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PubMed2003

Interpersonal analysis of grandiose and vulnerable narcissism.

This article examines the validity of grandiose and vulnerable subtypes of narcissistic character styles through an analysis of personality disorder criteria, interpersonal problems, and adult attachment styles in a nonclinical population. The grandiose personalities in this sample were rated high in the dramatic traits associated with narcissistic, antisocial, and histrionic personality disorders based on a diagnostic interview, and they reported domineering and vindictive interpersonal problems. However, despite the observation of narcissistic personality pathology, they denied interpersonal distress related to their interpersonal problems and the majority reported adult attachment styles reflective of positive self-representations (Secure, Dismissive). Vulnerable narcissistic individuals were represented by high ratings on avoidant personality disorder based on a diagnostic interview. They reported high interpersonal distress and greater domineering, vindictive, cold, and socially avoidant interpersonal problems. The majority reported adult attachment styles reflective of negative self-representations (Fearful, Preoccupied). The validity of grandiose and vulnerable narcissism based upon the results of this study was discussed in terms of clinical theory and with reference to the implications of two subtypes of narcissism for diagnosis and treatment.

Adolescent↗
PubMed2005

Adolescent attachment styles and their relation to the temperament and character traits of personality in a general population.

Attachment styles as well as personality traits in adolescents and adults have been found to be associated with their health outcomes and with their personality pathology. In this cross-sectional exploratory study, we study the relationship between attachment styles that derive from our data employing the items of Feeney et al. (1994) self-report attachment style questionnaire (ASQ), and personality traits given by the junior version of Cloninger et al. (1993) self-report temperament and character inventory (TCI), in a sample of 426 adolescents (54% females) from a general population. The secure attachment style was correlated significantly negatively with the personality trait harm avoidance (HA), but significantly positively with the personality traits novelty seeking (NS), reward dependence (RD), cooperativeness (CO) and self-transcendence (ST). The preoccupied (anxious/ambivalent) attachment style was correlated significantly positively with HA and NS, but significantly negatively with self-directedness (SD). The fearful-avoidant category was correlated significantly negatively with NS. Our five-factor solution of the attachment styles and their relation to the TCI point towards a need for a modification of the two-axis, four-category attachment model of Bartholomew (1990) and Bartholomew and Horowitz (1991), with their category dismissing-avoidant replaced by the two categories defined here as dismissing relations (correlated significantly negatively with CO) and dismissing others (correlated significantly negatively with RD and significantly positively with SD).

Adolescent↗
PubMed1998

Self-report assessment of the DSM-IV personality disorders. Measurement of trait and distress characteristics: the ADP-IV.

BACKGROUND: Self-report instruments assessing the DSM personality disorders are characterized by overdiagnosis due to their emphasis on the measurement of personality traits rather than the impairment and distress associated with the criteria. METHODS: The ADP-IV, a Dutch questionnaire, introduces an alternative assessment method: each test item assesses 'Trait' as well as 'Distress/impairment' characteristics of a DSM-IV criterion. This item format allows dimensional as well as categorical diagnostic evaluations. The present study explores the validity of the ADP-IV in a sample of 659 subjects of the Flemish population. RESULTS: The dimensional personality disorder subscales, measuring Trait characteristics, are internally consistent and display a good concurrent validity with the Wisconsin Personality Disorders Inventory. Factor analysis at the item-level resulted in 11 orthogonal factors, describing personality dimensions such as psychopathy, social anxiety and avoidance, negative affect and self-image. Factor analysis at the subscale-level identified two basic dimensions, reflecting hostile (DSM-IV Cluster B) and anxious (DSM-IV Cluster C) interpersonal attitudes. Categorical ADP-IV diagnoses are obtained using scoring algorithms, which emphasize the Trait or the Distress concepts in the diagnostic evaluation. Prevalences of ADP-IV diagnoses of any personality disorder according to these algorithms vary between 2.28 and 20.64%. CONCLUSIONS: Although further research in clinical samples is required, the present results support the validity of the ADP-IV and the potential of the measurement of trait and distress characteristics as a method for assessing personality pathology.

Adolescent↗
PubMed2004

The wish to die and the wish to commit suicide in the adolescent: two different matters?

We shall try to demonstrate the difference between two wishes--the wish to die and the wish to commit suicide--as they express themselves during adolescence. First, death is seen as irreversible, while the suicidal act, at least during adolescence, is seen as reversible. While thoughts of suicide may be a part of normal adolescence, and the suicidal act a manifestation of pathological development specific to this stage in life, the wish to die has no age restrictions and may accompany life as a shadow, devoid of any suicidal act, for many years. It should be noted that both of these wishes may be balanced with the wish to live. Pathology appears when there is an imbalance of wishes and abnormal developmental processes. This imbalance can result in two distinct activities: suicidal acts and death behaviors. We suggest that the two stem from different mechanisms and personality pathologies. Therefore, they should be evaluated separately in order to better understand differences between suicidal and other aggressive acts and manifestations of the death wish during adolescence.

Adolescent↗
PubMed2006

Is the appendix a useful appendage? An empirical examination of depressive, passive-aggressive (negativistic), sadistic, and self-defeating personality disorders.

Decisions about whether to include depressive, passive-aggressive, sadistic, and self-defeating disorders in Axis II have been made difficult by a relative dearth of data. We report the results of a study identifying potential defining features of these diagnoses and assessing their distinctiveness from other Axis II personality disorders (PDs). A national sample of experienced psychiatrists and psychologists used the SWAP-200 to describe a patient with a current axis II disorder or an appendix or deleted PD from DSM-II-R. We examined clinicians' descriptions of patients to identify their most characteristic features, and then applied an empirical clustering procedure, Q-factor analysis, to see whether versions of these disorders would emerge empirically. As currently conceptualized, only passive-aggressive PD was distinct from other PDs. When the data were subjected to Q-factor analysis, the first and largest grouping was a dysphoric (depressive) PD. A hostile-negativistic subcategory emerged that resembled passive-aggressive PD, along with a revised dependent diagnosis that included many self-defeating/masochistic features. The results suggest that a depressive or dysphoric personality may represent an internalizing spectrum of personality pathology, and that a hostile-negativistic PD may be distinct from the disorders in the text of DSM-IV. Sadistic and self-defeating PD do not appear to represent distinct disorders, although they include personality traits (sadism and revictimization) associated with distinct developmental histories.

Depression↗
PubMed2003

[Epidemiological study of the hepatitis C virus in our population and vaccine coverage].

OBJECTIVE: Epidemiological study of patients with chronic hepatitis C and its serological status in relation to the hepatitis A (HA) and B (HB) viruses. DESIGN: Descriptive cross-sectional study. SETTING: Two urban health centres. Participants. 291 patients with chronic hepatitis C. MAIN MEASUREMENTS VARIABLES: age, sex, year and reason for diagnosis, personal histories, alcohol intake, serological status of the HA and HB viruses and HIV, and initial level of transaminases. RESULTS: Mean age, 55 +/- 16. Sex, 52% women. Prevalence, 0.98%. Reason for diagnosis, 41% health study, 15% study of hepatic pathology, 18% study of other pathologies. Personal histories, surgical intervention, 37.5%; intravenous drug users, 21.4%; transfusion, 14%; high-risk sexual conduct, 2.4%; health material used more than once, 2.4%; family member HC positive, 1.4%; no personal history recorded, 26.5%. Alcoholism, 17.9%. Mean transaminases: AST, 79.7 +/- 100 (9-920); ALT, 114.8 +/- 160 (6-1640). HB serological status: natural immunity, 22%; chronic, 9%; vaccine immunity, 3%; negative, 44%; not recorded, 21%. HA serological status: natural immunity, 2%; vaccine immunity, 2.5%; negative, 9%; not recorded, 87%. HIV-positive: 4.5%. CONCLUSIONS: Prevalence was below the expected level. Knowledge of serological status needs to be improved, especially for HA. The degree of vaccine coverage in these patients for HA and HB should be increased.

Adult↗
PubMed2005

The construct of effortful control: an approach to borderline personality disorder heterogeneity.

BACKGROUND: The present study investigated the heterogeneity of DSM-IV borderline personality disorder (BPD) diagnosis as a function of the construct of effortful control. We hypothesized 3 subgroups of BPD patients based on effortful control, that would also differ in other areas of functioning, such as symptoms, interpersonal relations and personality organization. SAMPLING AND METHODS: Forty-seven clinically referred individuals were reliably diagnosed as meeting DSM-IV criteria for BPD using semistructured interviews. Effortful control, symptomatology, interpersonal functioning and personality organization were assessed using self-report questionnaires. RESULTS: Cluster and profile analyses were performed and identified 3 subgroups. Subgroup 1, with high effortful control, exhibited the fewest problems in symptoms, interpersonal functioning and personality organization. Subgroup 3, with low ratings of effortful control, had the most problems in these areas, and subgroup 2, a group high in some aspects of effortful control but low in others, ranged midway between groups 1 and 3. DISCUSSION: The findings indicate a relationship between attentional mechanisms and the clinical expression of borderline personality pathology. Effortful control is a valuable construct for identifying subgroups of BPD patients, thus helping to understand the heterogeneity in BPD. Limitations of the study include the exclusive use on self-report of effortful control, as well as the small sample size. Future research should further investigate the associations of neurocognition and borderline pathology, as well as different approaches to treatment of the different BPD subgroups.

Adult↗
PubMed2002

Personality traits and socio-epidemiological status of hospitalised elderly benzodiazepine users.

OBJECTIVE: to define personality traits and socio-epidemiological status of hospitalised elderly chronic benzodiazepine (BZD) users. METHODS: this case controlled study assessed psychological characteristics (using the Millon Clinical Multiaxial Inventory-MCMI-I) and socio-epidemiological status (sex, age, education, marital status and housing) in 40 hospitalised geriatric patients taking BZDs for at least 3 months and 40 non-users, excluding dementia. RESULTS: comparisons between groups: Compulsive personality pattern was more pronounced in the control group (p = 0.008). Severe personality pathology: a predisposition to borderline disorder was stronger among the BZD-users (p = 0.001). Clinical syndromes: anxiety, dysthymic disorder (p < 0.001) and tendency to alcohol dependence (p = 0.020) prevailed in the BZD-users. No severe syndromes were found. Widowed persons were more prevalent between the BZD-users (p = 0.03). All significant differences resulted from disparities between females. Predictors of BZD-use and clustering of traits: Dysthymic disorder was predictive of BZD-use (odds ratio (OR) 6.3 [95% confidence intervals (CI) 2.2-18.2]). It was strongly correlated with anxiety (r(s) = 0.93) and somatoform disorder (r(s) = 0.71). Dysthymic disorder and alcohol dependence predicted BZD-use in women (OR 15.3 [CI: 2.4-95.7] and OR 9.1 [CI: 1.2-64.9], respectively). There were no specific predictors in men. CONCLUSIONS: chronic elderly BZD-users are typically widowed females with dysthymic disorder, anxiety, predisposition to alcohol dependence and borderline disorder. Before prescribing BZDs, it is important to recognize the nature of the elderly population at risk for BZD-use and to consider a broader-ranging therapeutic management of the predisposing personality traits.

Aged↗
PubMed2006

What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases.

Since the first reports of transient global amnesia (TGA) were published in 1956, several neuropsychological and functional imaging studies have shed light on different aspects of this neurological syndrome. By establishing diagnostic criteria, Hodges and Warlow (1990b) have made it far easier to identify clinical TGA-related features. However, no comprehensive survey has been yet carried out in order to validate their criteria/findings or provide information about previously unknown features. In the present paper, (i) we review the literature published since Hodges and Warlow's study and seek to characterize the demographic and clinical features of TGA more accurately, (ii) we report 142 personal TGA cases, with supplementary information regarding both episodes and patients, such as precipitating events, associated symptoms and personality, and (iii) we suggest the existence of different groups of TGA patients, on the basis of a hierarchical cluster analysis. This revealed that in women, episodes are mainly associated with an emotional precipitating event, a history of anxiety and a pathological personality. In men, they occur more frequently after a physical precipitating event. In younger patients, a history of headaches may constitute an important risk factor. No link was found with vascular risk factors. The relevance of each of the above-mentioned variables is discussed in the light of our classification. An extensive description of cases from both the literature and our patient population allows us to refine the characterization of clinical TGA features.

Adult↗
PubMed2004

The influence of personality, measured by the Karolinska Scales of Personality (KSP), on symptoms among subjects in suspected sick buildings.

UNLABELLED: The aim was to study possible relationships between personality traits as measured by the Karolinska Scales of Personality (KSP), a self-report personality inventory based on psychobiological theory, and medical symptoms, in subjects with previous work history in suspected sick buildings. The study comprised 195 participants from 19 consecutive cases of suspected sick buildings, initially collected in 1988-92. In 1998-89, the KSP inventory and a symptoms questionnaire were administered in a postal follow-up study. There were 16 questions on symptoms, including symptoms from the eyes, nose, throat, skin, and headache, tiredness, and a symptom score (SC), ranging from 0 to 16, was calculated. The questionnaire also requested information on personal factors, including age, gender, smoking habits, allergy and diagnosed asthma. The KSP ratings in the study group did not differ from the mean personality scale norm scores, calculated from an external reference group. Females had higher scores for somatic anxiety (P < 0.01), muscular tension (P < 0.001), psychic anxiety (P < 0.01), psychasthenia (P < 0.05), indirect aggression (P < 0.05), and guilt (P < 0.05), while males scored higher on detachment (P < 0.001). Subjects with higher SC were found to display higher degree of somatic anxiety (P < 0.001), muscular tension (P < 0.001), psychic anxiety (P < 0.001), psychasthenia (P < 0.001), inhibition of aggression (P < 0.05), detachment (P < 0.05), suspicion (P < 0.01), indirect aggression (P < 0.01), and verbal aggression (P < 0.05). In addition, ocular, respiratory, dermal, and systemic symptoms (headache and tiredness) were significantly related to anxiety- and aggressivity-related scales. There were associations between personality scales and change of symptom score (SC) during the 9-year period. The associations between KSP personality traits and symptoms were more pronounced in females. In conclusion, there are gender differences in personality and SBS symptoms. Personality may play a role in the occurrence of symptoms studied in indoor environmental epidemiology. Our results support a view that measurement of personality could be of value in future studies and vulnerability to environmental stress. PRACTICAL IMPLICATIONS: Personality and personal vulnerability should be considered in both indoor environmental epidemiology and practical handling of building with suspected indoor problem, especially when the technical investigations fail to identify any obvious technical malfunction. Moreover, personality aspects should be considered among subjects with possible vulnerable personality exposed to environmental stress, and personality diagnosis can be a complementary tool useful when assessing 'sick building patients' in the medical services. We found no evidence of severe personality pathology in among those working in workplaces with environmental problems so called 'sick buildings'.

Adult↗
PubMed2002

A new language for psychoanalytic diagnosis.

Many psychoanalysts believe it is impossible to conduct empirical research without eviscerating or trivializing psychoanalytic constructs, and past research efforts have all too often reinforced this view. A new method for studying personality and personality pathology is presented that challenges such beliefs. This method, the Shedler-Westen Assessment Procedure (SWAP), captures the richness and complexity of psychoanalytic constructs and formulations while also providing reliable data for research. The method is being used to develop a new personality disorder taxonomy, as an alternative to the DSM, that is both empirically grounded and psychoanalytically relevant. Its role in psychoanalytic training and supervision is discussed, as is its value as a measure of structural change in psychoanalytic process and outcome research.

Humans↗
PubMed2004

[Eating disorders and personality disorders--possible interactions and their therapeutic implications].

Personality disorders are defined by a characteristic and enduring pattern of behaviour and inner experience that deviates distinctly from culturally defined norms. Examples include social insecurity or even distrust leading to withdrawal, or patterns of impulsiveness, affective instability or, possibly, self-harm. Personality disorders are distinct from other psychiatric disorders primarily by their enduring character. The prevalence of personality disorders among patients with eating disorders depends on population characteristics. In a specialised outpatient clinic that serves a defined catchment area, nearly one third of patients will fulfill the diagnostic criteria for a personality disorder. Hospitalized patients or patients in more specialised units will surely show a considerably higher prevalence. Several modes of interaction between eating disorders and personality disorders could be hypothesized. The treatment of patients with eating disorder should take into account the subgroup with comorbid personality pathology and evaluation and treatment should be planned accordingly, though this requires time and expertise. The issue should also be acknowledged in primary health care and attention be paid to symptoms of eating disorder also in cases in which symptoms of a personality disorder are more pronounced.

Feeding and Eating Disorders↗
PubMed1989

[Pathomorphosis of personality changes in patients with epilepsy].

Psychical features of 600 epileptic patients aged 5 to 40 were investigated in a long term clinical follow-up. Social changes, environmental factors, education faults had major effects on the patients. Classical personality traits were subject to a considerable pathomorphosis in these patients. Along with some positive traits as accuracy, economy, marked were egoism, egocentrism, dependency trends and other negative traits preventing social adaptation. The author stresses that correct education is crucial for prevention of pathological personality changes. This requires joint efforts of psychiatrists, teachers and sociologists.

Adolescent↗
PubMedDate not supplied

State personality disorder in social phobia.

To examine the effects of state on personality disorder characteristics, we compared individuals with social phobia before and after psychological intervention. Administration of the Personality Disorder Questionnaire (PDQ-4) before and after treatment allowed for the identification of three groups of patients: (1) individuals who showed elevated PDQ-4 scores but little changes from intake to post treatment (Trait PD group; n = 28); (2) individuals who showed a decrease in PDQ-4 scores from intake to post treatment (State group; n = 33); and (3) a group with no significant personality disorder characteristics at pre or post-treatment (No PD group; n = 32). There were trend differences between the Trait, State and No PD groups for being single, never married (81.5%, 44.4%, and 56.3%, p < .05) and a significant difference for having the generalized form of Social Phobia (96.4%, 88.9%, and 59.4%, p < .0001). The groups also differed in their level of trait anxiety (61.6, 51.2, 44.5, p < .001). Groups also differed in level of the personality measure Harm Avoidance (26.3, 23.3, 19.8, p < .0002). The reduction of personality disorder traits in the State PD groups from intake to post-treatment was not specific to any particular personality disorder or personality disorder cluster. Trait personality appeared to have a higher risk for suicide compared to the other two groups. A State Personality group was identified in individuals with social phobia by following changes in personality pathology from before and after a psychological intervention.

Adult↗
PubMed1981

[Diagnostic transesophageal atrial stimulation for sinus node function testing. II. Results in patients with and without sinus node syndrome].

By means of transoesophageal atrial stimulation of higher frequency in patients with sinus node syndromes (n = 78) in about 60% of the cases a prolonged sinus node recovery time could be proved. After the end of the stimulation secondary stops appeared in about half of the patients, so that in 81% of the cases at least one pathological result was established. By means of premature individual transoesophageal stimulation (n = 99) in 2/3 of the patients with sinus node syndrome we contrived to perform a calculation of the sinuatrial conduction time. Half of all calculable values were above the normal. In 1/3 of the examined persons pathological stimulation patterns were found. Altogether 90% of the patients showed at least one pathological result, when apart from prolonged sinus node recovery times and sinuatrial conduction times at the same time secondary stops after serial stimulation with higher frequency and abnormal behaviour patterns of the post-extrasystolic stops after individual stimulation were taken into consideration. In patients with different cardiovascular diseases without clinical or electrocardiographic reference to a sinus node dysfunction in 25% of the cases at least one pathological result was found, in which case cannot be clarified, whether latent functional sinus node disturbances or falsely positive results are in question or not. Altogether the non-invasive transoesophageal stimulation technique leads to on principle diagnostic evidences of the same value as the up to now usual stimulation of the right atrium. Methodical problems which arise from the stimulation of the righ atrium in transoesophageal approach are to be taken into consideration in the interpretation of the results.

Adult↗
PubMed1995

Personality traits in schizophrenia.

In recent years there has been a renewed interest in the integration of descriptive and interpersonal approaches to mental illness. Much of the impetus for this stems from the introduction in 1980 of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) (American Psychiatric Association 1980), with subsequent research and clinical reports documenting important interactions between Axis I syndromes and Axis II personality trait factors. While many research efforts have described comorbidity in affective and anxiety disorders, less attention has been directed toward clarifying the relationships between stable and enduring character traits and Axis I symptoms in schizophrenia. In this paper we propose that schizophrenic patients display both adaptive and pathological personality traits throughout the illness, and that clinical and research efforts to address the interactions between syndromic and personality factors ("trait-state" interactions) will further our understanding of patterns of symptom presentation and treatment response in these patients.

Adult↗
PubMed1987

The relation between drinking habits and neuroticism and weak ego among male and female alcoholic patients.

The relationship between drinking habits and personality functioning was studied in a consecutive series of 300 alcoholic inpatients during treatment and 2 1/2 years later. The alcoholic sample showed more signs of neuroticism and lack of ego strength than the general population. Among the alcoholics there was a relationship between advanced drinking habits and more pathological personality functioning. However at the follow-up improved drinking habits were connected only with improved self-esteem, particularly among female patients.

Adult↗
PubMedDate not supplied

[Alexithymia, health and psychopathology].

The term "alexithymia" is derived from the Greek and means "no words for feeling". Coined by Sifneos in 1972, alexithymia refers to a relative narrowing in emotional functioning. The salient clinical features of alexithymia include difficulties in recognizing and verbalizing feelings, endless description of physical symptoms instead of émotions, concrete speech and thought closely tied to external events, paucity of fantasy life. Although initially described in the context of psychosomatic illness, alexithymic characteristics may be observed in patients with a wide range of medical and psychiatric disorders. This study purpose to investigate the relationship between alexithymia and concepts of health's psychology: locus of control, family's cohesion and adaptability, personality's concepts,... Three groups of patients were established on base of their diagnosis: depression (n = 16), alcoholism (n = 16) and control group (n = 16). The following measures were administered: family's cohesion and adaptability (Olson), Multidimensional Health Locus of Control (Wallston and Wallston), externality scale (Rotter), Minnesota Multiphasic Personality Inventory. The results show alexithymic personality is less internal (t = 2.72; p = 0.011) than non-alexithymic subject (m = 20.88 +/- 6.19 vs m = 26.06 +/- 4.52). Furthermore the family's cohesion is lower (t = 2.961; p = 0.008) for the alexithymics than the non-alexithymics (m = 30.46 +/- 10.38 vs m = 40.27 +/- 5.44). This conclusions added to the more pathological personality's profile (11 scales on 14 were significant higher for for alexithymics) of alexithymics at the MMPI indicate alexithymia's concept is central in psychopathology if measures used are issued by the health's psychology.

Adult↗