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PubMed1989

Measurement of change in personality disorders.

The nature of personality disorders introduces a number of issues that have implications for the measurement of change. This article provides an overview of issues that should be considered in the assessment of change in personality disorders, including assessment of pervasiveness and impairment, behavior sampling issues, sources of information, problems associated with comorbidity with Axis I and other disorders, and problems with subject compliance.

Humans↗
PubMed2006

Treatment of borderline personality disorder with olanzapine.

Borderline personality disorder is one of the most problematic psychiatric disorders with aggressiveness and impulsivity as its two main characteristics. Our objective was to determine the efficacy of olanzapine on 20 patients with borderline personality disorder. Results were found to be affirmative in this respect.

Adult↗
PubMed1993

Antisocial personality disorder among drug abusers. Relations to other personality diagnoses and the five-factor model of personality.

Antisocial personality disorder among drug abusers has been associated with poor drug abuse treatment outcome and greater human immunodeficiency virus infection risk compared with drug abusers without the disorder. Despite this, less is known about the personality trait dimensions of antisocial drug abusers, or about the prevalence of axis II comorbidity among this group. Similarly, little is known about the personality trait dimensions of antisocial drug abusers compared with those with axis II diagnoses other than antisocial or those with no personality diagnosis. The present study compared the personality traits of 203 outpatient opioid drug abusers categorized into either a pure antisocial group (i.e., antisocial diagnosis only), mixed antisocial group (i.e., antisocial plus another axis II diagnosis), other axis II group (i.e., axis II diagnosis other than antisocial), or a non-axis II group. Psychiatric diagnoses were made using a structured interview and personality traits of the four groups were compared using a self-report measure of the five-factor model of personality. As predicted, the mixed group was significantly more prone to neuroticism compared with the pure group, with higher scores on the vulnerability to stress and hostility facets. The mixed group also had a greater score on the neuroticism domain compared with the non-axis II group, with higher scores on five of the six facets. Significant differences were also found on agreeableness. The mixed group had lower scores on this domain (i.e., had higher interpersonal antagonism) compared with the non-axis II group. Somewhat surprisingly, the agreeableness score for the pure group was not significantly different from those of the remaining three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed2000

Dimensions and categories: the "big five" factors and the DSM personality disorders.

The five-factor model of personality, which has been widely studied in personality psychology, has been hypothesized to have specific relevance for DSM-defined personality disorders. To evaluate hypothesized relationships of the five-factor model of personality to personality disorders, 144 patients with personality disorders (diagnosed via a structured interview) completed an inventory to assess the five-factor model. Results indicated that the majority of the personality disorders can be differentiated in theoretically predictable ways using the five-factor model of personality. However, while the personality disorders as a whole appear to be differentiable from normal personality functioning on the five factors, the patterns are quite similar across the disorders, a finding that may provide some insight into the general nature of personality pathology but may also suggest problems with discriminant validity. Third, it does not appear that considering disorders as special combinations of features (as might be expected in some categorical models) is more informative than considering them as the sum of certain features (as might be expected in a dimensional model).

Adolescent↗
PubMed1994

Obsessive compulsive patients with comorbid personality disorder: associated problems and response to a comprehensive behavior therapy.

BACKGROUND: The present study examined a group of patients who have obsessive compulsive disorder (OCD) and certain comorbid personality disorders to provide data on types of clinical problems that complicate treatment. Data are presented on patient response to a comprehensive behavior therapy. METHOD: Forty-one consecutively referred, adult, nonpsychotic patients with OCD were evaluated independently by their attending psychiatrist and a consulting psychologist for presence of DSM-III-R personality disorder. Thirty-one of these patients, for whom there was 100% agreement on presence or absence of a comorbid personality disorder, participated in a course of comprehensive behavior therapy. OCD patients with comorbid personality disorder (OCD+PD) were compared with a group of OCD patients without comorbid personality disorder (nonPD OCD) on pretreatment and treatment-related variables. RESULTS: There was significantly high interrater reliability between psychiatrist and psychologist on diagnosis of personality disorder (p < .001). OCD+PD patients demonstrated poorer response to prior psychiatric treatments and greater psychosocial and psychiatric impairment at pretreatment than did nonPD OCD patients. The OCD+PD patients demonstrated a moderate response to comprehensive behavior therapy, but below that of nonPD OCD patients. OCD+PD patients were also rated as more difficult to treat, required more psychiatric hospitalizations during treatment, and were more likely to terminate behavior therapy prematurely than were nonPD OCD patients. CONCLUSION: In modest samples of OCD+PD patients (N = 26), and nonPD OCD patients (N = 5), this study found that OCD patients with personality disorder had greater psychopathology, fewer coping and living skills, and were more resistant to psychiatric treatment than the nonPD OCD patients. In addition, when treated with a comprehensive behavior therapy that focuses on other clinical problems in addition to the OCD symptoms, the OCD+PD patients had an enhanced response to treatment.

Activities of Daily Living↗
PubMed2006

Admissions for personality disorders in Italy from 1988 to 1998.

BACKGROUND: Personality disorders affect a substantial proportion of the population. It is unclear, however, whether the burden of personality disorders on modern mental health services has been increasing. To fill this gap, we analyzed trends in admissions for personality disorders in Italy from 1988 to 1998. METHODS: We used the yearly data from the Italian Central Institute of Statistics to analyse trends in the total number of admissions for personality disorders and in the total number of first admissions for personality disorders. RESULTS: The absolute number of admissions for personality disorders almost trebled from 1988 to 1998, as well as the proportion of all psychiatric admissions that were for personality disorders. Whilst there has been a marked increase in the absolute number of first admissions, the proportion of all first psychiatric admissions that were for personality disorders showed a steady but modest increase, from 5.7% to 7.6%. CONCLUSION: In Italy, the burden of personality disorders on modern mental health services has been increasing. In terms of public health, these findings highlight the urgent need of developing policies to tackle the increasing demand of care of this difficult-to-treat patient population.

Journal Article↗
PubMed1999

Structure of personality disorders from the perspective of the Revised Neo Personality Inventory domain scales and the Psychopathology-5 Scales.

This study tested the generality and comprehensiveness of the five-factor model of personality as applied to the Personality Adjective Checklist's (Strack, 1987) personality disorder scales. A sample of 258 undergraduates (113 men and 145 women) completed the Personality Adjective Checklist, the Revised NEO Personality Inventory, and the Psychopathology-5 Scales for partial course credit. A combined principal axis analysis with varimax rotation was performed for nonoverlapping scales of the Personality Adjective Checklist, the Revised NEO Personality Inventory domain scales and the Psychopathology-5 scales. The results indicated four factors which were identified as Neuroticism, Extraversion, Disagreebleness, and Conscientiousness. Openness did not emerge as a separate factor. These results supported the comprehensiveness but not the generality of the five-factor model as applied to personality disorders.

Adult↗
PubMed2003

Depressive personality disorder: a critical overview.

Depressive personality disorder (DPD), which has a long tradition in psychiatry, currently resides in Appendix B ("Disorders for Further Study") of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. After a brief outline of this history, the authors review empirical research on DPD using the Robins and Guze criteria (discussed later) for diagnostic and clinical validity as a framework. Although DPD has unique features, the authors argue that this diagnosis can largely be subsumed under dysthymic disorder. As a result of diagnostic confusion, and of the small amount of research conducted in this area, recommendations for the assessment and treatment of DPD are necessarily speculative. The authors conclude that if personality disorders are maintained as categoric constructs, DPD may best be understood as a subtype of dysthymic disorder. A more radical solution would be to conceptualize DPD, along with the other personality disorders, as extreme positions along dimensional continua.

Depressive Disorder↗
PubMed2004

Depression and personality disorder.

Research into the relationship between depression and personality disorder is compromised by a number of methodologic factors, including differing concepts of personality disorder, the validity of a personality disorder diagnosis, the effect of mood on diagnosis, and the overlap between some personality disorder symptoms and mood symptoms. Personality pathology is common in patients with personality disorder. Reasons for this include a "scar" effect of chronic low mood on attitudes and behaviors, as well as possible risk factors via certain personality traits. The negative effect of comorbid personality disorder on treatment outcome in depressed patients may be less than previously believed. Possible reasons include treatment bias in non-controlled trials and the increasing use of selective serotonin reuptake inhibitors rather than tricyclic antidepressants. Many personality traits and disorders may be part of the psychopathology of depression and share a common origin.

Affect↗
PubMed2007

Childhood antecedents of personality disorder.

PURPOSE OF REVIEW: Given the substantial continuity of personality and axis I psychopathology from childhood to adult life, the present review explores whether and how recent research findings support the notion that personality disorders have their developmental precipitants in childhood. Potential childhood personality disorder antecedents will be reviewed from different research areas to enhance an insight into the genesis of a major set of adult psychiatric disorders with profound impact on the daily life. RECENT FINDINGS: There exists increasing evidence that personality disorders have their origins in early years of life at the observable symptomatic, biological, and genetic levels. A clear need for prospective (behavior genetic) studies, however, exists that will ultimately verify how and when childhood personality disorder features turn into adult maladaptive trait patterns. It is further suggested that these designs require a comprehensive taxonomy for the description of personality disorder antecedents in a developmentally appropriate way. SUMMARY: The call for a developmental perspective on adult personality disorders in recent debates on the construction of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, has created new avenues for an integrative longitudinal perspective on personality disorders and should stimulate child psychiatrists to consider the significance of emerging personality disorder symptoms at a young age.

Activities of Daily Living↗
PubMedDate not supplied

Personality disorders in students with depressive pathology.

In a group of 111 students with depressive disorders, 70% presented a concurrent personality disorder and nearly 15% had prominent personality traits. The unstable, obsessive, hysteric and dysthymic types of personality disorders were relatively more frequent, the higher percent of cases (27.3%) being included in the mixed subgroup of these disorders. The patients with personality disorders had: an earlier age of affective illness onset, a more marked depression severity, a higher frequency of recurrent and nonreactive depression forms. Nonbipolar major depressive disorders were associated with the presence of unstable and dysthymic types of personality disorders, while minor depressive disorders were related with hysteric, asthenic and mixed ones.

Adolescent↗
PubMed2003

The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder.

OBJECTIVE: The syndromal and subsyndromal phenomenology of borderline personality disorder was tracked over 6 years of prospective follow-up. METHOD: The psychopathology of 362 inpatients with personality disorders was assessed with the Revised Diagnostic Interview for Borderlines (DIB-R) and borderline personality disorder module of the Revised Diagnostic Interview for DSM-III-R Personality Disorders. Of these patients, 290 met DIB-R and DSM-III-R criteria for borderline personality disorder and 72 met DSM-III-R criteria for other axis II disorders (and neither criteria set for borderline personality disorder). Most of the borderline patients received multiple treatments before the index admission and during the study. Over 94% of the total surviving subjects were reassessed at 2, 4, and 6 years by interviewers blind to previously collected information. RESULTS: Of the subjects with borderline personality disorder, 34.5% met the criteria for remission at 2 years, 49.4% at 4 years, 68.6% at 6 years, and 73.5% over the entire follow-up. Only 5.9% of those with remissions experienced recurrences. None of the comparison subjects with other axis II disorders developed borderline personality disorder during follow-up. The patients with borderline personality disorder had declining rates of 24 symptom patterns but remained symptomatically distinct from the comparison subjects. Impulsive symptoms resolved the most quickly, affective symptoms were the most chronic, and cognitive and interpersonal symptoms were intermediate. CONCLUSIONS: These results suggest that symptomatic improvement is both common and stable, even among the most disturbed borderline patients, and that the symptomatic prognosis for most, but not all, severely ill borderline patients is better than previously recognized.

Adult↗
PubMed2005

Alcoholism and personality disorders: an exploratory study.

AIMS: To define the most frequent personality disorders related to alcohol dependence. METHODS: Using the International Personality Disorder Examination and the Millon Clinical Multiaxial Inventory-II for personality disorders, 30 consecutively recruited alcohol-dependent patients attending an outpatient clinic were compared with 30 consecutively recruited psychiatric patients with non-addictive disorders and 31 subjects from the general population chosen to match the patient samples for age, gender and socio-economic level. RESULTS: Forty percent of the alcohol-dependent patients and 16.6% of the general clinical sample (vs 6.4% of the normative sample) showed at least one personality disorder. Dependent personality disorders were most prevalent (13.3%), followed by paranoid and obsessive-compulsive personality disorders (10% each).

Adult↗
PubMed2004

Refining personality disorder diagnosis: integrating science and practice.

OBJECTIVE: Personality disorder researchers are currently evaluating a range of potential solutions to problems with the DSM-IV diagnostic categories. This article proposes changes to the diagnostic categories and criteria based on empirical findings from a national sample of patients with personality disorder diagnoses. METHOD: The Shedler-Westen Assessment Procedure (SWAP-200) is a personality assessment tool designed to capture the richness and complexity of clinical personality descriptions while providing reliable and quantifiable data. A national sample of experienced psychiatrists and psychologists used the SWAP-200 to describe either their conceptions (prototypes) of personality disorders (N=267) or current patients with personality disorder diagnoses (N=530). RESULTS: Clinicians" conceptions of personality disorders and their descriptions of actual patients overlapped with the DSM descriptions but also differed in systematic ways. Their descriptions were clinically richer than the DSM descriptions and placed greater emphasis on patients" mental life or inner experience. The study identifies potential diagnostic criteria that may be more defining of personality syndromes than some of the current DSM criteria. CONCLUSIONS: Diagnostic criterion sets should be expanded to better address the multiple domains of functioning inherent in the concept of personality and should more explicitly address patients' mental life or inner experience. The authors offer recommendations for revision of the diagnostic categories and criteria and also propose a prototype matching approach to personality disorder diagnosis that may overcome limitations inherent in the current diagnostic system.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2006

[Suicidal behaviour in borderline personality disorder].

Patients with borderline personality disorder have a substantially increased risk of self-destructive and suicidal behaviour, and are often seen as difficult to treat efficiently. A strong over-sensitivity to negative happenings in life, affective instability and impulsiveness are important risk factors for repetitive suicidal crises. Clinicians need to assess the suicide risk for individuals in general and more situation-specific risks. If there is a high risk, short term hospitalisation should be considered. Most patients will need long-term specialised treatment rather than a series of shorter treatments that might well worsen the prognosis. Several treatment models are currently available; among them are Dialectical Behaviour Therapy and Mentalisation-Based Therapy. The paper discusses how these treatment models address suicidal behaviour in patients with borderline personality disorder and the results that have been achieved in studies of treatment effectiveness.

Behavior Therapy↗
PubMed2006

Suicidal behavior in alcohol-dependent subjects: the role of personality disorders.

BACKGROUND: Comobidity of personality disorders (PDs) and alcohol dependence are considered to increase the risk for suicidal behavior. The aim of this study is to assess the influence of Diagnostic and Statistical Manual of Mental Disorder-fourth edition (DSM-IV) personality characteristics and comorbid axis I disorders on suicidal behavior in alcohol-dependent inpatients. METHODS: Characteristics of alcohol dependence and suicidal behavior were obtained using the Semi-Structured Assessment on Genetics in Alcoholism (SSAGA). Personality disorder characteristics were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders. RESULTS: Three-hundred seventy-six treatment-seeking alcohol-dependent subjects, of whom 55% were diagnosed to have a PD and approximately 25% had a history of at least 1 suicide attempt, were enrolled into the study. Subjects with PDs in all clusters reported a higher rate of suicide attempt history, depression episodes, and depression during the most serious attempt. As indicated by univariate and multivarate analysis, this pattern of suicide attempt characteristics was most pronounced in borderline disordered subjects and alcoholic individuals who live alone. CONCLUSION: Subjects with alcohol dependence who have various comorbid PDs and depression deserve special attention in psychiatric care to prevent suicide. Psychotherapeutic strategies may have to be adapted to treat this high-risk population.

Adult↗
PubMedDate not supplied

[Sociocultural aspects of the genesis of personality disorders].

The prevalence of personality disorders seems to be increasing in the last decades. Many sociologists and historians believe that since the end of World War II, we have seen important changes, social, cultural and economic, which could indicate that we are entering a new age. The Postmodern Age, after nearly 500 years of Modern Age. Postmodernits is characterized by an increase of the speed in all realms of life, permanent changes, materialism, dominance of capitalism as economic model, changes of roles, etc. We speculate about the posibility that the characteristics of postmodern society may be contributing to the increase of prevalence of personality disorders in general and some of them in particular.

Altruism↗