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PubMed2005

Neuroimaging and personality disorders.

Within the past several years, neuroimaging research on personality disorders has begun to develop. Personality disorders can be thought of as trait-like dysfunctional patterns in cognitive, affective, impulse control, and interpersonal domains. These domains of dysfunction have been linked to specific neural circuits. Developments in brain imaging techniques have allowed researchers to examine the neural integrity of these circuits in personality-disordered individuals. This article reviews the neuroimaging literature on borderline personality disorder, antisocial personality disorder (including psychopathy) and schizotypal personality disorder. Functional and structural studies provide support for dysfunction in fronto-limbic circuits in borderline and antisocial personality disorder, whereas temporal lobe and basal striatal-thalamic compromise is evident in schizotypal personality disorder.

Antisocial Personality Disorder↗
PubMed2004

Assessment and management of personality disorders.

Patients with personality disorders are common in primary care settings; caring for them can be difficult and frustrating. The characteristics of these patients' personalities tend to elicit strong feelings in physicians, lead to the development of problematic physician-patient relationships, and complicate the task of diagnosing and managing medical and psychiatric disorders. These chronic, inflexible styles of perceiving oneself and interacting with others vary widely in presentation. In the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., these styles are categorized into three clusters based on their prominent characteristics: cluster A, the odd or eccentric (e.g., paranoid, schizoid, schizotypal); cluster B, the dramatic, emotional, or erratic (e.g., antisocial, borderline, histrionic, narcissistic); and cluster C, the anxious or fearful (e.g., avoidant, dependent, obsessive-compulsive). Knowledge of the core characteristics of these disorders allows physicians to recognize, diagnose, and treat affected patients. The goal of management is to develop a working relationship with patients to help them receive the best possible care despite their chronic difficulties in interacting with physicians and the health care system. Effective interpersonal management strategies exist for these patients. These strategies vary depending on the specific diagnosis, and include interventions such as the use of specific communication styles, the establishment of clear boundaries, limit setting on the patients' behavior and use of medical resources, and provision of reassurance when appropriate. Additionally, medications may be useful in treating specific symptoms in some patients.

Adaptation, Psychological↗
PubMed2005

Association of personality disorders with Type A and Type B alcoholics.

Personality disorders frequently occur as comorbid disorder in alcohol-dependent subjects. Antisocial personality was described as an important characteristic in Cloninger's Type 2 and Babor's Type B subjects. The impact of other personality disorders on these alcoholism typologies, their pathogenesis and prognosis is, however, still unclear. The present study investigated the prevalence of personality disorders in 237 (194 males) detoxified alcohol-dependent patients after subtyping this sample according to Babor's Type A/B following the criteria suggested by Schuckit et al. (1995). Personality disorders were assessed with the SCID-II (DSM-IV). In all, 160 patients (68 %) could be classified as Type A, and 77 (32 %) as Type B. Type B subjects were younger, had an earlier onset,more alcohol intake and a more severe course of alcohol dependence. Type B patients had significantly more often any cluster A and B personality disorder, and significantly specifically more often a borderline, antisocial and avoidant personality disorder. There were no statistical differences concerning the other personality disorders. In summary, the Type A/B dichotomy using the criteria of Schuckit et al. (1995) was replicated successfully. Differences concerning cluster B personality disorder prevalence of Type B subjects demonstrated that these subjects are significantly more often affected from borderline and antisocial personality disorder. The impact of other personality disorders does not play a substantial role in subtyping alcoholics.

Adult↗
PubMed1999

Diagnostic discriminability of dysthymia and depressive personality disorder.

The Depressive Personality Disorder (DPD) is currently being considered for inclusion in future editions of DSM. However, there is little empirical research on DPD as currently defined in DSM-IV, including whether this disorder is sufficiently distinct from Dysthymic Disorder (Dysthymia). The goal of this study was to explore the relationship between DPD and Dysthymia with a sample of depressed outpatients. Scales were developed for the diagnostic criteria for both DPD and Dysthymia. These scales were then analyzed using cluster and factor analysis. Retroactive diagnostic assignment for these two disorders was also made using these scales. It was hypothesized that if DPD is a viable diagnostic category, then the DPD traits and Dysthymia symptoms would fall into different clusters, produce separate factors, and the comorbidity would be small. Two clusters and two factors, each with a close correspondence to DPD and Dysthymia, were statistically extracted from combined symptom and trait scales. However, 95% of those cases identified as meeting diagnostic criteria for DPD also met criteria for Dysthymia. Despite the ability to distinguish statistically DPD traits from Dysthymia symptoms, there was a high degree of comorbidity, compromising the clinical utility of DPD. The results do suggest, however, that DPD might be best conceptualized as a subcategory of Dysthymia.

Adult↗
PubMedDate not supplied

Associations of self-reported past "psychotic" phenomena with features of personality disorders.

Patients with borderline personality disorder (BPD) may present with "psychotic" phenomena, which can be defined as a range of specified "altered experiences of reality." This study investigated the associations between self-reported past psychotic phenomena and features of DSM-III-R personality disorders (PDs) in 57 inpatients without a previous diagnosis of the main disorders that involve delusions and hallucinations. The present findings include associations between past psychotic phenomena and features of BPD, between repeated self-harm and a report that "thoughts seemed put into head," and between psychotic phenomena and features of other PDs, particularly schizotypal PD. There was a high prevalence of BPD in the present sample. Dissociation, in the context of the features of BPD, may be a causal factor for the development of some of the psychotic phenomena presented by patients with PD.

Adolescent↗
PubMed1990

A comparison of two interviews for DSM-III-R personality disorders.

The study examined agreement between personality disorder diagnoses obtained using two structured interviews and the effect of depression on the diagnoses obtained. Twenty subjects were interviewed while depressed, using the Personality Disorder Examination and the Structured Clinical Interview for DSM-III-R Personality Disorder; both interviews are designed to yield DSM-III-R personality disorder diagnoses. Eighteen subjects were reinterviewed later, 17 after recovery. Diagnostic agreement between the two instruments for any disorder was fair (kappa = 0.38). Kappas for the personality disorder clusters ranged from 0.08 to 0.83. Kappas for individual personality disorders ranged from 0.18 for paranoid disorder to 0.62 for borderline disorder. While the depressive state did not consistently affect categorical diagnoses, dimensional scores tended to be higher when patients were depressed. A dimensional profile, in which scores on each disorder are generated for subjects, may be more reliable than categorical diagnoses derived from the same instrument.

Adult↗
PubMedDate not supplied

Developmental aspects of borderline personality disorder.

This study examined whether patients with borderline personality disorder and controls with other personality disorders remember their childhoods differently with respect to separation difficulties, evocative memory, temperamental factors such as frustration tolerance and mood reactivity, and onset of symptoms. Two hundred and ninety patients with borderline personality disorder and 72 with other personality disorders were assessed using an instrument to rate memories of separation difficulties, temperamental problems, and onset of symptoms before age 18. Patients with borderline personality disorder remembered more difficulties with separation between ages 6 and 17 years, more mood reactivity and poorer frustration tolerance between ages 6 and 17, and the onset of more symptoms (most prominently sadness, depression, anxiety, and suicidality) before age 18 than did patients with other personality disorders. The groups did not differ in reports of evocative memory before age 18. These results indicate that many of the features of adult patients with borderline personality disorder may initially appear during childhood and adolescence and that these features may be used to differentiate borderline from other personality disorders.

Adult↗
PubMed1987

Prognostic validity of self-report and interview measures of personality disorder in depressed inpatients.

Presence of personality disorders was assessed with the Structured Interview for the DSM-III Personality Disorders (SIDP) in a series of 78 nonpsychotic inpatients with major depression. Measures of severity of depression were administered at admission, at discharge, and 6 months after admission. Outcome for the depression was especially poor in patients meeting criteria for multiple personality disorders from multiple DSM-III clusters. A subgroup of 38 patients received both the SIDP interview and a self-report measure of personality disorder, the Personality Diagnostic Questionnaire. Depressed inpatients who met more than the median number of personality disorder criteria by either measure were approximately half as likely to show improvement at discharge and at 6-month follow-up than were patients with less than the median number of criteria.

Adult↗
PubMedDate not supplied

Impulsivity, suicidality and alcohol use disorders in adolescents and young adults with borderline personality disorder.

Borderline Personality Disorder (BPD) is a severe and disabling psychiatric condition that typically emerges in late adolescence or early adulthood. Nearly 50% of individuals with BPD have a co-occurring Alcohol Use Disorder (AUD) at some point in the course of their illness. This study explores clinical characteristics of adolescents and young adults (age 30 years and younger) with BPD and AUD (N=21) compared to BPD without any history of substance use disorders (N=17). Based on theoretical considerations and previous findings, we hypothesized that adolescents and young adults with BPD and AUDs would be more impulsive and exhibit higher rates of suicidal behavior than individuals with BPD and no substance use disorders. Consistent with our first hypothesis, the BPD/AUD group was more impulsive than the BPD only group. However, the two groups did not differ on measures of suicidal behavior. Overall, impulsivity was correlated with total number of suicide attempts in the adolescent/young adult group. When older BPD participants were included in the comparison (up to age 55), the BPD/AUD group exhibited more lifetime suicide attempts that were higher in medical lethality than the BPD only group, suggesting an overall increased lifetime suicide risk in the BPD/AUD group. The relationship between impulsivity, AUD, and suicidal behavior and lifetime suicide risk in adolescent and young adults with BPD is discussed.

Adult↗
PubMed2004

Recent trends in the pharmacotherapy of personality disorders.

This article reviews pharmacologic trials conducted between 2000 and 2003 directed at the treatment of borderline personality disorder, antisocial personality disorder, and schizotypal personality disorder. Atypical antipsychotics, antiepileptics, selective serotonin reuptake inhibitors, omega fatty acids, and opioid antagonists have all been studied in the treatment of borderline personality disorder with positive results. Atypical antipsychotics have been studied in both schizotypal personality disorder and antisocial personality disorder, again with encouraging outcome reports. Implications of personality changes in response to pharmacologic treatment are discussed. Based on the prevalence of these disorders and the burden they cause to afflicted individuals and society, further trials are unequivocally indicated.

Anticonvulsants↗
PubMed1995

Aspects of depression associated with borderline personality disorder.

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

Adult↗
PubMed2006

Psychosocial outcome in bipolar I patients with a personality disorder.

This study examined whether comorbid personality disorders and other clinical factors were predictive of functional morbidity in bipolar I disorder. Fifty-one participants with a diagnosis of bipolar I were assessed for personality disorders and administered measures of symptomatic and functional outcomes approximately 1 year after a psychiatric hospitalization. Forty-five percent of the sample met criteria for at least one personality disorder, and patients with a personality disorder reported higher levels of residual symptoms at the time of assessment. Two thirds of participants displayed compromised functional outcomes. The three outcome domains examined (i.e., occupational, residential, social/leisure) were related to a range of clinical characteristics, and for all three, either the presence of a personality disorder diagnosis or maladaptive trait scores was associated with impaired functioning. These relationships, however, were not independent of mood symptoms according to multivariate analysis. Residual depression predicted poorer residential and social/leisure outcomes independent of personality disorders or maladaptive traits.

Activities of Daily Living↗
PubMed1993

Personality disorders: an overview for the physician.

Personality disorders are common clinical syndromes that often go unrecognized in medical practice. Because patients with personality disorders receive care in all clinical settings, physicians could profit from a heightened awareness of the personality psychopathology of their patients and its impact on medical practice. Personality traits are universal and describe the "normal" range of behavior, while personality disorders are characterized by enduring maladaptive patterns. The etiology of personality disorders is multifactorial. Physician awareness of the multiple manifestations of specific personality disorders is helpful in matching the proper interventions to appropriate patients. Although management is symptomatically palliative rather than curative, physicians and patients alike can benefit from appropriate recognition and treatment of personality disorders.

Behavior Therapy↗
PubMedDate not supplied

The psychopharmacology of borderline personality disorders.

DSM-III borderline personality disorder defines a group of patients who are characterised by impulsivity and unpredictable behaviour, inappropriate aggression, intense and unstable relationships and are often associated with repeated suicidal behaviour. A substantial body of research has established an association between disturbance of serotonin and also dopamine and suicidal behaviour in depression. A similar relationship is also seen in studies of personality disorders which suggests the association is not specific to depression. A placebo controlled study of low dose flupenthixol has been shown to significantly reduce subsequent suicidal behaviour in patients with personality disorders without depression or schizophrenia. Evidence points to a biological basis for suicidal behaviour and borderline personality disorder and possibly of pharmacotherapy.

Borderline Personality Disorder↗
PubMed1987

Geriatric depression and DSM-III-R personality disorder criteria.

The relationship between personality traits and late-life depression is not well established. The Personality Disorder Examination (PDE), a recently developed structured interview for diagnosing DSM-III-R* personality disorders, has provided a methodological advance for studies in this area. The PDE was administered to 36 cognitively intact elderly individuals. The sample consisted of 21 patients who had recovered from depression and 15 normal volunteers. Two of the patients met DSM-III-R criteria for personality disorder according to the PDE. The patient group received higher scores on PDE items related to each personality diagnosis (P less than .01) except antisocial personality disorder. These preliminary data suggest that elderly patients with a history of major depression have more lifetime personality dysfunction than normal elderly individuals, although no specific pattern could be identified.

Aged↗
PubMed1996

Establishing the severity of personality disorder.

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

Humans↗
PubMed1995

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

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

Adult↗
PubMed2003

Executive and nonexecutive neuropsychological functioning in antisocial personality disorder.

OBJECTIVE: To examine the relationships between antisocial personality disorder and executive abilities as well as antisocial personality disorder with other domains of cognitive functioning. BACKGROUND: Previous research has suggested that antisocial personality disorder is associated with impaired executive functioning. However, methodological limitations of past research have resulted in inconsistent findings. METHODS: Executive functioning and other cognitive abilities were compared in four demographically matched groups of middle-aged community dwelling male veterans (N = 336). The groups were: (A). those with active antisocial personality disorder psychopathology; (B). those with a lifetime prevalence of antisocial personality disorder but inactive antisocial personality disorder psychopathology; (C). a nonantisocial personality disorder psychiatrically matched control group; and (D). a normal control group. RESULTS: Multivariate analysis of variance revealed that the four groups were not statistically significantly different on measures of executive functioning or other cognitive abilities. CONCLUSIONS: Those with antisocial personality disorder perform at comparable levels to psychiatric and normal controls with respect to executive functioning and other domains of cognitive ability (i.e., language, memory, visuospatial, and motor abilities). An incidental finding was that, over time, the antisocial personality disorder groups improved more than control groups on a measure of general intellectual aptitude.

Adult↗