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PubMed2001

The relationship between comorbid personality disorders and treatment received in patients with anxiety disorders.

Few studies have addressed the relationship between the presence of a comorbid personality disorder and the amount of psychiatric treatment received by patients with an Axis I disorder. This issue has not been studied in patients with anxiety disorders. In a prospective, naturalistic, longitudinal study of anxiety disorders, 526 subjects were assessed with the Personality Disorder Examination, and types of treatment received in 1991 and 1996 were identified. In 1991, compared to subjects without a personality disorder, subjects with a personality disorder were as likely to receive medication and they received a greater number of medications. Subjects with borderline personality disorder were more likely to receive heterocyclic antidepressants and interventions characteristic of psychodynamic psychotherapy and cognitive therapy; they also reported receiving a greater number of medications and types of psychosocial treatment than other subjects. In 1996, subjects with borderline personality disorder were more likely to receive psychodynamic interventions. These findings suggest that in patients with an anxiety disorder, the presence of a comorbid personality disorder is associated with receiving a greater number of medications but not with a greater likelihood of receiving pharmacologic or psychosocial treatment. However, the presence of borderline personality disorder is associated with a greater likelihood of receiving, and receiving a greater number of, certain types of somatic and psychosocial treatments.

Adult↗
PubMed1992

Rorschach indicators of Multiple Personality Disorder.

The increase in reported cases of Multiple Personality Disorder underscores a great need to differentiate clearly this from other psychiatric disorders and from simulation of Multiple Personality Disorder. Two sets of Rorschach signs have been advanced as clinical markers by their developers, namely Barach and also Wagner, Allison, and Wagner. As the Wagner signs are prevalent in much of the research on Rorschach responses in Multiple Personality Disorder, the purpose of the present study was to evaluate these signs using Wagner's administration and the resulting Rorschach protocols of 16 Multiple Personality Disorder patients and 16 psychiatric controls. Analysis indicated that this system was deficient in correctly classifying these 32 protocols. A new marker, the Splitting Response, emerged, however, which was more useful. This response, in combination with at least one Dissociative response, produced an accuracy rate of 94%. These new criteria may be useful aids in the detection of Multiple Personality Disorder from Rorschach protocols. Replication is urged.

Adult↗
PubMed1997

[New approaches for understanding borderline personality disorder].

The concept of Borderline Personality Disorders was developed from North-American psychiatric and psychoanalytic thought. During recent years different contributions on this disorder emerged from several psychological paradigms. Four current trains of research are reviewed: Approaches based upon the five-factor-model of personality, Linehan's behavioristic approach, interpersonal concepts as shown by Benjamin and a self-developed subject-centered approach focussing on the patients' subjective theories of illness. These models converge into a concept which interprets Borderline Personality Disorders as disturbances of personal identity. The patients fail when attempting to overcome the tension between being a person and being a subject in their interpretation of the world and themselves. At the end of the article consequences for therapy are highlighted.

Borderline Personality Disorder↗
PubMed1989

An external validity study of the MMPI Personality Disorder Scales.

This study examined the external validity of the MMPI Personality Disorder (PD) scales. Patients diagnosed with personality disorders (n = 23), according to a structured interview, were contrasted with medical control subjects and psychiatric patients with no personality disorder (n = 33). The MMPI PD scales could discriminate patients with any personality disorder and patients with specific clusters of personality disorders. Convergent validity was demonstrated by high correlations between the MMPI PD scales and the comparable Millon Clinical Multiaxial Inventory scales, as well as the number of DSM-III personality disorder symptoms. This study represents a preliminary step in the external validation of the MMPI PD scales.

Adult↗
PubMed1998

Special feature: pharmacotherapy in personality disorders.

Recent epidemiological and psychobiological studies indicate that psychopharmacology is promising, even for the treatment of personality disorders. Psychotropic drugs may have positive effects on personality disorders that show a close-relationship to Axis I disorders (e.g., schizotypal personality disorder--schizophrenia simplex; avoidant personality disorder--generalized social phobia; borderline personality disorder--affective disorders, etc.). In addition, psychotropic drugs may influence certain psychopathological symptom clusters (e.g., cognitive-perceptual organization, impulsivity/aggressivity, affective instability, anxiety/inhibition) present in various disorders. Psychotropic drugs may also be indicated when psychiatric comorbidity exists. The results of clinical pharmacological studies are reviewed with reference to cluster A, B, and C personality disorders. Some guidelines can be drawn from these trials. Clinically, the use of psychotropic drugs in symptomatic crises should be considered, especially when a secondary psychiatric comorbidity exists. Pharmacotherapy is well indicated for personality disorders closely associated with Axis I disorders. Usually pharmacotherapy is short term, although in some cases long-term treatment may be promising. However, pharmacotherapy must always refer to a supportive therapeutic interaction between physician and patient.

Anticonvulsants↗
PubMed2005

The prevalence of DSM-IV personality disorders in psychiatric outpatients.

OBJECTIVE: The largest clinical epidemiological surveys of personality disorders have been based on unstructured clinical evaluations. However, several recent studies have questioned the accuracy and thoroughness of clinical diagnostic interviews; consequently, clinical epidemiological studies, like community-based studies, should be based on standardized evaluations. The Rhode Island Methods to Improve Diagnostic Assessment and Services project is one of the largest clinical epidemiological studies to use semistructured interviews to assess a wide range of psychiatric disorders conducted in general clinical outpatient practice. In the present report, the authors examined the frequency of DSM-IV personality disorders in a patient group and the comorbidity among them. METHOD: Eight hundred fifty-nine psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality upon presentation for treatment. RESULTS: Slightly less than one-third of the patients were diagnosed with one of the 10 official DSM-IV personality disorders (N=270, 31.4%). When the patients with personality disorder not otherwise specified were included, the rate of any personality disorder increased to almost half of the group (N=391, 45.5%). The majority of patients meeting criteria for one of the specific personality disorders were diagnosed with more than one. Avoidant, borderline, and obsessive-compulsive personality disorder were the most frequent specific diagnoses. CONCLUSIONS: Personality disorders, as a group, are among the most frequent disorders treated by psychiatrists. They should be evaluated in all psychiatric patients because their presence can influence the course and treatment of the axis I disorder that patients typically identify as their chief complaint.

Adult↗
PubMed1987

Treatment of outpatients with borderline personality disorder.

Outpatient treatment of patients with borderline personality disorder is sometimes more difficult and more challenging than inpatient treatment. Because symptoms are frequently less florid and more variable in the outpatient, diagnostic evaluation must proceed at a slower pace. Diagnostic distinctions among patients with borderline personality disorder are based on whether the predominant symptoms displayed are "affective," "schizotypal," or "impulse-disordered." Outpatient evaluation requires a keen sensitivity to the presenting problems and the ability to assign priorities to treatment issues. Pharmacotherapy can be of advantage in treating outpatients with borderline personality disorder, but care must be taken in selecting appropriate drugs and dosage and in communicating to the patient what can be expected during therapy. Borderline patients with impulse-control disorders, especially substance abuse, cannot be treated effectively with individual psychotherapy alone. Although many creative and articulate psychodynamic formulations of borderline personality disorder have been proposed, an initial "cognitive" approach to psychotherapy combined with pharmacotherapy can be effective in alleviating acute symptoms, and more psychodynamic approaches can be employed when the patient is better equipped to use them.

Ambulatory Care↗
PubMed1979

Classification of personality disorder.

An interview schedule was used to record the personality traits of 130 psychiatric patients, 65 with a primary clinical diagnosis of personality disorder and 65 with other diagnoses. The results were analysed by factor analysis and three types of cluster analysis. Factor analysis showed a similar structure of personality variables in both groups of patients, supporting the notion that personality disorders differ only in degree from the personalities of other psychiatric patients. Cluster analysis revealed five discrete categories; sociopathic, passive-dependent, anankastic, schizoid and a non-personality-disordered group. Of all the personality-disordered patients 63 per cent fell into the passive-dependent or sociopathic category. The results suggest that the current classification of personality disorder could be simplified.

Humans↗
PubMed1997

Comorbidity of personality disorders and major depression in patients with somatoform pain disorders or medical illnesses with long-standing work disability.

The comorbidity between major depression and personality disorders in patients with long-standing work disability at a rehabilitation clinic was investigated. Sixty patients with a somatoform pain disorder and 66 patients with different medical illnesses were assessed by means of a self rating scale for major depression, and the SCID screen personality disorder questionnaire. In the total series, 27% of the patients had a diagnosis of major depression and 34.9% had at least one personality disorder. Personality disorders were significantly more common in patients with medical illness than in patients with a somatoform pain disorder. There was a high frequency of comorbidity between major depression and personality disorders, especially borderline and avoidant personality disorders. If this is due to a common pathogenetic mechanism, it could explain why SSRIs are effective in both depression and some personality disorders.

Adult↗
PubMedDate not supplied

Using mentalisation to treat patients with borderline personality disorder.

This article provides an overview of personality disorders, before focusing on borderline personality disorder. The role of mentalisation in the development of borderline personality disorder is explored. It is suggested that mentalisation-based treatment can greatly improve outcomes for patients.

Adult↗
PubMed2003

Evaluating NEO Personality Inventory-Revised profiles in veterans with personality disorders.

Fifty-one psychiatric, veteran outpatients were assessed for personality disorders on the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997a) and were also administered the NEO Personality Inventory-Revised (NEO-PI-R; Costa & McCrae, 1992). Results were compared to Trull and Widiger's (1997) hypotheses about the profiles of such patients and similar past studies. Correlations between NEO-PI-R facets and SCID-II personality disorder symptom clusters generally occurred in the expected direction. Facets hypothesized to be associated with a given personality disorder were able to predict variance in their respective SCID-II personality disorder scores for seven of ten personality disorders. In general, results support the facet-level conceptualizations of these disorders, except for Obsessive-Compulsive Personality Disorder.

Diagnostic and Statistical Manual of Mental Disord↗
PubMedDate not supplied

[Factors associated to the diagnoses of borderline personality disorder in psychiatric out-patients].

INTRODUCTION: Borderline personality disorder (BPD) is the most common personality disorder in clinical settings, however, this disorder presents diagnostic difficulties because of the own heterogeneous character. The purpose of this study was to describe and examine the possible relationship between clinic-psychobiographical aspects of the patients and diagnoses of BPD. METHOD: A transversal study was assessed in 73 psychiatric outpatients, by protocol of data collection about social and demographic aspects, psychobiographic aspects about childhood, sexual history and psychiatric earlier. International Personality Disorders Examination (IPDE) was used to evaluate the personality disorder. RESULTS: Borderline patients self-reported of traumatics experiences, physical and/or sexual abuse in childhood in more percentage than the group without BPD. Sexual identity disturbance and homosexual relations were associated with BPD. Psychiatry earlier of hospitalization, suicide attempts and substance use disorders were more frequent in BPD patients. CONCLUSIONS: These results suggest a profile that can be use to suspect a BPD and help to do precocious diagnoses.

Adolescent↗
PubMed1996

Suicidality and personality disorders in adolescence.

The prevalence of personality disorders is higher among suicidal adolescent inpatients (15.3% out of 163) than among nonsuicidal adolescent inpatients (8.6% out of 374). Among the personality disorders, the borderline syndromes or emotionally unstable personality disorders were more frequent in the suicidal adolescents. Limited emotional control, intolerance of frustration, and impulsiveness are important characteristics of suicidal adolescents.

Adolescent↗
PubMed2007

Cluster A personality disorders: considering the 'odd-eccentric' in psychiatric nursing.

Psychiatric nurses are familiar with the concept of personality disorder because of their contact with persons with the most common personality disorder in clinical settings - borderline type, who frequently engage mental health services. Perhaps it is this familiarity that has focused research and clinical attention on borderline personality disorder compared with the other personality disorders. The significance of cluster A personality disorders for nursing is multifaceted because of their severity, prevalence, inaccurate diagnosis, poor response to treatment, and similarities to axis I diagnoses. Despite this, literature reviews have established that relatively few studies have focused on the treatment of the cluster A personality disorders - paranoid, schizotypal, and schizoid - resulting in a dearth of evidence-based interventions for this group of clients. A discussion of these disorders in the context of personality disorder and their individual characteristics demonstrates the distinctive and challenging engagement techniques required by psychiatric nurses to provide effective treatment and care. It is also strongly indicated that the discipline of psychiatric nursing has not yet begun to address the care of persons with cluster A personality disorders.

Adaptation, Psychological↗
PubMed1993

The Roscommon Family Study. III. Schizophrenia-related personality disorders in relatives.

OBJECTIVES: We sought to clarify the familial relationship between five putative schizophrenia-related personality disorders (schizotypal [SPD], paranoid, schizoid, avoidant, and borderline) and schizophrenia, other nonaffective psychoses, and affective illness. DESIGN: A case-controlled epidemiologic family study using DSM-III-R criteria. PARTICIPANTS: Five hundred thirty-four probands selected from a psychiatric case register or electoral register, of whom 415 were personally interviewed, and 2043 living and traceable relatives, of whom 1753 were personally interviewed. RESULTS: Compared with relatives of unscreened controls, relatives of probands with schizophrenia had a highly significantly increased prevalence of SPD, and modest, but significant, increased prevalences of paranoid, schizoid, and avoidant personality disorders. Borderline personality disorder was rare, with a modest clustering of cases in relatives of affective disorder probands. The prevalence of SPD was also significantly elevated in relatives of probands with SPD and with other nonaffective psychoses but not in relatives of probands with psychotic or nonpsychotic affective illness. In contrast to the pattern seen for schizophrenia, the prevalence rate of SPD was substantially greater in parents than in siblings of schizophrenic probands. CONCLUSIONS: Schizotypal personality disorder has a strong familial relationship with schizophrenia. Paranoid, schizoid, and avoidant, but not borderline, personality disorders may have a significant familial relationship with schizophrenia. Schizotypal personality disorder also reflects the familial liability to other psychotic disorders but probably not to affective illness. Fitness effects may substantially influence the pattern of schizophrenia-related personality disorders in relatives.

Adolescent↗
PubMed1992

The prevalence of personality disorders in 210 women with eating disorders.

BACKGROUND: The purpose of this study was to assess the prevalence, reliability, and predictive value of comorbid personality disorders in a large sample of 210 women seeking treatment for anorexia nervosa (N = 31), bulimia nervosa (N = 91), or mixed disorder (N = 88). METHOD: All subjects were interviewed using the Structured Interview for DSM-III Personality Disorders as part of a longitudinal outcome study of eating disorders currently underway at Massachusetts General Hospital. RESULTS: Of the 210 subjects, 27% had at least one personality disorder; the most commonly observed was borderline personality disorder in 18 subjects (9%). The highest prevalence of personality disorders was found in the anorexia nervosa/bulimia nervosa group at 39%, followed by 22% in the anorexics and 21% in the bulimic sample. We found statistically significant differences regarding the distribution of personality disorders across eating disorder groups. The dramatic personality disorder cluster was differentially distributed across groups; this finding was accounted for by higher rates of borderline personality disorder in the bulimia nervosa and anorexia nervosa/bulimia nervosa groups than in the anorexia nervosa group. The anxious personality disorder cluster was differentially distributed across groups with higher rates in the anorexia nervosa and anorexia nervosa/bulimia nervosa samples. Those subjects with a comorbid personality disorder had a significantly slower recovery rate than those without a comorbid personality disorder. CONCLUSION: The prevalence of personality disorders is not high in treatment-seeking women with eating disorders compared with previously studied samples. The greatest frequency of comorbid personality disorders is in the anorexia nervosa/bulimia nervosa group; this subset also had longer duration of eating disorder illness and much greater comorbid Axis I psychopathology compared with the rest of the sample. Future studies should address whether personality disorders have predictive value in the long-term course and outcome of eating disorders.

Adolescent↗
PubMed2005

Taxonomic implications of three prospective studies on the course and outcome of personality disorders.

The Children in the Community (CIC) Study (Cohen, Crawford, Johnson, & Kasen, this issue), the McLean Study of Adult Development (MSAD; Zanarini, Frankenburg, Hennen, Reich, & Silk, this issue), and the Collaborative Longitudinal Personality Disorders Study (CLPS; Skodol et al., this issue) are three large prospective studies on the course and outcome of psychiatric disorders, borderline personality disorder, and personality disorders, respectively. These studies, involving approximately 2,000 subjects, have yielded an enormous amount of scientifically and clinically relevant information. In this commentary, I primarily aim to discuss the implications for future revisions to the DSM classification of personality disorders.

Disease Progression↗
PubMed2004

Clinicians' personality descriptions of prototypic personality disorders.

Many studies have indicated close convergence of the DSM-IV personality disorders and the five-factor model (FFM) of personality functioning. However, questions have been raised concerning the ability of clinicians to describe personality disorders in terms of the FFM. This study developed a FFM description by practicing clinicians of each DSM-IV personality disorder. Clinicians rated a prototypic case of each DSM-IV personality disorder in terms of the FFM. These ratings, which achieved excellent reliability, were then averaged to produce a consensus FFM profile for each personality disorder. The consensus ratings showed good agreement with previous research that examined both researchers' and clinicians' application of the FFM to prototypic cases of personality disorders. These results suggest that clinicians can conceptualize and apply the FFM to personality disorders in a consistent way. The results further suggest that the FFM may provide a richer and more comprehensive description of personality difficulties than the current DSM-IV personality disorder categories.

Adult↗