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PubMed1987

Covariation of criteria sets for avoidant, schizoid, and dependent personality disorders.

Avoidant personality disorder was a new addition to DSM-III. Reaction to its inclusion was mixed. Critics cited the lack of empirical data and the overlap with schizoid disorder. The authors consider the overlap and covariation among avoidant, schizoid, and dependent symptoms and diagnoses in a sample of 84 inpatients diagnosed by using a semistructured interview. Items for avoidant disorder covaried with criteria for dependent disorder but not with criteria for schizoid disorder. The authors point out the implications of these results for the revision of DSM-III (DSM-III-R).

Adult↗
PubMed1988

Techniques in the treatment of multiple personality disorder.

Multiple personality disorder, once considered to be rare, is being diagnosed with increasing frequency in the 1980s. The purpose of this paper is to present and discuss twenty techniques used in the treatment of multiple personality disorder. The primary treatment is psychotherapy but a number of adjuvant interventions are also required. The techniques discussed should be of use to therapists and represent a step towards definition of a treatment package for controlled trials, of which none have been conducted to date.

Abreaction↗
PubMed1999

Factors differentiating personality-disordered individuals with and without a history of unipolar mood disorder.

The relationship between mood disorders and personality disorders has been of longstanding interest to clinicians. Despite theoretical reasons to do so, virtually no studies have examined factors that discriminate personality-disordered subjects with a history of mood disorder (PD/HMD) from personality-disordered subjects without a history of mood disorder (PD). This study examined demographic variables, patterns of comorbidity, measures of life functioning, personality traits, and early life experiences differentiating PD/HMD (n = 83) from PD (n = 214). Diagnoses were assigned using structured clinical interviews and a best-estimate procedure. The results suggest that subjects with borderline personality disorder are more likely to have a life history of mood disorder than are subjects with other personality disorders. In addition, PD/HMDs are more likely to receive a diagnosis of anxiety disorder or alcoholism, to have lower Global Assessment of Functioning (GAF) scores, and to have sought treatment than PDs. On self-report measures of personality, PD/HMDs endorse higher levels of trait anxiety and affective lability (e.g., Harm Avoidance, Neuroticism) than do PDs. PD/HMDs are also more likely to report childhood physical and emotional abuse than are PDs, and to describe their parents as using affectionless control. No differences were found between Axis II clusters as a function of mood disorder history. The discussion suggests a potential model in which early environmental stress interacts with constitutional vulnerabilities to put individuals at an increased risk for both mood and anxiety disorders as well as personality disorders.

Adolescent↗
PubMed1988

Comparing three systems for diagnosing narcissistic personality disorder.

Narcissistic personality disorder (NPD) has been a widely used diagnostic entity. However, opinions about its descriptive validity differ considerably. Hitherto, three diagnostic systems have been developed, those by DSM-III, Akhtar and Thomson, and Kernberg. This paper compares these three systems with respect to concordance among diagnostic criteria, and conceptual themes around which the criteria cluster. The results indicate low concordance among the specific criteria used in these systems but a consensus about the conceptual themes describing self-experience, interpersonal relations and other aspects of NPD. This suggests that NPD is comprised of some core characteristics. However, a reconceptualization of the understanding of NPD must precede further empirical investigations.

Humans↗
PubMed1994

Epidemiology of psychiatric disorders in Edmonton. Antisocial personality disorders.

3258 randomly selected adult household residents of Edmonton, Canada, were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). 104 subjects fulfilled DSM-III antisocial personality disorder (ASP) criteria. Lifetime prevalence rates were found to be significantly higher in males and in the younger adult age groups. The age of onset (i.e. age at which conduct disorder symptoms first appeared) was found to be under 10 years in the majority of cases, with females lagging just slightly behind males. Symptom patterns and frequencies were examined and the relative risks for these symptoms were calculated. Comorbidity, calculated using full DSM-III severity criteria, but without exclusion criteria, revealed an increased prevalence of nearly every other psychiatric disorder in those with antisocial personality disorder, with 90.4% having at least one other lifetime psychiatric diagnosis.

Adolescent↗
PubMed2002

[Personality and personality disorders II. The Specificity of the DAPP-model as a diagnostic system for personality disorders].

The 'Dimensional Assessment of Personality Pathology - Basic Questionnaire' (DAPP) measures 18 traits to provide a systematic representation of the overall domain of personality disorders (PD). The present study investigated the relationships between DAPP personality profiles and dimensional assessments of DSM-IV PD in general population subjects (n = 156), and a sample of 220 nonpsychotic psychiatric patients (including n = 67 PD patients). Using nonmetric multidimensional scaling models the similarities between the 18 DAPP-factors and the dimensional scores of the 12 DSM-IV PD (inclusive appendix) were graphically represented in a 2-dimensional similarity-system. Here each DSM-IV PD dimension could be described by a distinct profile of DAPP-factors. Overall results support the assumption that PD can be represented by a dimensional system of personality traits with sufficient sensitivity and specificity.

Humans↗
PubMed1991

Factor structure of DSM-III-R personality disorders shown by self-report questionnaire: implications for classifying and assessing personality disorders.

A modified version of the revised Personality Diagnostic Questionnaire (PDQ-R), based on DSM-III-R personality disorders (PD), was completed by 74 psychiatric patients. A factor analysis of the scores for each of the PD (i.e. of the number of positive DSM-III-R criteria for each of the PD) yielded 3 factors that defined 3 PD clusters. These were similar to the 3 DMS-III-R PD clusters for 7 of the 11 PD categories. The 3-group solution of a cluster analysis of the patients (using their scores of positive criteria for each of the PD) did not reflect these factors; the main discriminating variable between the 3 groups of patients was the total number of positive PD criteria. It is suggested that, for the routine assessment of patients, the most important derivative of the DSM-III-R classification of PD is the total score of positive PD criteria.

Adult↗
PubMed2006

Possible link between childhood separation anxiety and adulthood personality disorder in patients with anxiety disorders in Japan.

OBJECTIVE: The aim of this study was to examine whether childhood separation anxiety symptoms associate with adulthood anxiety disorders or personality disorders. METHOD: Separation Anxiety Symptom Inventory (SASI), Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), and Global Assessment of Functioning (GAF) were administered to 134 outpatients with anxiety disorders and SASI was administered to 176 healthy volunteers (controls) recruited in Japan from April 1999 through November 2003. RESULTS: SASI scores were not correlated with age or sex in controls. In contrast, SASI scores were higher in patients with anxiety disorders than in controls, especially in women. SASI showed good test-retest reliability (Pearson correlation coefficient = 0.8). One hundred thirteen patients (84.3%) had no comorbid anxiety disorder while 21 (15.7%) had any, and those with comorbid anxiety disorder tended to show higher SASI scores (p = .053). In total, 60 (44.8%) of 134 patients had at least 1 personality disorder, and the most frequent disorders were from cluster C (36.6%). The subgroup with comorbid personality disorders showed earlier onset (p < .01), higher SASI scores (p < .01), and poorer recovery of global functioning (p < .05) than the noncomorbid subgroup. Stepwise multiple regression analysis revealed that SASI scores were higher in female (p < .05) and younger (p < .01) patients and most strongly correlated with number of comorbid personality disorders in adulthood (p < .01). CONCLUSION: These results suggest that there is a continuum of anxiety disorders from childhood to adulthood, the severity of separation anxiety appears to increase the risk of severe anxious-fearful personality disorders in adulthood, and those with severe separation anxiety, particularly females, may progress to suffer from comorbid adult anxiety disorders.

Adult↗
PubMed2005

Bipolar disorder with comorbid cluster B personality disorder features: impact on suicidality.

BACKGROUND: Because of their overlapping phenomenology and mutually chronic, persistent nature, distinctions between bipolar disorder and cluster B personality disorders remain a source of unresolved clinical controversy. The extent to which comorbid personality disorders impact course and outcome for bipolar patients also has received little systematic study. METHOD: One hundred DSM-IV bipolar I (N = 73) or II (N = 27) patients consecutively underwent diagnostic evaluations with structured clinical interviews for DSM-IV Axis I and cluster B Axis II disorders, along with assessments of histories of childhood trauma or abuse. Cluster B diagnostic comorbidity was examined relative to lifetime substance abuse, suicide attempt histories, and other clinical features. RESULTS: Thirty percent of subjects met DSM-IV criteria for a cluster B personality disorder (17% borderline, 6% antisocial, 5% histrionic, 8% narcissistic). Cluster B diagnoses were significantly linked with histories of childhood emotional abuse (p = .009), physical abuse (p = .014), and emotional neglect (p = .022), but not sexual abuse or physical neglect. Cluster B comorbidity was associated with significantly more lifetime suicide attempts and current depression. Lifetime suicide attempts were significantly associated with cluster B comorbidity (OR = 3.195, 95% CI = 1.124 to 9.088), controlling for current depression severity, lifetime substance abuse, and past sexual or emotional abuse. CONCLUSIONS: Cluster B personality disorders are prevalent comorbid conditions identifiable in a substantial number of individuals with bipolar disorder, making an independent contribution to increased lifetime suicide risk.

Adult↗
PubMed1998

Personality disorders and relationship to personality dimensions measured by the Temperament and Character Inventory in patients with obsessive-compulsive disorder.

The occurrence of personality disorders was investigated in 36 patients with obsessive-compulsive disorder by means of the SCID Screen questionnaire. In addition, the personality dimensions were explored by means of the Temperament and Character Inventory (TCI). In total, 75% of the patients fulfilled the criteria for a personality disorder according to the SCID Screen questionnaire, mostly (55%) within cluster C. Several significant correlations were found between the separate personality disorders (PD) and subscales of the TCI, the most pronounced being between avoidant and obsessive-compulsive PD and novelty-seeking and self-directedness. Strong correlations were also found between self-directedness and paranoid and borderline PD. In multiple regressions where the presence of PD in clusters A, B and C, respectively, were used as dependent variables and where the separate subscales of the TCI were used as independent variables, the multiple R reached 0.68, 0.76 and 0.80 in clusters A, B and C, respectively. Thus 46-64% of the variance in the personality disorder clusters could be explained by the TCI subscales.

Adult↗
PubMed1995

Somatoform and personality disorders: syndromal comorbidity and overlapping developmental pathways.

We review the literature on the relationship between somatoform disorders and personality disorders, which reveals that approximately two in three patients with a somatoform disorder meet criteria for a personality disorder. We suggest that the most clinically salient problems presented by patients with somatoform disorders reflect dysfunctions of personality. We also examine research on the childhood antecedents of somatoform disorders and argue for reconsidering somatoform disorders, along with personality disorders, as disorders of development. Our argument involves rejecting the traditional approach to classification in favour of a prototypical polythetic view. We also suggest that the perspectives of developmental psychopathology and life-span research offer more to this field than the search for biological substrates or principles based on descriptive psychopathology, which to date have yielded meagre research findings with limited clinical utility.

Adolescent↗
PubMedDate not supplied

Evaluation of DSM-IV personality disorder criteria as assessed by the structured clinical interview for DSM-IV personality disorders.

The primary objective of this research was to investigate the psychometric and diagnostic efficiency properties of DSM-IV personality disorder (PD) criteria as assessed by the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Logistic regression analyses were also employed to identify discriminating and nondiscriminating diagnostic criteria within specific PD categories. Results based on a community sample of 149 psychotropic medication-free persons, 58% of whom had at least one PD as determined from the SCID-II, suggest problems with the assessment and/or conceptualization of some PD categories, most notably obsessive-compulsive PD. For many PD concepts, diagnostic criteria were identified that either detracted from the overall internal consistency and diagnostic efficiency of their associated PD criteria set or failed to uniquely discriminate individuals with specific PDs from those without. Most of these findings cannot be clearly attributed to limitations associated with the method used to assess PD criteria.

Adult↗
PubMed1994

The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders.

BACKGROUND: One of the aims of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration joint program on psychiatric diagnosis and classification is the development and standardization of diagnostic assessment instruments for use in clinical research worldwide. The International Personality Disorder Examination (IPDE) is a semistructured clinical interview compatible with the International Classification of Diseases, Tenth Revision, and the DMS-III-R classification systems. This is the first report of the results of a field trial to investigate the feasibility of using the IPDE to assess personality disorders worldwide. METHODS: The IPDE was administered by 58 psychiatrists and clinical psychologists to 716 patients enrolled in clinical facilities at 14 participating centers in 11 countries in North America, Europe, Africa, and Asia. To determine interrater reliability, 141 of the IPDEs (20%) were independently rated by a silent observer. To determine temporal stability, 243 patients (34%) were reexamined after an average interval of 6 months. RESULTS: The IPDE proved acceptable to clinicians and demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. CONCLUSION: It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.

Adult↗
PubMed2006

Social-emotion recognition in borderline personality disorder.

Borderline personality disorder (BPD) is characterized by interpersonal disturbances, but the neurocognitive aspects of these symptoms are poorly understood. We hypothesized that patients with BPD have impaired perception of emotional expressions, which are related to symptoms of interpersonal dysfunction. To control potential confounding factors, this study excluded subjects with comorbid diagnoses known to be associated with impaired affect perception. We tested 43 outpatients with BPD and 26 healthy controls on emotion recognition tasks (facial, prosodic, and integrated facial/prosodic), nonemotional facial feature recognition, and interpersonal antagonism (Buss-Durkee Hostility Index). Patients with BPD showed normal ability to recognize isolated facial or prosodic emotions but had impaired recognition of emotions in integrated facial/prosodic stimuli, as well as impaired discrimination of nonemotional facial features. In patients with BPD, impaired recognition of integrated emotional stimuli was associated with interpersonal antagonism, particularly suspiciousness and assaultiveness. These results suggest that patients with BPD have deficits in higher order integration of social information, which may be related to some of the more serious symptoms of the disorder.

Adult↗
PubMed1996

The morbidity of DSM-III-R dependent personality disorder.

Dependent personality has long been discussed by clinicians, and by empirical researchers more recently. Little empirical evidence so far has been presented as the type and degree of disability with which it is associated. This report provides some empirical data in that regard. To examine this question, those with and without DSM-III-R dependent personality were compared in male veterans drawn from an outpatient psychiatry clinic (dependent and nondependent groups). Standardized interview assessments were used to determine axes I and II disorders and family history. The dependent personality disorder group had significantly lower socioeconomic status and poorer functioning in the family/home sphere. They had significantly more social phobia, borderline traits, and histrionic traits. In relatives, there was significantly more generalized anxiety disorder, simple phobia, drug abuse, and dramatic personality disorder cluster. There are clearly documentable vulnerabilities and morbidities associated with dependent personality disorder.

Ambulatory Care↗
PubMed2002

Personality and mood correlates of avoidant personality disorder.

Avoidant personality disorder (APD) has been recognized as prevalent and clinically important; however, it is not clear how APD maps onto established personality and mood dimensions. In this cross-sectional survey study, 365 college students completed questionnaires assessing APD features and theoretically relevant personality and mood dimensions. Based on these self-report data, 6.6% may meet DSM-IV criteria for APD. Hierarchical regression analyses showed that APD features were associated with introversion, neuroticism, low self-esteem, and pessimistic expectancies. Additionally, APD features were linked with self-reports of elevated emotional responsiveness to threats and reduced emotional responsiveness to incentives (the behavioral inhibition system and behavioral activation system scales). After controlling for the effects of other personality, temperament, and cognitive measures, affective distress (i.e., anger, anxiety, and depression) was no longer related to APD. Results are consistent with APD models that emphasize the joint influences of emotional vulnerability and social-cognitive triggering and sustaining factors.

Adolescent↗