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PubMed2000

Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study.

OBJECTIVE: Suicidal behavior is highly prevalent in borderline personality disorder and major depressive episode, although the characteristics of suicide attempts in the two disorders are believed to differ. Comorbidity of borderline personality disorder and major depressive episode may obscure characteristics of suicide attempts that are uniquely related to the psychopathology of each disorder. We compared suicidal behavior in patients with borderline personality disorder, major depressive episode, and borderline personality disorder plus major depressive episode to determine whether characteristics of suicide attempts differed between groups and if aspects of core psychopathology predicted specific attempt characteristics. METHOD: Eighty-one inpatients with borderline personality disorder, including 49 patients with borderline personality disorder plus major depressive episode, were compared to 77 inpatients with major depressive episode alone on measures of depressed mood, hopelessness, impulsive aggression, and suicidal behavior, including lifetime number of attempts, degree of lethal intent, objective planning, medical damage, and degree of violence of suicide methods. RESULTS: No significant differences were found in the characteristics of suicide attempts between patients with borderline personality disorder and those with major depressive episode. However, patients with both disorders had the greatest number of suicide attempts and the highest level of objective planning. An increase in either impulsive aggression or hopelessness or a diagnosis of borderline personality disorder predicted a greater number of attempts. Hopelessness predicted lethal intent in all three groups and predicted objective planning in the group with both disorders. Medical damage resulting from the most serious lifetime suicide attempt was predicted by number of attempts. CONCLUSIONS: Comorbidity of borderline personality disorder with major depressive episode increases the number and seriousness of suicide attempts. Hopelessness and impulsive aggression independently increase the risk of suicidal behavior in patients with borderline personality disorder and in patients with major depressive episode.

Adolescent↗
PubMed2000

Toward an empirically based classification of personality disorder.

A framework for an empirically based classification of personality disorder is proposed that has two components: (a) a definition of personality disorder, and (b) a scheme for describing individual differences in personality disorder traits. It is suggested that the diagnosis process should begin by establishing the presence of personality disorder and then proceed to a description of the personality on a set of trait dimensions. It is argued that a definition of personality disorder should reflect an understanding of the nature of the "harmful dysfunction" implied by a diagnosis of personality disorder. With this approach, personality disorder is defined as the failure to solve life tasks involving the development of integrated representations of self and others, and the capacity for adaptive kinship and societal relationships. The second component of a classification is a system to describe individual differences. It is suggested that these should be based on taxonomies of normal and disordered traits, and that the classification incorporates both higher-order patterns and more specific basic traits. Given that personality appears to be inherited as a large number of genetic dimensions, it is suggested that the primary level for describing individual differences is that of the basic or lower-level traits rather than broader or higher-level traits used in descriptions of normal personality.

Empiricism↗
PubMed1990

Structured interview data on 102 cases of multiple personality disorder from four centers.

Patients with multiple personality disorder (N = 102) at four different centers were interviewed with the Dissociative Disorders Interview Schedule. The presenting characteristics of the patients at all four centers were very similar. The clinical profile that emerged included a history of childhood physical and/or sexual abuse in 97 (95.1%) of the cases. The subjects reported an average of 15.2 somatic symptoms, 6.4 Schneiderian symptoms, 10.2 secondary features of the disorder, 5.2 borderline personality disorder criteria, and 5.6 extrasensory experiences; their average score on the Dissociative Experiences Scale was 41.4. The results indicate that multiple personality disorder has a stable, consistent set of features.

Borderline Personality Disorder↗
PubMed1993

Personality disorders in patients with somatisation disorder. A controlled study.

Twenty-five women with somatisation disorder (SD) were compared with matched patient controls for the presence of personality disorders. Personality was assessed with the Personality Assessment Schedule (PAS). Interviewers were unaware of the patients' diagnoses. All controls had DSM-III-R axis I diagnoses of depressive or anxiety disorders. The prevalence of personality disorders among patients with somatisation disorder was 72% compared with 36% among controls. Certain personality disorders, including passive-dependent, histrionic, and sensitive-aggressive, occurred significantly more often in the SD patients than controls.

Adult↗
PubMedDate not supplied

Diagnostics discrepancies between ICD-10 and DSM-IV in personality disorders.

INTRODUCTION: 50 % of the patients seen in the mental health clinics have personality disorders and their diagnosis is very important to establish the patient's prognosis and treatment. The clinician usually only uses one nosology, the ICD-10 or the DSM-IV and is aware of the differences between them. However, he/she gives preference to his/her favorite nosology. MATERIAL AND METHOD: A total of 248 patients seen in a mental health clinic were included in the study. They were diagnosed of anxiety (n = 121) and depressive (n = 127) disorders, with a mean age of 32.3 years for anxiety disorders and 32.4 years depressive disorders. The International Personality Disorders Examination (IPDE) Screening Questionnaire in its DSM-IV and ICD-10 versions was administered to observe the degree of concordance between the two nosologies. RESULTS AND DISCUSSION: The female population predominated in our sample, these being 35.5 % men with anxiety disorders and 65,5 % women, and 29.10 % men and 70.9 % women with depressive disorders. An observational study was performed by studying the percentage with 3 or more positive items and also percentage with 6 or more positive items. It was observed that the DSM-IV version produced more positive diagnoses and more comorbidity. Thus, it is necessary to consider whether the ICD-10 version subdiagnoses personality disorders or the DSM-IV version gives false positives. The qualitative differences between the ICD-10 and the DSM-IV must also be considered. The ICD-10 does not include narcissistic and schizotypal personality disorders and subdivides the borderline personality disorder into two subcategories, so that a given patient can receive different diagnoses according to the nosology used. CONCLUSIONS: In the patient sample studied, diagnostic discrepancies in personality disorders between DSM-IV and ICD-10 are so important that the World Health Organization and the American Psychiatry Association should consider unifying categories and diagnostic criteria of personality disorders in the next nosologies.

Adult↗
PubMed2004

Dimensions of personality disorders in offenders.

BACKGROUND: Owing to criticisms of current concepts of personality disorders such as high comorbidity, criteria overlap and arbitrary thresholds of categorical diagnoses, a dimensional assessment is proposed that considers interrelations between different personality disorders. Results of previous factor analyses using dimensional personality disorder scores have indicated that one underlying dimension shows strong similarities to the concept of psychopathy and is similarly related to criminal recidivism. AIM: The authors examined the underlying dimensions of ICD-10 personality disorders, to analyse their association with criminal behaviour in general, and with specific criminal history variables. METHOD: Study samples included 105 offenders and 80 non-criminal controls. Personality disorders were measured using a clinical structured interview (IPDE), measures of personality using self-report (NEO-FFI, IPC, HDHQ), and criminal history variables obtained from court records. RESULTS: Three underlying personality disorder factors could be identified, which showed identical structures in both the forensic and the non-forensic sample. Factor 1 comprised emotionally unstable, histrionic, paranoid and dissocial traits and showed strong similarity to the construct of psychopathy. Factor 2 was defined by anankastic personality disorder scores and an inverse relation to schizoid personality features. Factor 3 showed high negative loadings of anxious and dependent personality disorders. Self-report measures of personality and criminal history variables yielded different associations with the three PD dimensions. Offenders with high scores on factor 1 were highly aggressive, violent and impulsive. CONCLUSIONS: The findings generally replicated previous analyses using DSM-III personality disorder scores. Differences can be explained by the different constructs of personality disorders included in ICD-10. Although a diagnosis of psychopathy is not currently included in these diagnostic systems, the authors' findings indicate that a highly inter-related pattern of personality disorder scores constitutes psychopathic personality disorder and can be used to identify impulsive, hostile and violent offenders.

Adult↗
PubMed2001

Recent developments in research of trauma and personality disorders.

Although the association between trauma and personality disorders, particularly borderline personality disorder (BPD), has been well established, the etiologic role of trauma in the development of personality disorders has been a topic of debate. Numerous mediation models have been put forth to explain how trauma can serve as a risk factor for the subsequent development of BPD. The symptomatic overlap between the proposed complex post-traumatic stress disorder diagnosis and BPD has fueled research efforts aimed at determining whether these are distinct disorders or should both be considered as trauma spectrum disorders. Treatment implications of this diagnostic differentiation are discussed.

Borderline Personality Disorder↗
PubMed2006

Prevalence and correlates of personality disorder in Great Britain.

BACKGROUND: Epidemiological data on personality disorders, comorbidity and associated use of services are essential for health service policy. AIMS: To measure the prevalence and correlates of personality disorder in a representative community sample. METHOD: The Structured Clinical Interview for DSM-IVAxis II disorders was used to measure personality disorder in 626 persons aged 16-74 years in households in England, Scotland and Wales, in a two-phase survey. RESULTS: The weighted prevalence of personality disorder was 4.4% (95% CI 2.9-6.7). Rates were highest among men, separated and unemployed participants in urban locations. High use of healthcare services was confounded by comorbid mental disorder and substance misuse. Cluster B disorders were associated with early institutional care and criminality. CONCLUSIONS: Personality disorder is common in the community, especially in urban areas. Services are normally restricted to symptomatic, help-seeking individuals, but a vulnerable group with cluster B disorders can be identified early, are in care during childhood and enter the criminal justice system when young. This suggests the need for preventive interventions at the public mental health level.

Adolescent↗
PubMedDate not supplied

Personality disorders among difficult patients.

OBJECTIVE: To determine the association between "difficult" patient status and personality disorder. DESIGN: A survey using the Diagnostic Interview for Personality Disorders. PARTICIPANTS: Twenty-one patients nominated by 9 family medicine providers who subjectively experienced their care as difficult and 22 control subjects systematically selected from the same practices. MAIN OUTCOME MEASURE: The presence of personality disorder measured by the Diagnostic Interview for Personality Disorders. RESULTS: Personality disorders were more prevalent among the difficult patients: 7 of 21 difficult patients and 1 of 22 control subjects had at least 1 personality disorder (P = .02). Five of 7 difficult patients had dependent personality disorder. None of the providers realized that the difficult patients had personality disorders. CONCLUSIONS: Unrecognized personality disorder can make difficult provider-patient relationships more likely. Dependent personality disorder may be especially difficult. Improved physician awareness of personality disorders may lead to more effective understanding and treatment of some difficult patients.

Adult↗
PubMedDate not supplied

[Pharmacotherapy in personality disorders: methodological issues and results].

The pharmacotherapy of personality disorders is less developed than are psychological treatments in this area, but they are a logical prolongation of psychobiological models of personality and temperament, and respond to the need of many clinicians in front of difficult patients. The assessment of drugs effects in personality disorders includes some important conceptual and methodological issues. Categorical or dimensional instruments evaluating baseline personality and under-treatment changes are now available. Such studies are necessary of long duration, with difficult patients, and use specific outcome criteria. The results obtained in the field of pharmacotherapy of personality disorders can be classified according to DSM IV axis-II categorization. In anxious personalities (cluster C), some isolated studies suggest a favourable effect of antidepressants on obsessive-compulsive dimension, on avoidant personality disorder, and on inhibition and trait-anxiety, especially when serotoninergic agents are used. Few studies have been conducted in cluster A personality disorders, and some are in favour of the interest of low doses of antipsychotic drugs in this group. Most studies have been conducted in cluster B, and especially in antisocial and borderline personality disorders. Partial positive results have been obtained using various classes of drugs for dealing with aggression and impulsive behaviors, including lithium, beta-blockers, carbamazepine, valproate, antipsychotic drugs, and also SSRIs. Self-harm and suicidal behaviors seem to be partially but significantly improved by antidepressants and low doses of antipsychotics. Opioid antagonisms may be helpful for these indications in the future. Other symptom-oriented strategies for psychopharmacology have been conceptualized, focused on depressive personality, emotional lability, cognitive and perceptual disturbances, or interpersonal sensitivity. Overall, the pharmacotherapy of personality disorder remains to date one of the less explored in psychiatry research. Nevertheless, it may lead in the future to the development of effective treatments, in complement to psychotherapy, for actually severe, chronic, and disabling disorder.

Antidepressive Agents↗
PubMed1982

Passive-aggressive personality disorder. Treatment implications of a clinical typology.

Patients with passive-aggressive personality disorder or personality traits represent a very difficult group on which surprisingly little is written. The authors delineate four patterns of passive-aggressive behavior that pose different problems in learning and adaptation. These are the anxiety-inhibited, environmentally inhibited (masochistic), and resentful-vindictive patients and patients inhibited by existential choice. All four types meet the DSM-III criteria for passive-aggressive personality disorder; they may also occur as significant personality traits apart from the fully developed personality disorder. The difficulties that these patients present are the same for clinicians of every theoretical perspective. Using one treatment approach, assertiveness training, the authors offer specific suggestions in the treatment of each type of passive-aggressive patient. These suggestions should aid the clinicians in avoiding premature termination, and fostering both a positive therapeutic alliance and a successful treatment outcome.

Adult↗
PubMed1999

The relationship among three models of personality psychopathology: DSM-III-R personality disorder, TCI scores and DSQ defences.

BACKGROUND: Current systems of describing personality pathology have significant shortcomings. A polydiagnostic approach is used to study the relationship between psychological, psychoanalytical and psychopathological models of personality. METHODS: The subjects were 256 patients enrolled in treatment studies of major depression and bulimia nervosa. Subjects were assessed using the Temperament and Character Inventory (TCI), the Defense Style Questionnaire (DSQ) and the Structured Clinical Interview for DMS-III-R personality disorders (SCID-II). RESULTS: Subjects had high rates of DSM-III-R personality disorders with 52% having at least one personality disorder. Cluster A personality disorders were correlated with low reward dependence, high harm avoidance and low self-directedness and cooperativeness. Cluster B personality disorders were related to high novelty seeking and low self-directedness and cooperativeness. Cluster C personality disorders were correlated with high harm avoidance and low novelty seeking and low self-directedness. Immature defences were related to DSM-III-R personality symptoms, but individual defences were not related to personality clusters in a predictable way. Immature defences were strongly related to low self-directedness and cooperativeness. Both TCI self-directedness scores and immature defence scores were moderately predictive of the presence and number of personality disorders. CONCLUSION: A widely accepted clinical nosology (DSM-III-R personality disorders) rated using a clinical interview correlates reasonably predictably with two theoretical models derived from different paradigms and rated using self-reports. This might be seen as providing concurrent validity for all three models. However, serious methodological shortcomings confront studies of this type, including sample selection and measurement of personality dysfunction. One way to begin to resolve these problems is to study which personality measures are best related to treatment response and prognosis.

Adolescent↗
PubMed2005

Quantitative electroencephalographic measures in homicidal men with antisocial personality disorder.

Many symptoms of antisocial personality disorder have been proposed to be related to decreased daytime vigilance. To explore this hypothesis, quantitative analyses were conducted of the electroencephalographic (EEG) activity of drug-free and detoxified homicidal male offenders with antisocial personality disorder as the primary diagnosis. Subjects comprised 16 men recruited from a forensic psychiatric examination in a special ward of a university psychiatric hospital. Fifteen healthy age- and gender-matched controls with no criminal record or history of physical violence consisted of hospital staff and students. An overall reduction of alpha power was observed in the waking EEG of offenders. A bilateral increase in occipital delta and theta power was also found in these individuals. This study provides further support to the growing evidence of brain dysfunction in severe aggressive behavior. Homicidal offenders with antisocial personality disorder seem to have difficulties in maintaining normal daytime arousal. Decreased vigilance, together with social and psychological variables, may explain their aberrant behavior in everyday life. New studies are, however, needed to specify the vigilance problems of this patient group.

Adult↗
PubMed2002

Gender role and personality disorders.

Many researchers have hypothesized relationships between personality disorders and gender role (i.e., masculinity and femininity). However, research has not addressed if people who are masculine or feminine more often meet the criteria for personality disorders. The present study examined whether college students (N = 665, 60% women) higher in masculinity or femininity more often exhibited features of the 10 DSM-IV personality disorders. Feminine men exhibited more features of all the personality disorders except antisocial. Dependent traits were associated with higher femininity and lower masculinity. Antisocial traits were associated with masculinity. Both men and women who typically behaved consistent with their gender had more narcissistic and histrionic features, whereas participants who typically behaved unlike their gender had more features of the Cluster A personality disorders.

Adolescent↗
PubMed2005

A developmental perspective on personality disorders: lessons from research on normal personality development in childhood and adolescence.

Recent work on normal personality development in children and adolescents points to several conclusions that are relevant for understanding personality pathology. First, child temperament and adult personality traits share many features in common. Second, youths' individual differences can be described in terms of the Big Five personality traits observed in adults; an integrative taxonomy of individual differences in childhood and adolescence is articulated in this article. Third, personality is already moderately stable by the preschool years, but considerable personality change occurs well into the adult years. Taken together, these findings suggest that childhood personality functioning can and should be integrated into developmental research and applied work on personality disorders.

Adolescent↗
PubMed2006

Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders.

Participants were 30 adult outpatients diagnosed with avoidant personality disorder or obsessive-compulsive personality disorder who enrolled in an open trial of cognitive therapy for personality disorders. Treatment consisted of up to 52 weekly sessions. Symptom evaluations were conducted at intake, at Sessions 17 and 34, and at the last session. Alliance variables were patients' first alliance rating and "rupture-repair" episodes, which are disruptions in the therapeutic relationship that can provide corrective experiences and facilitate change. Stronger early alliances and rupture-repair episodes predicted more improvement in symptoms of personality disorder and depression. This work points to potentially important areas to target in treatment development for these personality disorders.

Adult↗
PubMed1997

[Diagnosis and therapy of personality disorders].

Approximately 10% of the unselected population are affected with personality disorders, among the patients of psychiatrists and family doctors the quota goes up to 40%. Personality disorders comprise deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations. They are stable and lead frequently to subjective distress and/or to impaired social functioning. The division in subgroups is made on the reason of typical patterns of experience and behaviour, but overlapping between different subtypes is frequent. People with personality disorders often come into conflicts with their environment because of their maladaptive behaviour which lead to crises and need of intervention. Psychopharmaca can be given in such situations, but substances with an addictive potential like benzodiazepines should not be prescribed for a longer period. The long-term psychotherapy of personality disordered persons requires an individual planing after a careful analysis of the behaviour pattern and should focus on concretely defined and reachable aims. Personality disordered persons belong to the most difficult patients, their long-term treatment demands appropriate therapeutic skills. In the primary care family doctors therapy and support is important but several basic rules should be followed.

Combined Modality Therapy↗
PubMed1999

Use of the TAT in the assessment of DSM-IV cluster B personality disorders.

The Social Cognition and Object Relations Scale (SCORS), developed by Western, Lohr, Silk, Kerber, and Goodrich (1985), is a diagnostic instrument used to assess an array of psychological functioning by using clinical narratives such as the Thematic Apperception Test (TAT; Murray, 1943) stories. This study investigated the utility of the SCORS to differentiate between Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) antisocial personality disorder (ANPD), borderline personality disorder (BPD), narcissistic personality disorder (NPD), and Cluster C personality disorder (CPD). A sample of 58 patients was separated into four groups: ANPD (n = 9), BPD (n = 21; 18 with a primary BPD diagnosis and 3 with prominent borderline traits who met 4 of the 5 DSM-IV criteria necessary for a BPD diagnosis), NPD (n = 16; 8 with a primary NPD diagnosis and 8 with prominent narcissistic traits who met 4 of the 5 DSM-IV criteria necessary for a NPD diagnosis), and CPD (n = 12). These groups were then compared on the 8 SCORS variables by using 5 TAT cards (1, 2, 3BM, 4, and 13MF). Spearman-Brown correction for 2-way mixed effects model of reliability for the 8 SCORS variables ranged from .70 to .95. The results of categorical and dimensional analyses indicate that (a) SCORS variables can be used to differentiate ANPD, BPD, and NPD; (b) the BPD group scored significantly lower (greater maladjustment) than did the CPD group on certain variables; (c) the BPD group scored significantly lower (greater maladjustment) than did the NPD group on all 8 SCORS variables; (d) the ANPD group scored significantly lower than did the NPD group on certain variables; (e) certain variables were found to be empirically related to the total number of DSM-IV ANPD, BPD, and NPD criteria; and (f) certain variables were found to be empirically related to Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Personality disorder scales. The results of this study are discussed in terms of clinical utility, conceptual, and theoretical implications.

Adult↗