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PubMed2001

Patterns of personality pathology in patients with generalized anxiety disorder, panic disorder with and without agoraphobia, and social phobia.

The relationship between co-occurring personality disorders and anxiety disorders (panic disorder with or without agoraphobia, social phobia, and generalized anxiety disorder) was examined, taking into account the effect of major depression. This article describes findings for 622 participants in the Harvard/Brown Anxiety Research Project, a longitudinal follow-up study of DSM-III-R-defined anxiety disorders. A total of 24% of participants had at least one personality disorder, with avoidant, obsessive compulsive, dependent, and borderline most common. Generalized anxiety disorder, social phobia, and major depression were positively associated with the occurrence of one or more personality disorders, whereas panic disorder with agoraphobia was not associated. Major depression was associated in particular with dependent, borderline, histrionic, and obsessive compulsive personality disorders and social phobia was associated with avoidant personality disorder. Whereas some of our findings confirm results from earlier studies, others are somewhat inconsistent with previous results and indicate the need for further investigation.

Adult↗
PubMed2004

Electrodermal reactivity and its association to substance use disorders.

Poor electrodermal response modulation is associated with substance use disorders, but the specificity of the relationship has not been tested. To test this, 112 college students were assessed for psychiatric symptoms using structured interviews and for ability to modulate skin conductance responses to 2-s 92- or 110-dB white noise blasts that varied in temporal predictability. Twenty-eight good and 28 poor modulators were compared on symptoms of alcohol and illicit drug use disorders, personality disorders (antisocial, borderline, histrionic, and narcissistic), social and specific phobia, and depression. As expected, poor modulators had significantly more symptoms of substance use disorders than good modulators. Groups did not differ in symptoms of anxiety disorder, depression, or personality disorders marked by disinhibition. Poor electrodermal response modulation may reflect a biological risk factor for substance use disorders in particular.

Adolescent↗
PubMed2001

Gender-related distribution of personality disorders in a sample of patients with panic disorder.

OBJECTIVE: We examined gender differences in the frequency of DSM-IV personality disorder diagnoses in a sample of patients with a diagnosis of panic disorder (PD). METHOD: One hundred and eighty-four outpatients with a principal diagnosis of PD (DSM-IV) were enrolled. All patients were evaluated with a semi-structured interview to collect demographic and clinical data and to generate Axis I and Axis II diagnoses in accordance with DSM-IV criteria. RESULTS: Males were significantly more likely than females to meet diagnoses for schizoid and borderline personality disorder. Compared to males, females predominated in histrionic and cluster C diagnoses, particularly dependent personality disorder diagnoses. A significant interaction was found between female sex and agoraphobia on personality disorder (PD) distribution. CONCLUSIONS: Male PD patients seem to be characterized by more severe personality disorders, while female PD patients, particularly with co-morbid agoraphobia, have higher co-morbidity rates with personality disorders belonging to the 'anxious-fearful cluster'.

Adult↗
PubMed1998

Comorbidity of DSM-IV personality disorders in a nonclinical sample.

The issue of comorbidity within the Axis II personality disorders was explored using a large sample of university students who were administered the Coolidge Axis II Inventory (CATI). Comorbidity patterns with this normal sample were compared with recent clinical data reported by several other researchers. The results confirm the high degree of comorbidity within Axis II and the similarity in the comorbidity patterns with clinical and nonclinical samples. With the CATI, a 30.4% comorbidity rate was obtained for Histrionic and Narcissistic Personality disorders (Pd). The paranoid, passive-aggressive and borderline personality disorder traits were comorbid with several other Pds. For Cluster A, there was low comorbidity except for Paranoid Pd and Schizotypal Pd. With Cluster B, the co-occurrence was moderate to strong. A moderate amount of interrelationship was obtained for the Cluster C Pds. The DSM-IV clusters were also strongly interrelated. An additional finding was the similarity between self-report and structured interview methodology in obtained personality disorder comorbidity.

Adolescent↗
PubMed2005

The therapeutic alliance in the treatment of personality disorders.

Because personality disorders are associated with significant impairment in interpersonal relationships, special issues and problems arise in the formation of a therapeutic alliance in the treatment of patients with these disorders. In particular, patients with narcissistic, borderline, and paranoid personality traits are likely to have troubled interpersonal attitudes and behaviors that will complicate the patient's engagement with the therapist. While a strong positive therapeutic alliance is predictive of more successful treatment outcomes, strains and ruptures in the alliance may lead to premature termination of treatment. Therefore, clinicians need to consider the patient's characteristic way of relating in order to select appropriate interventions to effectively retain and involve the patient in treatment. Research has shown not only the importance of building an alliance but also that this alliance is vital in the earliest phase of treatment. The author first reviews several definitions of the therapeutic alliance with reference to how they apply to the treatment of patients with personality disorders. Issues relevant to forming a therapeutic alliance with patients with personality disorders are then discussed in terms of the three DSM-IV-TR personality disorder clusters. However, the author notes that these categories do not adequately capture the complexity of character pathology and that clinicians also need to consider which aspects of a patient's personality pathology are dominant at the moment in considering salient elements of the therapeutic alliance. In dealing with Cluster A personality disorders (schizotypal, schizoid, and paranoid personality disorders), what is most relevant for alliance building is the profound impairment in interpersonal relationships. The Cluster B "dramatic" personality disorders (antisocial, borderline, histrionic, and narcissistic) are all associated with pushing the limits. Consequently, clinicians need to exercise great care to avoid crossing inappropriate lines in a quest to build an alliance with patients with one of these disorders. Patients with Cluster C "anxious/fearful" personality disorders (avoidant, dependent, and obsessive-compulsive personality disorders) are emotionally inhibited and averse to interpersonal conflict. These patients frequently feel guilty and internalize blame for situations even when there is none, a tendency that may facilitate alliance building because the patients are willing to take some responsibility for their dilemma and may engage somewhat more readily with the therapist to sort it out, compared with patients with more severe Cluster A or B diagnoses. The author then reviews considerations relevant to treatment alliance that arise in the different treatment approaches that may be used with patients with personality disorders, including psychodynamic psychotherapy/psychoanalysis, cognitive-behavioral therapies, and psychopharmacology. The author also discusses issues, especially splitting, that arise in the alliance when patients with personality disorders are treated in inpatient psychiatric hospital settings.

Adult↗
PubMed1985

The classification of personality disorder: II. The problem of diagnostic criteria.

Although operational definitions have led to improved reliability of psychiatric diagnoses generally, this is not the case for personality disorders. It is suggested that this is due to a failure to develop definitions composed of criteria that can be reliably identified. Instead, extensive use is made of traits and other dispositions as criteria for assessing these conditions despite an extensive literature indicating that trait judgements are unreliable. The reasons for the low reliability of trait judgements are discussed, and the use of behavioral criteria is advocated as one way to increase diagnostic reliability. The results of a preliminary investigation show that the reliabilities of clinicians' judgements of the behaviors associated with Schizoid, Histrionic, and Compulsive Personality Disorders are comparable to the reliabilities of their judgements of the traits associated with these conditions. These results support the feasibility of developing behavioral criteria for assessing personality.

Behavior↗
PubMed2001

Dramatic-erratic personality disorder symptoms: II. Developmental pathways from early adolescence to adulthood.

This study examined the relationship over time between Cluster B personality disorder symptoms (borderline, histrionic, and narcissistic symptoms) and comorbid internalizing and externalizing symptoms in a community sample of 407 adolescents. Cross-lagged longitudinal models tested (a) the hypothesis that Cluster B symptoms reflect primary disturbances that give rise to co-occurring internalizing and externalizing symptoms; and (b) the alternative hypothesis that these Axis I symptom clusters reflect primary problems that interfere with normal personality development. Internalizing and externalizing symptoms each predicted subsequent Cluster B symptoms in girls, although these effects occurred only at specific developmental stages. Cluster B symptoms in boys and girls at ages 10 to 14 years predicted externalizing symptoms two years later. Instead of clearly supporting one hypothesis over the other, longitudinal models suggested gender-specific developmental effects that were partially consistent with both hypotheses.

Adolescent↗
PubMed1998

Refining the measurement of axis II: a Q-sort procedure for assessing personality pathology.

The measurement of personality disorders (PDs) has proven to be a difficult enterprise. This article describes two initial studies of the validity and reliability of the Shedler-Westen Assessment Procedure (SWAP), a Q-sort procedure that quantifies clinical judgment, which may be useful both for assessing personality pathology and for empirically refining Axis II categories and diagnostic criteria. In the first study, 153 clinicians from a random national sample used a version of the Q-sort to describe either a prototype or actual patient with either a borderline, antisocial, histrionic, or narcissistic personality disorder. Correlations between aggregated prototype and actual patient profiles provided evidence for convergent and discriminant validity, and a cluster-analytic procedure (Q-factor analysis) produced revised criteria for the four disorders that minimized the problem of comorbidity. In Study 2, a pilot sample of patients were interviewed using a clinical research interview that mirrors the way clinicians assess personality and PDs. The study yielded promising results with respect to the possibility of obtaining reliable Q-sort descriptions based on an interview that resembles a clinical interview rather than the direct-question format used in current Axis II structured interviews. It also produced strong correlations between Q-sort descriptions made by interview and those made independently by the treating clinician, further supporting the validity of the instrument. The findings suggest the potential utility of the SWAP as a measure of PDs and as a method for empirically refining Axis II categories and criteria.

Adult↗
PubMed2003

[Hysteria and aging].

In the elderly, the manifestations of hysteria can take uncommon aspects such as durable conversion disorders for which a diagnosis is difficult in the context of polypathology, dissociative symptoms looking like some dementia syndromes, noisy psychiatric symptomatology with, in particular, severe depressive episodes or hallucinations. These disorders can appear without a context of histrionic personality. The evolution of hysterical disorders during life is not well known. First of all, because the nosographic systems are not constant and, secondly, because the disorders themselves can vary when observed at different times. The aging subject is exposed to an increasing symptomatology or conversely, to an improvement due to the waekening of the narcissism. It is also possible that a continuum could be established from hysterical symptoms in the adulthood to delusions or hallucinations in the elderly. The relation with the old hysteric subject must be marked by empathy and by the conviction that improvement will only lead back to a basal symptomatology.

Aged↗
PubMed1988

[Evaluation using DSM-III of the clinical activity of a psychiatry department at a general hospital].

The DSM-III multiaxial classification was used to evaluate the one-year clinical activity of a psychiatry and medical psychology department in a general hospital. Compared to the general population, the patients (n = 1,071) corresponded to a sample of professionally active subjects in which top and middle executives as well as students were over=represented. Fifty-one per cent of the patients suffered from anxiety or affective disorders, while 9 per cent presented somatoform disorders. Histrionic and dependent personalities were more frequent in women. Thirty six per cent of the subjects had a concurrent physical illness. Psychosocial stress and altered adaptation were higher in unemployed people and in patients with physical illness. Specific diagnostic and socioprofessional patterns corresponded to the various types of mental care: psychoanalytically oriented psychotherapy, behaviour therapy, psychopharmacological treatments, consultation-liaison, pain consultation.

Adult↗
PubMedDate not supplied

Differences in DSM-III-R and DSM-IV diagnoses in eating disorder patients.

Two hundred eighty-eight eating disorder patients were administered the DSM-III-R Structured Clinical Interview (SCID) and the DSM-IV SCID for axis I and II. Concordance between DSM-III-R and DSM-IV was excellent for the axis I affective and anxiety disorders, bulimia nervosa, and substance abuse/dependence. It was also excellent for axis II paranoid, schizoid, borderline, and antisocial personality disorders. Agreement between the two nosological systems was lower for alcohol abuse/dependence with a kappa of.63. Kappas were also poor for the following personality disorders: schizotypal (.44), histrionic (.29), dependent (.54), obsessive-compulsive (.62) and not otherwise specified (.63). There was a substantial difference in the diagnosis of anorexia nervosa between DSM-III-R and DSM-IV. Fourteen patients were diagnosed with anorexia nervosa, binge/purge type, using DSM-IV criteria, while only six received the diagnoses of anorexia nervosa and bulimia nervosa using DSM-III-R criteria. Kappa was.49 and the percent agreement was 79%. While there are considerable areas of overlap in DSM-IV and DSM-III-R, there are also areas of substantial differences. Clinicians and researchers must be very cautious when attempting to compare data from the different nosologies.

Adult↗
PubMed1991

Occurrence of schizotypal and borderline symptoms in parasuicide patients: comparison between subjective and objective indices.

Seventy-six patients were interviewed within a week of admission following a parasuicide episode. Axis II diagnosis on DSM-III was made for schizotypal, borderline, histrionic, and antisocial personality disorder. In addition patients completed a self-rating questionnaire, the Schizotypy Questionnaire of Claridge & Broks (1984), which assesses schizotypal and borderline personality traits. The objective and subjective indices of schizotypal and borderline symptoms correlated significantly but allocation of patients to a diagnosis missed several patients who nevertheless rated themselves as having a high frequency of these symptoms. There was an asymmetry of symptom pattern reminiscent of Foulds & Bedford's (1975) hierarchy model. The presence of schizotypal symptoms appeared to be higher in the hierarchy: they predicted borderline symptoms, but a high frequency of borderline symptoms did not necessarily predict schizotypy. We suggest that the occurrence of schizotypal symptoms should become a more explicit focus of clinical assessment and treatment of these patients, especially those who repeatedly harm themselves and we suggest ways in which cognitive therapies may be adapted to do this.

Adolescent↗
PubMedDate not supplied

[Heredity and role of serotonin in aggressive impulsive behavior].

The idea that heredity could influence behaviour, including personality is very old. Until the early 1980s, the evidence for genetic influences on personality derived almost exclusively from twin studies. More recently, studies comparing twins raised together with those raised in different environment confirmed that about 40% of the observed personality variance can be attributable to genetic factors. Since complex behaviours, such as those underlying personality functioning, are likely to be influenced by many genes, a continuum of genetic risk underlying behavioural dimensions that extend from normal to abnormal behaviour has been hypothesized. Behaviours related to aggressive impulses regulation could delineate a biologically anchored model of dispositions to both normal and pathological functioning: these behaviours are identified in animal species where they are genetically transmitted, and a growing body of evidence suggests that disturbances in the regulation of aggressive impulses could belong to a behavioural dimension (disturbances of impulse control) linked to serotonin. Theorists involved in modelling personality according to psychobiologic basis agree with the idea of an inhibitory function of serotonin on impulsive behaviour and recognise that the way individuals control their impulses could underlie a basic psychobiological personality dimension. According to genotypes and to environmental factors, these serotonin mediated behaviours may be diversely expressed varying from minor personality peculiarities (characterised by impulsivity, hostility, irritability, psychopathic deviance, excessive violence or by more clear-cut personality dysfunctioning such as antisocial, borderline, narcissistic and histrionic personality traits or disorders) to major psychiatric disturbances (suicidal behaviour, overt aggressive behaviour, intermittent explosive disorder, pathological gambling, pyromania, bulimia and some type of substance or alcohol abuse). Finally, recent molecular genetic studies have demonstrated that genes encoding some key proteins involved in serotonin transmission could present some polymorphism in relation with impulsive-aggressive behaviours.

Aggression↗
PubMed2006

Cerebral information processing in personality disorders: I. Intensity dependence of auditory evoked potentials.

Patients with personality disorders such as the histrionic type exaggerate their responses when receiving external social or environmental stimuli. We speculated that they might also show an augmenting pattern of the auditory evoked potential N1-P2 component in response to stimuli with increasing levels of intensity, a response pattern that is thought to be inversely correlated with cerebral serotonin (5-HT) activity. To test this hypothesis, we collected auditory evoked potentials in 191 patients with personality disorders (19 patients with the paranoid type, 12 schizoid, 14 schizotypal, 18 antisocial, 15 borderline, 13 histrionic, 17 narcissistic, 25 avoidant, 30 dependent and 28 obsessive-compulsive) and 26 healthy volunteers. Their personality traits were measured using the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). Compared with healthy subjects and other patient groups, the histrionic group scored higher on the basic traits Affective Instability, Stimulus Seeking, Rejection and Narcissism, and on the higher traits Emotional Dysregulation and Dissocial, than the other groups, and the schizoid group scored lower on most of the DAPP-BQ basic and higher traits. In addition, the histrionic group showed steeper amplitude/stimulus intensity function (ASF) slopes at three midline scalp electrodes than the healthy controls or the other patient groups. The ASF slopes were not correlated with any DAPP-BQ traits in the total sample of 217 subjects. However, the DAPP-BQ basic trait Rejection was positively correlated with the ASF slopes at all three electrode sites in the histrionic group. The increased intensity dependence of the auditory N1-P2 component might indicate that cerebral 5-HT neuronal activity is, on average, weak in the histrionic patients.

Adult↗
PubMed1986

Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria.

Two hundred and eighty-three chronic pain patients, consecutive admissions to the Comprehensive Pain Center of the University of Miami School of Medicine, received an extensive psychiatric evaluation based upon the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria and flowsheets. All patients received the following type of diagnoses: DSM-III axis I; DSM-III axis II, and personality type. The distribution of assigned diagnoses for the entire patient sample was reviewed and a statistical comparison between male and female patients was performed with regards to the prevalence of each diagnosis. Anxiety syndromes and depression of various diagnostic types were the most frequently assigned axis I diagnoses with over half the patient sample receiving each of these diagnoses. Males were significantly overrepresented in the axis I diagnoses of intermittent explosive disorders, adjustment disorders with work inhibitions, and alcohol abuse and other drug dependence, while females were significantly overrepresented in disorders of current depression of various diagnostic types and somatization disorders. 58.4% of the patients fulfilled criteria for axis II personality disorder diagnoses. The most frequently personality disorders found in the patient group were dependent (17.4%), passive aggressive (14.9%), and histrionic (11.7%). Males were significantly overrepresented in paranoid and narcissistic disorders while females were overrepresented in histrionic disorder. The most frequent personality types found in the patient group were compulsive (24.5%) and dependent (10.6%). All personality types were similarly distributed between the sexes. The results of the present study were compared to a previous study of DSM-III diagnoses in chronic pain patients and are discussed in terms of the prevalence of DSM-III diagnoses in the general population. Questions are raised as to the applicability of certain DSM-III diagnoses in the chronic pain population.

Adjustment Disorders↗
PubMed1988

Intent and lethality of suicide attempts among female borderline inpatients.

Data relevant to variations in self-destructive behavior are reported for 40 female borderline inpatients. These data were assessed in relation to measures of the patients' suicidal intent, the lethality of their attempts, and their empirically derived suicide risk. Variation in the seriousness of suicide attempts was accounted for primarily by age, number of suicide attempts, presence of an eating disorder, psychotic features, and family history variables, with generalized anxiety disorder as a mitigating factor. In addition to age and number of attempts, concomitant histrionic and antisocial features were differentially predictive of the empirically derived risk of suicide.

Adult↗
PubMed1984

Ego development and DSM-III Axis II: personality disorders.

Investigated the relationship between Loevinger 's levels of ego development and DSM-III Axis II personality disorder diagnoses, with a private psychiatric clinic sample of 400 patients. A breakdown of the ego development levels for each personality disorder is provided. Personality disorders that cluster in the dramatic, emotional and erratic cluster of the DSM-III ( histrionic , narcissistic, antisocial and borderline personality disorders) were found to have the majority of individuals who scored below the conformity level in the sample, with almost half of the individuals in this personality cluster below the conformity level. Another finding was that the psychiatric patient sample was devoid of individuals at the highest levels of ego functioning. Also, individuals who had their personality diagnoses deferred, predominantly due to psychotic mental disorders, typically were at or above the conformity level.

Ego↗
PubMed1989

Substance abuse and psychopathology. A diagnostic screening of Italian narcotic addicts.

This report evaluates, using DSM III, the psychopathological profile of 226 heroin users taken in at the clinical centre of "Cascina Verde" Therapeutic Community (Milan, Italy) and admitted to a psychotherapeutic, retraining, integrated, both out-and-in-patient treatment. The outcome shows that 30% of subjects are to be diagnosed according to Axis I while 61% are to be considered among Axis II personality disorders. A portion of 16% is to be referred to the "schizophrenic spectrum", 25% has histrionic, narcissistic, antisocial and borderline personality disorders and the remaining are to be referred to an extremely heterogeneous category. The report shows also data concerning Axes IV and V, always according DSM III.

Adolescent↗