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PubMed2000

Deconstructing dependency in a five-factor world: a meta-analytic review.

Meta-analysis of studies assessing the relation between interpersonal dependency test scores and five-factor model (FFM) domain scores revealed that dependency scores are positively correlated with FFM Neuroticism and Agreeableness scores and negatively correlated with FFM Extraversion, Openness, and Conscientiousness scores. The magnitudes of these correlations were all in the small-to-moderate range, and comparable score intercorrelations were obtained when participants' dependency levels were assessed by means of a trait dependency questionnaire, dependent personality disorder questionnaire, or dependent personality disorder interview. These findings have implications for researchers' efforts to deconstruct dependency into its basic trait elements and for the dimensional approaches to personality disorders being considered for future versions of the Diagnostic and Statistical Manual of Mental Disorders.

Affect↗
PubMed2003

Personality and depression in women.

Personality disorders and traits should be assessed in studies concerned with the etiology and treatment of depression in women. There has been a considerable amount of research concerned with the effect of personality functioning on the etiology and treatment of depression, and much of this research has concerned personality traits and disorders for which significant gender differences and issues apply. The importance of personality functioning, and the particular relevance to women and gender-related issues, is illustrated in this paper with regard to dependent personality disorder and dependent personality traits. Implications for future research on the etiology and treatment of depression in women are provided.

Adult↗
PubMedDate not supplied

[Personality disorders in a nonclinical sample of adolescents].

OBJECTIVE: To examine the comorbidity of borderline personality disorder and other personality disorders in a nonclinical sample of high-school students. METHOD: 311 high-school students who completed the French version of the CES-D (Center for Epidemiological Studies-Depression Scale), were asked to participate to interviews evaluating personality functioning: 60 subjects (19%) accepted to participate in the study. The mean CES-D score of these 60 subjects (16 boys, 44 girls, mean age=17.7 1.7) was significantly higher than the mean score of the whole sample (23.9 10.4 versus 16.7 9.8). Thus the interviewed sample was not representative of the population of high-school students. Subjects were assessed using the major depressive episode module of the MINI (Mini International Neuropsychiatric Interview) and the SIDP IV (Structured Interview for DSM IV Personality). Inter-rater reliability was determined by comparing the independent ratings of interviewers and an experienced clinician on a random sample of 20 interviews. For DSM IV borderline personality disorder diagnosis, the Cohen's kappa coefficient was 0.85. For personality disorder criteria, kappa ranged from 0.6 to 1.0 (average kappa=0.79). RESULTS: Sixteen of these subjects (26,7%, 4 males, 12 females) received a diagnosis of borderline personality disorder according to DSM IV criteria. The mean CES-D score of borderline subjects (30.6 10.2) was significantly higher than the mean score of nonborderline subjects (21.6 10.5). Of the 16 borderline subjects, 11 (75%) received a diagnosis of major depressive disorder versus 14 (31%) of the non borderline subjects. None of the other personality disorders approached the frequency of borderline personality disorder. The next most frequent diagnoses were depressive and dependent personality disorders which occurred in respectively in 16.6% and 10% of the 60 subjects. All the personality-disorders occurred at higher rates in the group with borderline personality disorder with the exception of obsessive-compulsive personality disorder which was diagnosed only in nonborderline subjects. Of the 16 borderline subjects, 11 (68.7%) met the criteria for another personality disorder which were depressive personality disorder (N=5), paranoid personality disorder (N=4), dependent personality disorder (N=3), antisocial personality disorder (N=2), histrionic personality disorder (N=2), avoidant personality disorder (N=2), negativistic personality disorder (N=2), schizotypal personality disorder (N=1), narcissistic personality disorder (N=1), self-defeating personality disorder (N=1). The optional diagnoses (self-defeating, depressive and negati-vistic personality disorders) accounted for 8 of 23 (34.7%) cases of personality disorders diagnosed among borderline subjects. Among these 11 adolescents, 5 received 2 diagnoses of personality disorders (borderline and paranoid personality disorders, N=1; borderline and dependent personality disorders, N=1; borderline and depressive personality disorders, N=3), 3 received 3 diagnoses (borderline, antisocial and histrionic personality disorders, N=1; borderline, avoidant and negativistic personality disorders, N=1; borderline, depressive and negativistic personality disorders, N=1), 3 received 5 diagnoses (borderline, paranoid, histrionic, narcissistic and dependent personality disorders, N=1; borderline, paranoid, dependent, avoidant and depressive personality disorders, N=1; borderline, paranoid, schizotypal, antisocial and self-defeating personality disorders, N=1). Among the 44 adolescents (12 boys, 32 girls) without borderline personality disorder, 10 (22.7%) (3 boys, 7 girls) met the criteria for another personality disorder which were depressive personality disorder (N=5) or cluster C disorders -obsessive-compulsive personality disorder (N=4), dependent personality disorder (N=2), avoidant personality disorder (N=1) - with the exception of one diagnosis of histrionic personality disorder. Two subjects received 2 diagnoses (obsessive-compulsive and depressive personality disorder). The internal consistency of personality disorders criteria was assessed with Cronbach's alpha coefficient. Borderline personality disorder criteria had high internal consistency (0.82). The factor structure of borderline personality disorder criteria was studied with an exploratory factorial analysis which extracted three factors. The eigenvalues were 3.70, 1.06, and 1.01. Confirmatory factorial analyses were conducted. The correlated two-factor model and the three-factor model fit the data well but the correlation between factors was, however, judged too high, ranging from 0.70 to 0.78. The one-factor model proved to have a good fit (Goodness of Fit Index=0.89, Comparative Fit Index=0.90, Root Mean Square Residual=0.07). As a previous study showed the frequency of two schizotypal personality disorder criteria (odd beliefs/magical thinking experiences and unusual perceptual experiences), an exploratory factorial analysis was performed on the combined set of criteria of borderline and schizotypal personality disorders. It yielded 2 factors: the first factor consisted of all the borderline personality disorder criteria, odd beliefs/magical thinking, and unusual perceptual experiences and could be called the borderline factor; the second factor consisted of the paranoid and the social avoidance criteria and could be called the interpersonal hypersensitivity factor. A confirmatory factor analysis showed that this two-factor model provided a good fit to the data (GFI=0.82, CFI=0,91, RMSR=0.10). The correlation between factors was weak (0.25). These results suggest that odd beliefs/magical thinking and unusual perceptual experiences are a component of borderline symptomatology in adolescents. DISCUSSION: The high frequency of major depressive disorder and personality disorders in the interviewed sample may be due to the possibility that adolescents with psychological problems have used the interview as a way to obtain attention and support from a psychologist. The interviewed sample, which was characterized by a high intensity of depressive symptomatology and by a high frequency of borderline personality disorder, could thus be seen as intermediate between a clinical and a community sample. Our results may be more generalizable to an outpatients population of adolescents. This study found conflicting results about the construct validity of borderline personality disorder in adolescent. The high internal consistency and the one-factor structure of the borderline personality disorder criteria argue for their validity in adolescents. However, the high rates of comorbidity of borderline personality disorder with depression and other personality disorders, extended to clusters A, B and C and to optional diagnoses, suggest the lack of construct validity of either borderline personality or cluster B disorders in adolescents. CONCLUSION: Borderline symptomatology in adolescents appears more in adequacy with a dimensional model than with a typological classification. More studies are needed to assess and improve the construct validity of borderline personality disorder in adolescents.

Adolescent↗
PubMed1995

Comorbidity of axis I and axis II disorders.

OBJECTIVE: In light of continuing controversies concerning the DSM-III-R system for diagnosing personality disorders, their construct validity, and the assignment of disorders to a particular axis, the authors studied patterns of axis I-axis II comorbidity. METHOD: Semistructured interviews were used to assess axis I and axis II disorders in 200 inpatients and outpatients. Odds ratios were calculated to determine significant comorbidity between classes of current axis I disorders and axis II personality disorders diagnosed according to two methods and defined at two diagnostic thresholds. Distributions of personality disorder traits were also compared in patients with and without axis I disorders. RESULTS: Significantly elevated odds ratios were found for co-occurrence of current mood disorders with avoidant and dependent personality disorders; anxiety disorders with borderline, avoidant, and dependent personality disorders; psychotic disorders with schizotypal, borderline, and dependent personality disorders; psychoactive substance use disorders with borderline and histrionic personality disorders; and eating disorders with schizotypal, borderline, and avoidant personality disorders. These results held when conservative and liberal definitions of personality disorders were used. Non-specific axis I and axis II associations were confirmed for distributions of personality disorder traits. CONCLUSIONS: Significant associations occurred between most axis I classes of disorders and axis II disorders and traits in more than one cluster. All axis I classes of disorders except mood disorders co-occurred with borderline personality disorder; however, patients with mood disorders had elevated levels of borderline traits. When any personality disorder was present, there were significant odds that a mood, anxiety, psychotic, or eating disorder would also be present; psychoactive substance use disorders, in contrast, significantly co-occurred with borderline and histrionic personality disorders.

Adolescent↗
PubMed1998

Implicit and self-attributed dependency needs in dependent and histrionic personality disorders.

Theorists speculate that dependent personality disorder (DPD) and histrionic personality disorder (HPD) are both associated with high levels of implicit (i.e., unconscious) dependency needs but speculate that only DPD is associated with high levels of self-attributed (i.e., conscious) dependency needs. To test this hypothesis, 444 undergraduates (236 women and 208 men) completed the Personality Diagnostic Questionnaire-Revised (PDQ-R), along with widely used measures of implicit dependency needs (the Rorschach Oral Dependency Scale; ROD), and self-attributed dependency needs (the Interpersonal Dependency Inventory; IDI). Correlational analyses and comparisons of IDI and ROD scores in participants scoring above and below the PDQ-R DPD and HPD thresholds supported theorists' speculations regarding implicit and self-attributed dependency needs in DPD and HPD. Implications of these results are discussed, and suggestions for future studies are offered.

Adolescent↗
PubMed1999

[Combined alcohol dependence and personality disorder and its legal consequences with respect to commitment].

People frequently consuming an excessive amount of alcohol often show symptoms of personality disorder. Personality disorder and alcohol dependence are frequently connected with each other. However, there are only very few conditions enhancing concomitant dependence and personality disorder to the rank of a mental disease according to German guardianship legislation. If the patient's condition meets the criteria of a psychic disease and endangers his own health and public safety, commitment to a mental hospital or guardianship are justified. The purpose of this clinical analysis was to compare the medical proposal for treatment with legal prerequisites which are indispensable for involuntary admission to a mental hospital. Whereas the Psychiatric Disorders Act intends to avert danger to the public, guardianship legislation aims at individual help. We present a patient who suffered from alcoholism and simultaneously met criteria of a serious personality disorder, which was classified according to ICD-10 (F 60.31). As the aggravation of the symptoms was most likely to entail serious danger to his health the judge ordered immediate involuntary admission. Two other patients had similar comorbidity but had to be released from hospital because of finalisation of detoxification. Neither dependence nor personality disorder were pronounced enough to restrict the rights of the individual. Our analysis shows that the psychiatrist must present with an expert medical report that quantifies the extent of alcoholism and personality disorder and characterises them as psychic disease. Consequently, for the purpose of quantifying the extent of dependence, we recommend to apply the European Addiction Severity Index whose suitability should be assessed.

Adult↗
PubMed2005

Matricide by person with bipolar disorder and dependent overcompliant personality.

Matricide is an infrequent form of homicide. This paper is to present a case of matricide with typical characteristics of the act but interesting particularities as well. The perpetrator was a 43-year-old man, respected member of his community, with over compliant characteristics, eagerness in serving people and caring his parents, good social adaptation before and after the crime. He abandoned his family and work in order to better serve his old, disabled but over demanding mother who frequently insulted and humiliated him. Suddenly he came to a state of "mental confusion" and strangled her. After the crime, the perpetrator manifested the symptoms of a bipolar disorder and also received the diagnosis of dependant personality disorder. Years later, he presented again a crisis of escalating aggressive urge for which he was hospitalized. Many people and associations of his hometown actively demanded the minimal possible punishment for him. The case is discussed especially concerning: a) hypotheses about the aetiopathogeny of the act, b) the constant support provided to the perpetrator by his family and social environment.

Adult↗
PubMed1997

Covariance in the measurement of depression/anxiety and three Cluster C personality disorders (avoidant, dependent, obsessive-compulsive).

One hundred and eight-four clients referred to a research outpatient psychological clinic, and meeting the acceptance criterion of 16 or more on the BDI at screening, were diagnosed as either-depressed and/or anxious using both Present State Examination and the Diagnostic and Statistical Manual of Mental State Disorders criteria. Clients were assessed for the presence of Cluster C personality disorders using the Personality Disorder Examination of Loranger et al. (1985). Twenty-two per cent made diagnosis of avoidant, dependent or obsessive-compulsive personality disorder. Significant correlation was found between screening/intake depression index scores and total scores on the three Cluster C personality disorders, although little correlation was found between diagnostic criteria for affective and personality disorders. Some association was shown between the clinical components of personality disorder traits in the anxious-fearful group and current anxiety symptoms, although not as clearly as expected.

Adult↗
PubMed1989

National field trial of the DSM-III-R diagnostic criteria for self-defeating personality disorder.

A national field trial of the criteria for self-defeating personality disorder was conducted in 1986. Among psychiatrists with a special interest in personality disorders there was a lack of consensus as to the need for the category in DSM-III-R. Although the diagnosis was more commonly made for female patients, the disorder was by no means rare in male patients. The diagnostic criteria for the disorder had high sensitivity and specificity. However, a series of analyses indicated that the category had limited descriptive validity and considerable overlap with borderline and dependent personality disorders.

Adult↗
PubMed1996

Excessive dependency and depression: is the relationship specific?

Excessive dependency has been hypothesized to be both a risk factor and a complication of depression. The purpose of this study was to test the specificity of the relationship between DSM-III-R dependent personality disorder (DPD) and depressive disorders. Two hundred subjects were independently administered the Structured Clinical Interview for DSM-III-R (SCID) and the Personality Disorder Examination (PDE) face-to-face by two experienced clinicians. Comorbidity of DPD and axis I disorders of five different types was examined. Dependent personality disorder was associated with mood disorders, both bipolar disorder and major depression, but was also associated with several anxiety disorders, bulimia, and nonaffective psychotic disorders. Dependent-personality disorder was associated with borderline, avoidant, schizotypal, obsessive-compulsive, narcissistic, and paranoid personality disorder made no significant additional contribution to the association between personality disorder and axis I disorder. These results suggest the DPD represents maladaptive traits and behaviors that cut across a range of personality psychopathology and are related to a variety of types of psychological distress. Thus, a specific++ relationship od DPD to depression was not supported.

Adolescent↗
PubMed2001

Antecedents of opioid dependence and personality disorder: attention-deficit/hyperactivity disorder and conduct disorder.

Both attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) were explored as possible antecedents of opioid dependence and personality disorder. One hundred adult opioid-dependent, treatment-seeking male inpatients were explored; an extended clinical semistructured interview to collect sociodemographic, drug use related, and clinical data and the Structured Clinical Interview for DSM-IV personality disorders SCID-II were carried out. Four groups of patients, namely ADHD alone (4 patients), ADHD + CD (7 patients), CD alone (47 patients) and no ADHD/no CD (42 patients) were identified and compared with each other. The results indicate that ADHD alone does not predispose to the development of opioid dependence in male inpatients. Childhood ADHD may nevertheless be found more frequently in male opioid addicts due to its comorbidity with CD, which was identified in more than half of our sample. Patients with ADHD history seemed to go through the drug abuse career earlier and to develop more frequently histrionic and obsessive-compulsive personality disorder. Over half of the CD patients developed borderline and/or antisocial personality disorder; both ADHD and CD predispose significantly to the PD development. Early substance use preventive measures are necessary in children and adolescents suffering from CD and from ADHD comorbid with CD.

Adolescent↗
PubMed2003

Line bisection performance in patients with personality disorders.

INTRODUCTION: Normal line bisection deviation to the left of the true centre has been interpreted as resulting from relative right hemisphere activation. Right hemisphere involvement has also been associated with the problems in dependency and attachment from infancy to adulthood. This hemispheric association predicts that patients diagnosed with dependent personality disorder will deviate significantly to the left on the line bisection task. METHODS: This hypothesis was tested by comparing the results of the line bisection task obtained respectively from 30 right-handed healthy volunteers and 14, 16, 18, and 26 outpatients with schizotypal, antisocial, borderline, and dependent personality disorders. Subjects completed eight horizontal line bisection tasks and the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ), a self-report measure of 18 traits delineating personality disorder. RESULTS: Patients with dependent personality disorder bisected significantly leftward compared to healthy controls. Dependent personality disorder patients scored significantly higher on DAPP-BQ Insecure Attachment, and lower on DAPP Stimulus Seeking, Callousness, Intimacy Problems, and Conduct Problems compared to the healthy controls and all other patient groups. CONCLUSIONS: Line bisection differentiates dependent personality disorder from other personality disorder diagnoses and healthy controls. This study thus suggests that line bisection can be used to enhance diagnostic specificity of dependent personality disorder and localises the brain areas implicated in the disorder.

Journal Article↗
PubMedDate not supplied

Personality disorders in cocaine dependence.

To assess the relationship between cocaine dependence and personality disorders, we administered the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) to 50 patients who were hospitalized for cocaine dependence. We modified the SCID-II so that patients were asked to indicate whether personality traits (if present) occurred during periods of drug use, abstinence, or both. Thirty-seven patients (74%) received at least one axis II diagnosis; 69% of these diagnoses were present both during periods of drug use and abstinence. Only one patient received a diagnosis during periods of drug use alone. These findings suggest that personality disorder diagnoses in cocaine-dependent patients remain relatively stable regardless of current drug use patterns. These data support clinicians' addressing these maladaptive personality traits as part of treatment for cocaine dependence.

Adult↗
PubMed1994

Validity of self-defeating personality disorder.

OBJECTIVE: The purpose of this study was to assess the validity of DSM-III-R self-defeating personality disorder. METHOD: Applicants for inpatient treatment of personality disorders (N = 100) or psychoanalysis (N = 100) were independently evaluated face to face by experienced clinicians using the Structured Clinical Interview for DSM-III-R and the Personality Disorder Examination. Internal consistency; agreement between assessments; diagnostic efficiency of criteria; prevalence; sex ratio; comorbidity with axis I and II disorders; and relationship to education, current employment, and selection for psychoanalytically oriented treatment were examined. RESULTS: The internal consistency of the criteria set and the agreement between psychiatric assessments of self-defeating personality disorder were fair. The most discriminating criteria were those referring to a) choices leading to disappointment, failure, or mistreatment and b) rejection of opportunities for pleasure. A consensus diagnosis of self-defeating personality disorder was more common than all but three other axis II disorders. The sex ratio of the subjects with this diagnosis was not significantly different from the sex ratio of the entire subject group or of patients with other personality disorders. Significant comorbidity with borderline and dependent personality disorders and with current mood disorders was found. Patients with self-defeating personality disorder resembled patients with other personality disorders in educational attainment and treatment assignment. They were more likely to be employed. CONCLUSIONS: These data lend little support to the validity of self-defeating personality disorder as a separate personality disorder category.

Adolescent↗
PubMedDate not supplied

Separation anxiety in adulthood: a phenomenological investigation.

Separation anxiety disorder is well recognized as a juvenile psychiatric disorder, but it appears to be rarely diagnosed in adulthood. Drawing on our clinical impressions and a review of the relevant literature, we sought to investigate whether separation anxiety symptoms could be identified in adulthood. Forty-four subjects recruited by a media campaign were administered a semistructured interview and a self-report checklist for adult separation anxiety (ASA) symptoms, as well as the Separation Anxiety Symptom Inventory (SASI), a retrospective measure of early separation anxiety symptoms. Diagnoses of major depressive disorder (MDD), panic disorder (PD), agoraphobia (Ag), and dependent personality disorder were made using the SCID-P and SCID-II. Thirty-six subjects met criteria for a putative diagnosis of ASA based on a global clinical rating and/or endorsement of DSM-IV-derived criteria. Although most subjects dated the separation anxiety symptoms to their juvenile years, it was notable that one third reported the first onset of separation anxiety symptoms in adulthood. Although comorbid lifetime anxiety or depressive disorders were common, the majority of subjects reported that the separation anxiety symptoms predated other axis I disorders. Only six subjects (17%) were diagnosed with dependent personality disorder. Although limited by the method of sampling, this preliminary study suggests the need to examine more systematically whether a form of separation anxiety disorder may occur in adulthood.

Adult↗
PubMed1987

Sex distribution of DSM-III personality disorders in psychiatric outpatients.

The author determined the sex distribution of 170 outpatients with a DSM-III diagnosis of personality disorder measured by standardized instruments and compared his findings with DSM-III predictions. They confirmed the prediction of more women diagnosed as having histrionic personality disorder and more men diagnosed as having paranoid, compulsive, and antisocial personality disorders. The predicted excess of women diagnosed as having borderline and dependent personality disorders was not confirmed.

Ambulatory Care↗