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PubMed1999

Personality disorders and depression: comorbidity.

Depression and comorbid personality disorders relate to one another in three distinct ways: 1) personality disorders may precede the development of depression and render an individual vulnerable to depression; 2) depression may precede the personality disorder and foster the development of the personality disorder; 3) there may be an interface between personality disorders and depression, which has been deemed depressive personality disorder. This article reviews data on the comorbidity of depression, particularly chronic depression, and personality disorders. This article also reviews data on the effect of comorbid personality disorders on treatment for depression, and the effect that treatment for depression has on personality disorders. Comorbid personality disorders generally do not impede treatment for depression. Successful treatment for depression is associated with improvement in personality disorders.

Comorbidity↗
PubMed2003

Exploring the link between character, personality disorder, and neuropsychological function.

Personality deviations and deficits in cognitive executive function are common among forensic populations. The present study on incarcerated offenders explored whether there are links between the two domains. Personality was assessed using the Temperament and Character Inventory (TCI). Neuropsychological performance, including visual working memory, attentional set-shifting and planning, were tested with the Cambridge Neuropsychological Test Automated Battery (CANTAB). Subjects with personality disorders scored high on harm avoidance, and low on self-directedness and cooperativeness. Personality disordered offenders did not differ from the comparison groups (offenders without personality disorder, and non-criminal controls) with regard to CANTAB measures of visual working memory (delayed matching to sample, spatial working memory) and planning (Stockings of Cambridge), but they made a larger number of errors on the attentional set-shifting task. Dimensional analysis of the personality and neuropsychological variables revealed significant associations between self-directedness and cooperativeness on the one hand, and attentional set-shifting on the other. Intellectually disabled, non-criminal individuals (marginal mental retardation) who performed poorly on attentional set-shifting also scored low on self-directedness and cooperativeness. The results indicate that poor development of certain personality traits may be associated with deficits in neuropsychological functioning.

Adult↗
PubMed2002

Personality disorders at the crossroads.

Personality disorders are now at a crossroads with respect to theory, research, and conceptualization. In this article, we review relevant and current issues within the personality disorder field. After reviewing changes in the conception of personality disorders across the past half century (1952 to 2002), we focus on the issue of continuity versus discontinuity methodologies for assessing personality, interactionism, treatments, resolved and unresolved issues, and future directions. The issue of continuity versus discontinuity is a theme in this article. We conclude that the evidence is in favor of a reapprochment between a categorical classification system and a dimensional system and we also outline the difficulties in achieving this change.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2006

Substance use disorders in men with antisocial personality disorder: a study in Turkish sample.

This study investigated the prevalence of substance use disorders (SUDs) and "substance of choice" in 500 male Turkish psychiatric outpatients manifesting a DSM-IV diagnosed antisocial personality disorder (APD) and a SUD diagnoses (the Structured Clinical Interview for DSM-IV). Lifetime SUDs were diagnosed in 86% of APD subjects. Alcohol, cannabis, and inhalant use disorders were the most frequent among substance use, 75.6%, 67.4%, and 35.6%, respectively. This sample's "substance of choice" differed from reported Western populations; a result which may be influenced by socio-cultural variations. The study's limitations are noted.

Adult↗
PubMedDate not supplied

[Personality disorders in patients with panic disorder].

The relationship between personality disorders and panic disorder in adults is analyzed in this study. The patients included in this work presented anxiety disorder with agoraphobia and were compared with a group of normal controls. The percentage of patients with personality disorder was 46% significantly higher than those encountered in the control group (16%). The existence of these disorders do not seem to modify the severity of panic disorder.

Adult↗
PubMed2005

The children in the community study of developmental course of personality disorder.

The Children in the Community (CIC) Study is an ongoing investigation of the course of psychiatric disorders including personality disorders (PDs) in an epidemiological sample of about 800 youths. In addition to tracking developmental trajectories over 20 years from adolescence into adulthood, the CIC Study has used prospective data to investigate early risks for Axis II disorders and symptoms (including both environmental factors and early characteristics), implications of comorbidity with Axis I disorders, and associated negative prognostic risk of adolescent PDs into adulthood. The substantial independent impact of PD on subsequent Axis I disorders, suicide attempts, violent and criminal behavior, interpersonal conflict, and other problematic adult outcomes confirms the importance of attention to these problems when they manifest in early adolescence. The implications of study findings for potential changes in the DSM are discussed.

Adolescent↗
PubMed1990

Personality disorders and criminal responsibility.

Personality disorder as a diagnostic concept has developed as a result of the world-wide spread of DSM III in recent years. This article confines itself to a discussion of axis II of DSM III, that is, to the axis on which personality disorders are set out. In particular, it investigates the implications of the diagnostic concept of personality disorder for forensic psychiatry.

Forensic Psychiatry↗
PubMed1995

Six cases of patients with mental retardation who have antisocial personality disorder.

Evidence that antisocial personality disorder occurs in association with mental retardation is presented through case reports of six mildly to moderately retarded men who received a diagnosis of antisocial personality disorder. The men were identified when referred by care providers for more thorough psychological and psychiatric assessments. Their histories were marked by thefts, rapes, multiple assaults, arson, and other predatory acts; a lack of remorse for such actions; criminal charges; and predisposing factors such as an impoverished family. Only one man had received the diagnosis of antisocial personality disorder before the assessments, suggesting that clinicians are reluctant to find sociopathic behavior clinically significant in the presence of mental retardation.

Adult↗
PubMed2001

Response to cognitive therapy in depression: the role of maladaptive beliefs and personality disorders.

This study examined whether personality disorder status and beliefs that characterize personality disorders affect response to cognitive therapy. In a naturalistic study, 162 depressed outpatients with and without a personality disorder were followed over the course of cognitive therapy. As would be hypothesized by cognitive theory (A. T. Beck & A. Freeman, 1990), it was not personality disorder status but rather maladaptive avoidant and paranoid beliefs that predicted variance in outcome. However, pre- to posttherapy comparisons suggested that although patients with or without comorbidity respond comparably to "real-world" cognitive therapy, they report more severe depressive symptomatology at intake and more residual symptoms at termination.

Adolescent↗
PubMedDate not supplied

Personality disorder in obsessive compulsive disorder: a controlled study.

In order to assess Axis II pathology in Obsessive Compulsive Disorder patients as compared to other anxiety disorder patients, the Personality Disorder Examination was administered to 258 anxiety disorder patients. In contrast to a number of recent reports, a low rate of personality disorder diagnoses were found in the OCD sample as well as the anxiety disorder control subjects. The findings of the current investigation are discussed in terms of state-trait confounding.

Agoraphobia↗
PubMed2002

Chronological relationship between antisocial personality disorder and alcohol dependence.

Personality disorders, and particularly antisocial personality disorder (ASPD), frequently co-occur with alcohol dependence. ASPD is considered to be an important cofactor in the pathogenesis and clinical course of alcohol dependence. The chronological relationship between the onset of symptoms of ASPD and alcohol-dependence characteristics has not yet been studied in great detail and the role of ASPD in classification schemes of alcohol dependence as suggested by Cloninger and Schuckit has yet to be determined. We studied 55 alcohol-dependent patients to assess the prevalence and age at manifestation of ASPD, conduct disorder characteristics as well as alcohol dependence by employing the Semi-Structured Assessment for the Genetics of Alcoholism and the Structured Clinical Interview for DSM-III-R. Results indicate that the onset of ASPD characteristics precede that of alcohol dependence by some 4 years. This finding suggests that in patients with ASPD, alcohol dependence might be a secondary syndrome as suggested by previous research.

Adult↗
PubMed1989

Narcissistic personality disorder in childhood.

Narcissistic personality disorders can be identified in childhood and adolescence using the same diagnostic criteria as for adults. There are, however, additional descriptive characteristics specific to children: in particular, quality of friendships, quality of performance in school, gaze aversion, pathologic play, and separation anxiety. Various developmental pathways may present a special risk for the formation of narcissistic personality disorder: having narcissistic parents, being adopted, being abused, being overindulged, having divorced parents, or losing a parent through death. The diagnosis of narcissistic personality disorder has important implications for treatment. The goals of treatment (in intensive psychoanalytic psychotherapy) are to work on the grandiose self, the pathologic defense mechanisms that interfere with development, and interactions with parents and peers. Concomitant parent counseling or family therapy is strongly recommended to work on the maladaptive narcissistic defenses operating at the family level, which help to maintain the disorder.

Adaptation, Psychological↗
PubMed2000

[Impulse control and affect regulation in personality disorders].

In borderline and antisocial personality disorder there is a close interaction between affect dysregulation and impulse control disorder. Different approaches are presented that focus on affective responses to experimental stimuli in these personality disorders. Results suggest that in borderline personality disorder intense emotional responses occur in the context of specific stressors, in particular fear of being abandoned. Evidence for a general emotional hyperreactivity was not found; on the contrary, female borderline subjects rather showed reduced emotional arousal. Regarding the psychopathic subtype of antisocial personality disorder, results provided strong support for the theory of emotional detachment, which may predispose to violence through a lack of feeling of fear or also of compassion which could counteract violent impulses. Consequences for psychotherapy in BPD are considered.

Affect↗
PubMed2006

Adolescent axis I and personality disorders predict quality of life during young adulthood.

PURPOSE: To investigate and compare the prospective association of adolescent Axis I mental disorder and personality disorder (PD) with young adult quality of life (QOL) in the general population. METHODS: Seven hundred fifty mothers and youths participating in a prospective longitudinal community-based study were interviewed. Mental disorders were measured at a mean age 16 years. QOL as the outcome indicators were assessed at a mean age 22. RESULTS: Adolescent Axis I disorder predicted elevated negative affect and higher levels of stress some 6 years later. Adolescent PD predicted elevated negative affect and higher levels of stress, and also problems in social support and relationships, and poorer residential, mobility, and financial and health resources in adulthood. Youths with both Axis I disorder and one or more PDs had the worst outcomes with regard to health problems, stressful occupational or educational settings, and resources, net of the effects of adolescent health problems. Nevertheless, some aspects of adult QOL were not significantly related to adolescent disorder, including a positive perspective on the future, own morale in a chosen occupation or educational setting, or the amount of autonomy experienced in that setting. CONCLUSIONS: Among adolescents in the community, PDs during adolescence may have a more adverse impact on young adult QOL than do Axis I disorders. A combination of Axis I and PD may represent a particular risk for new physical health problems and resource inadequacy, including poor access to health care.

Adolescent↗
PubMed1990

Standardized assessment of personality disorders in obsessive-compulsive disorder.

We assessed 96 patients with obsessive-compulsive disorder for DSM-III personality disorder diagnoses with a standardized interview instrument (Structured Interview for the DSM-III Personality Disorders). Fifty patients (52%) met criteria for at least one personality disorder, with mixed, dependent, and histrionic personality disorders most frequently diagnosed. Compulsive personality disorder was diagnosed in only 6 patients (6%), 5 of whom had had onset of obsessive-compulsive symptoms before the age of 10 years, indicating that DSM-III compulsive personality disorder is not invariably a premorbid condition for the development of obsessive-compulsive disorder. Schizotypal personality disorder, at 5%, was found to be less common than in past samples, reflecting differences in either assessment methods or sampling.

Adolescent↗
PubMed2006

[Nacissistic personality disorder].

The narcissistic personality disorder is the extreme form of the so-called narcissistic personality style, which is characterized by exaggerated self-importance coupled with an inordinate desire to be admired, ideas of grandiosity and a strong sense of entitlement, an absence of empathy and feelings of envy. In contact with others, the narcissist appears arrogant, readily feels injured, and takes advantage of other to achieve his own ends. A central psychodynamic role in the development of the condition is a labile sense of self-worth and its overcompensation. Psychotherapeutic treatment aims initially to develop an awareness of the problem in the patient, correction of cognitive dysfunction and a reduction in aggressive or disdainful behavior. Impulsive and aggressive behavior and attacks of depression may be reduced through the use of selective serotonin reuptake inhibitors.

Aggression↗
PubMed2005

Cluster B personality disorders are associated with allelic variation of monoamine oxidase A activity.

Genetic variants of the monoamine oxidase A (MAOA) have been associated with aggression-, anxiety-, and addiction-related behavior in several nonclinical and clinical populations. Here, we investigated the influence of allelic variation of MAOA activity on aggression-related personality traits and disease risk in patients with personality disorders. Personality disorders were diagnosed with the Structured Clinical Interview of DSM-IV and were allocated to cluster A, B, and C. Personality features were assessed by the revised NEO Personality Inventory and the Tridimensional Personality Questionnaire. The genotype of the MAOA gene-linked polymorphic region (MAOA-LPR) was determined in 566 patients with personality disorders and in 281 healthy controls. MAOA genotype was significantly associated with cluster B personality disorders (chi2=7.77, p=0.005, df=1) but not with cluster C personality disorders. In total, 26.0% of cluster B patients were hemi- or homozygous for the low-activity variant of the MAOA genotype, compared to 16.4% in the control group. Associations between MAOA variants and personality domains related to impulsivity and aggressiveness were inconsistent. Our findings further support the notion that allelic variation of MAOA activity contributes modestly to the balance of hyper- (impulsive-aggressive) and hyporeactive (anxious-depressive) traits.

Adolescent↗
PubMed2004

Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission.

OBJECTIVE: The purpose of this study was to assess the prevalence of axis I disorders among patients with borderline personality disorder over 6 years of prospective follow-up. METHOD: A semistructured interview of demonstrated reliability was used to assess presence or absence of comorbid axis I disorders in 290 patients who met Revised Diagnostic Interview for Borderlines criteria and DSM-III-R criteria for borderline personality disorder and 72 patients who did not meet these criteria but did meet DSM-III-R criteria for another axis II disorder. Over 94% of surviving patients were reinterviewed about their axis I disorders at 2-year, 4-year, and 6-year follow-up periods. RESULTS: Although the patients with borderline personality disorder experienced declining rates of many axis I disorders over time, the rates of these disorders remained high, particularly the rates of mood and anxiety disorders. Patients whose borderline personality disorder remitted over time experienced substantial decline in all comorbid disorders assessed, but those whose borderline personality disorder did not remit over time reported stable rates of comorbid disorders. When the absence of comorbid axis I disorders was used to predict time to remission, the absence of substance use disorders was a far stronger predictor of remission from borderline personality disorder than was the absence of posttraumatic stress disorder, mood disorders, other anxiety disorders, or eating disorders, respectively. CONCLUSIONS: The results of this study suggest that axis I disorders are less common over time in patients with initially severe borderline personality disorder, particularly for patients whose borderline personality disorder remits over time. The findings also suggest that substance use disorders are most closely associated with the failure to achieve remission from borderline personality disorder.

Adult↗