dimensions are also included: self-directedness (SD), cooperativeness (CO), and self-transcendence (ST). We compared personality scores between diagnostic groups and assessed heritability in a sample of 101 families collected for genetic studies of BD. A genome-wide SNP linkage analysis was then performed in the subset of 51 families for which genetic data was available. Significant group differences were observed between BD subjects, their first-degree relatives, and independent controls for all but RD and PS, and all but HA and RD were found to be significantly heritable in this sample. Linkage analysis of the heritable dimensions produced several suggestive linkage peaks for NS (chromosomes 7q21 and 10p15), PS (chromosomes 6q16, 12p13, and 19p13), and SD (chromosomes 4q35, 8q24, and 18q12). The relatively small size of our linkage sample likely limited our ability to reach genome-wide significance in this study. While not genome-wide significant, these results suggest that aspects of personality may prove useful in the identification of genes underlying BD susceptibility. © 2013 Elsevier B.V. All rights reserved.

Dreams of personality disordered subjects.

PubMed

Guralnik, O; Levin, R; Schmeidler, J

1999-01-01

Dreams provide access to underlying personality structure, defensive and adaptive functions, and they elucidate the psychological forces that lead to overt symptomatic behavior. Two hundred three dreams of 39 personality disordered patients were factor analyzed and compared with Hall and Van de Castle's normative data (Hall C, Van de Castle RI [1966] The content analysis of dreams. New York: Appleton-Century-Crofts). Results included a five-factor solution that sheds light on some core issues of the dreamers. Comparisons between the groups resulted in the personality-disordered group demonstrating more estrangement in their dreams, fewer interactions, and more emotionality. In their interactions, they demonstrated a lower ratio of aggressive interactions yet a higher tendency to view themselves as the aggressor. Results are related to theoretical literature on personality and defensive styles, mostly from a psychodynamic perspective.

Conscientiousness and obsessive-compulsive personality disorder.

PubMed

Samuel, Douglas B; Widiger, Thomas A

2011-07-01

A dimensional perspective on personality disorder hypothesizes that the current diagnostic categories represent maladaptive variants of general personality traits. However, a fundamental foundation of this viewpoint is that dimensional models can adequately account for the pathology currently described by these categories. While most of the personality disorders have well established links to dimensional models that buttress this hypothesis, obsessive-compulsive personality disorder (OCPD) has obtained only inconsistent support. The current study administered multiple measures of 1) conscientiousness-related personality traits, 2) DSM-IV OCPD, and 3) specific components of OCPD (e.g., compulsivity and perfectionism) to a sample of 536 undergraduates who were oversampled for elevated OCPD scores. Six existing measures of conscientiousness-related personality traits converged strongly with each other supporting their assessment of a common trait. These measures of conscientiousness correlated highly with scales assessing specific components of OCPD, but obtained variable relationships with measures of DSM-IV OCPD. More specifically, there were differences within the conscientiousness instruments such that those designed to assess general personality functioning had small to medium relationships with OCPD, but those assessing more maladaptive variants obtained large effect sizes. These findings support the view that OCPD does represent a maladaptive variant of normal-range conscientiousness.

Dependent personality features in a complex case of borderline personality disorder.

PubMed

Nirestean, Tudor; Lukacs, Emese; Nirestean, Aurel; Gabos Grecu, Iosif

2016-11-01

Borderline personality disorder is a complex disease model as it encompasses a diversity of pathological personality traits and psychopathological symptoms. It is not surprising, therefore, that it is often manifested by personality disorders across all three clusters and accompanied by other mental (Axis I) disorders. This melange makes both psychological treatment and pharmacotherapy especially challenging, and this paper describes the case of a particularly complex case of a 33-year-old Romanian patient, who has a history of severe deprivation in childhood, mood and substance use disorder in association with borderline pathology. In the course of treatment from many sources and interventions, it has become clear that dependence is a key component of the pathology and has been rewarded with a degree of success in management. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Personality disorder features as predictors of symptoms five years post-treatment.

PubMed

Jansson, Irene; Hesse, Morten; Fridell, Mats

2008-01-01

Personality disorders are associated with dysfunction in a variety of areas. Recent longitudinal research has shown that personality disorders are also predictive of problems later in life, as well as of poor response to treatment of depression and anxiety. This study assessed whether personality disorder features were associated with psychiatric symptoms in a cohort of women treated for substance abuse in Sweden. Patients were diagnosed with personality disorders using the Structured Clinical Interview for DSM-IV (SCID-II) personality questionnaire and SCID-II interview, and were then administered a self-report questionnaire designed to measure symptoms of psychiatric illness, the Symptoms Checklist-90 (SCL-90), during and five years after treatment. Concurrently, features of all personality disorders, except histrionic, were associated with SCL-90 score. At five-year follow-up, most personality disorders remained associated with SCL-90 score, with the exception of paranoid and schizoid personality disorder. After controlling for baseline score on the SCL-90, conduct disorder, borderline personality disorder, and narcissistic personality disorder remained significantly associated with symptoms at follow-up. After controlling for abstinence and baseline score, only borderline personality disorder features remained associated with SCL-90 score at follow-up. Patients with personality disorders should be monitored after treatment for psychiatric symptoms.

Impulsive personality traits in male pedophiles versus healthy controls: is pedophilia an impulsive-aggressive disorder?

PubMed

Cohen, Lisa J; Gans, Sniezyna Watras; McGeoch, Pamela G; Poznansky, Olga; Itskovich, Yelena; Murphy, Sean; Klein, Erik; Cullen, Ken; Galynker, Igor I

2002-01-01

Pedophilia is characterized by sexual attraction to prepubescent children. Despite the extensive literature documenting the pervasive and pernicious effects of childhood sexual abuse, there is surprisingly little psychiatric literature on pedophilia and its etiology remains enigmatic. In recent years, the psychiatric literature on the phenomenology, neurobiology, and treatment of impulsive-aggressive disorders has grown significantly. As some investigators have conceptualized pedophilia as an impulsive-aggressive disorder, it is of interest whether recent advances in the study of impulsive-aggressive disorders might shed light on pathological mechanisms underlying pedophilia. In the following study, 20 male subjects with a DSM-IV diagnosis of pedophilia, heterosexual type were recruited from an outpatient facility for sexual offenders and compared to 24 demographically similar control subjects. Groups were compared on three personality instruments--the Millon Clinical Multiaxial Inventory-II (MCMI-II), the Temperament and Character Inventory (TCI), and the Dimensional Assessment of Personality Impairment-Questionnaire (DAPI-Q)--to assess for select impairment in impulsive-aggressive personality traits. Pedophiles showed severe and pervasive personality impairment relative to controls. Although there was evidence of impulsivity, the findings do not suggest a predominance of impulsive-aggressive traits, and in fact provide evidence of inhibition, passive-aggression, and harm avoidance. The notion of "compulsive-aggression" in pedophilia is proposed.

Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder

PubMed Central

Aymamí, N.; Jiménez-Murcia, S.; Granero, R.; Ramos-Quiroga, J. A.; Fernández-Aranda, F.; Claes, L.; Sauvaget, A.; Grall-Bronnec, M.; Gómez-Peña, M.; Savvidou, L. G.; Fagundo, A. B.; del Pino-Gutierrez, A.; Moragas, L.; Casas, M.; Penelo, E.; Menchón, J. M.

2015-01-01

Objectives. (1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. Method. A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. Results. Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18–35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. Conclusion. The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits. PMID:26229967

Personality Disorders in Obsessive-Compulsive Disorder: A Comparative Study versus Other Anxiety Disorders

PubMed Central

Pena-Garijo, Josep; Edo Villamón, Silvia; Ruipérez, M. Ángeles

2013-01-01

Objective. The purpose of this paper is to provide evidence for the relationship between personality disorders (PDs), obsessive compulsive disorder (OCD), and other anxiety disorders different from OCD (non-OCD) symptomatology. Method. The sample consisted of a group of 122 individuals divided into three groups (41 OCD; 40 non-OCD, and 41 controls) matched by sex, age, and educational level. All the individuals answered the IPDE questionnaire and were evaluated by means of the SCID-I and SCID-II interviews. Results. Patients with OCD and non-OCD present a higher presence of PD. There was an increase in cluster C diagnoses in both groups, with no statistically significant differences between them. Conclusions. Presenting anxiety disorder seems to cause a specific vulnerability for PD. Most of the PDs that were presented belonged to cluster C. Obsessive Compulsive Personality Disorder (OCPD) is the most common among OCD. However, it does not occur more frequently among OCD patients than among other anxious patients, which does not confirm the continuum between obsessive personality and OCD. Implications for categorical and dimensional diagnoses are discussed. PMID:24453917

Sustained unemployment in psychiatric outpatients with bipolar depression compared to major depressive disorder with comorbid borderline personality disorder.

PubMed

Zimmerman, Mark; Martinez, Jennifer H; Young, Diane; Chelminski, Iwona; Dalrymple, Kristy

2012-12-01

The morbidity associated with bipolar disorder is, in part, responsible for repeated calls for improved detection and recognition. No such clinical commentary exists for improved detection of borderline personality disorder in depressed patients. Clinical experience suggests that borderline personality disorder is as disabling as bipolar disorder; however, no studies have directly compared the two disorders. For this reason we undertook the current analysis from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project comparing unemployment and disability rates in patients with bipolar disorder and borderline personality disorder. Patients were interviewed with semi-structured interviews. We compared three non-overlapping groups of depressed patients: (i) 181 patients with DSM-IV major depressive disorder and borderline personality disorder, (ii) 1068 patients with major depressive disorder without borderline personality disorder, and (iii) 84 patients with bipolar depression without borderline personality disorder. Compared to depressed patients without borderline personality disorder, depressed patients with borderline personality disorder were significantly more likely to have been persistently unemployed. A similar difference was found between patients with bipolar depression and major depressive disorder without borderline personality disorder. No differences were found between patients with bipolar depression and depression with borderline personality disorder. Both bipolar disorder and borderline personality disorder were associated with impaired occupational functioning and thus carry a significant public health burden. Efforts to improve detection of borderline personality disorder in depressed patients might be as important as the recognition of bipolar disorder. © 2012 John Wiley and Sons A/S.

Comorbidity of Personality Disorders and Adult Attention Deficit Hyperactivity Disorder (ADHD)--Review of Recent Findings.

PubMed

Matthies, Swantje; Philipsen, Alexandra

2016-04-01

Children suffering from attention deficit hyperactivity disorder (ADHD) may remit until adulthood. But, more than 60-80% have persisting ADHD symptoms. ADHD as an early manifesting neurodevelopmental disorder is considered a major risk factor for the development of comorbid psychiatric disorders in later life. Particularly, personality disorders are oftentimes observed in adult patients suffering from ADHD. If ADHD and personality disorders share common etiological mechanisms and/or if ADHD as a severely impairing condition influences psychological functioning and learning and leads to unfavorable learning histories is unclear. The development of inflexible and dysfunctional beliefs on the basis of real and perceived impairments or otherness due to the core symptoms of ADHD is intuitively plausible. Such beliefs are a known cause for the development of personality disorders. But, why some personality disorders are more frequently found in ADHD patients as for example antisocial and borderline personality disorder remains subject of debate. Because of the high prevalence of ADHD and the high impact of personality disorders on daily functioning, it is important to take them into account when treating patients with ADHD. Research on the developmental trajectories leading to personality disorders in adult ADHD patients might open the door for targeted interventions to prevent impairing comorbid clinical pictures.

Personality Trait Differences in Boys and Girls with Clinical or Sub-Clinical Diagnoses of Conduct Disorder versus Antisocial Personality Disorder

ERIC Educational Resources Information Center

Taylor, Jeanette; Iacono, William G.

2007-01-01

This study tested differences in personality traits measured by the Multidimensional Personality Questionnaire (MPQ) in a community sample of adolescents with definite or probable conduct disorder (CD) diagnoses that did not progress to a diagnosis of antisocial personality disorder (ASPD) by early adulthood (n=43), those with definite or probable…

High Prevalence of Personality Disorders in Skin-restricted Lupus Patients.

PubMed

Jalenques, Isabelle; Rondepierre, Fabien; Massoubre, Catherine; Bonnefond, Sophie; Schwan, Raymond; Labeille, Bruno; Perrot, Jean-Luc; Collange, Marianne; Mulliez, Aurelien; D'Incan, Michel

2017-08-31

Psychiatric and personality disorders have been extensively documented in patients with systemic lupus erythematosus (SLE). However, the prevalence of personality disorders in skin-restricted lupus (SRL) patients remains unknown. The aim of this study was to assess the prevalence of personality disorders in SRL outpatients and to examine the associated factors. We evaluated 60 SRL outpatients and 118 controls matched for sex, age and education level. On the basis of the Personality Diagnostic Questionnaire 4+, 38% of patients vs 20% of controls fulfilled the criteria for at least one personality disorder (OR 2.2 [95% CI 1.01-4.6], p = 0.048). Only one patient with a personality disorder had specialised mental health care. Late lupus onset and more frequent past treatments by thalidomide were associated factors. This study evidences a high prevalence of personality disorders in SRL patients and shows that most SRL patients with personality disorder do not receive specialised mental health care.

Non-suicidal Self-injury in Different Eating Disorder Types: Relevance of Personality Traits and Gender.

PubMed

Islam, Mohammed A; Steiger, Howard; Jimenez-Murcia, Susana; Israel, Mimi; Granero, Roser; Agüera, Zaida; Castro, Rita; Sánchez, Isabel; Riesco, Nadine; Menchón, José M; Fernández-Aranda, Fernando

2015-11-01

The study explored lifetime prevalence of non-suicidal self-injury (NSSI) in female and male individuals with eating disorders (ED) and compared ED symptoms, general psychopathology and personality traits across individuals with and without a history of NSSI. The incremental discriminative capacity of gender on the manifestation of lifetime NSSI was also studied. A total sample of 1649 consecutively admitted ED patients (1515 women and 134 men) participated in the current study [339 ED + NSSI (ED with NSSI) and 1310 ED - NSSI (ED without NSSI)]. Specific self-report measures were included and other clinical and psychopathological indices. The observed lifetime prevalence of NSSI was 20.6% (20.9% in women and 17.2% in men). NSSI was not associated with ED type or gender. However, ED + NSSI patients exhibited more impulsive behaviour, substance-abuse disorders and additional impulse-control disorders, were younger and had more previous treatments. Age was shown to affect the presentation of NSSI. Additionally, ED + NSSI patients exhibited more severe ED and general psychopathological symptoms and had more dysfunctional personality traits when compared with ED - NSSI. ED + NSSI was found to be positively associated with harm avoidance and self-transcendence but negatively with reward dependence, self-directedness and cooperativeness. Thus, the variables with stronger capacity to identify the presence of ED + NSSI were younger age, harm avoidance, self-directedness and self-transcendence. A lack of association between sex and ED subtype with the presence of NSSI was observed. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

Comorbidity between personality disorders and depressive symptomatology in women: A cross-sectional study of three different transitional life stages.