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PubMed1994

Personality and personality disorders.

The mental disorders that most clearly relate to personality are the personality disorders. The purpose of this article is to review the support for the hypothesis that the personality disorders of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) represent variants of normal personality traits. We focus in particular on the efforts to identify the dimensions of personality that may underlie the personality disorders. We then illustrate the relationship of personality to personality disorders using the five-factor model, discuss conceptual issues in relating normal and abnormal personality traits, and consider methodological issues that should be addressed in future research.

Adaptation, Psychological↗
PubMed2000

The prevalence of personality disorder among UK primary care attenders.

OBJECTIVE: To determine the prevalence rate of personality disorder among a consecutive sample of UK primary care attenders. Associations between a diagnosis of personality disorder, sociodemographic background and common mental disorder were examined. METHOD: Three hundred and three consecutive primary care attenders were examined for the presence of ICD-10 and DSM-4 personality disorders using an informant-based interview. RESULTS: Personality disorder was diagnosed in 24% (95% CI: 19-29) of the sample. Personality-disordered subjects were more likely to have psychiatric morbidity as indicated by GHQ-12, to report previous psychological morbidity, to be single and to attend the surgery on an emergency basis. 'Cluster B' personality disorders were particularly associated with psychiatric morbidity. CONCLUSION: There is a high prevalence rate of personality disorders among primary care attenders. These disorders are associated with the presence of common mental disorder and unplanned surgery attendance. Personality disorders may represent a significant source of burden in primary care.

Adult↗
PubMed1999

Revising and assessing axis II, Part II: toward an empirically based and clinically useful classification of personality disorders.

OBJECTIVE: The DSM-IV classification of personality disorders has not proven satisfying to either researchers or clinicians. Incremental changes to categories and criteria using structured interviews may no longer be useful in attempting to refine axis II. An alternative approach that quantifies clinical observation may prove useful in developing a clinically rich, useful, empirically grounded classification of personality pathology. METHOD: A total of 496 experienced psychiatrists and psychologists used the Shedler-Westen Assessment Procedure-200 (SWAP-200) to describe current patients diagnosed with axis II personality disorders. The SWAP-200 is an assessment tool that allows clinicians to provide detailed, clinically rich descriptions of patients in a systematic and quantifiable form. A statistical technique, Q-analysis, was used to identify naturally occurring groupings of patients with personality disorders, based on shared psychological features. The resulting groupings represent an empirically derived personality disorder taxonomy. RESULTS: The analysis found 11 naturally occurring diagnostic categories, some of which resembled current axis II categories and some of which did not. The findings suggest that axis II falls short in its attempt to "carve nature at the joints": In some cases it puts patients who are psychologically dissimilar in the same diagnostic category, and in others it makes diagnostic distinctions where none likely exist. It also fails to recognize a large category of patients best characterized as having a dysphoric personality constellation. The empirically derived classification system appears to be more faithful to the clinical data and to avoid many problems inherent in the current axis II taxonomy. CONCLUSIONS: The approach presented here may be helpful in refining the existing taxonomy of personality disorders and moving toward a system of classification that lies on a firmer clinical and empirical foundation. In addition, it can help to bridge the gap that often exists between research and clinical approaches to personality pathology.

Factor Analysis, Statistical↗
PubMed1989

Personality disorders in opiate addicts show prognostic specificity.

Early studies examining the relationship of personality disorders to opiate addiction attempted to define an "addictive personality." Later research found that personality disorders in opiate addicts were common but heterogeneous. We examined whether different comorbid personality disorders have prognostic specificity. Rates of depression and alcoholism as well as assessments of specific problems were measured in a 2.5-year follow-up of 150 treated opioid addicts. Using DSM-III criteria, we found that borderline personality disorder predicted more depressive disorders and alcoholism at follow-up; yet greater recovery from these disorders was seen. Borderline patients had more severe psychiatric problems as measured by the Addiction Severity Index. Other ASI outcomes differed by personality disorder; antisocial addicts had more legal problems, and narcissistic addicts had more medical problems. These results suggest that treatment for opiate addicts be tailored to the specific needs of the patients, which can be predicted, in part, by their comorbid personality disorder diagnosis.

Adult↗
PubMed2003

[Personality disorders and psychopathology following trauma. Reflection on diagnostic classification].

Pervasive personality disorders have been shown to be long-term sequelae of cumulative childhood physical and sexual traumatization. This finding is not reflected in DSM-IV and ICD-10 classifications where post-traumatic stress disorder is confined to intrusions, avoidance, numbing, and hyperarousal. However, there is growing evidence that trauma etiology should be taken into account in planning treatment for personality disorders. It is not yet clear whether childhood traumatization is more strongly associated with borderline personality disorder than with other personality disorders. The finding of a substantial overlap between borderline personality disorder and dissociative identity disorder gives rise to discussions concerning the relationship of these two pathologies.

Adult↗
PubMed1999

Serum cholesterol and impulsivity in personality disorders.

Decreased serum cholesterol has been associated with impulsive aggressive behaviors. This study was designed to explore the relationship between serum cholesterol levels and measures of impulsive aggression in personality disordered patients. Forty-two personality disordered patients (14 borderline personality disorder, 28 other personality disorders) were included. Fasting serum cholesterol was measured by standard enzymatic assay. An ANOVA was performed with factors of gender and diagnosis, looking at two-way interactions between the factors and serum cholesterol. Patients with borderline personality disorder were found to have significantly lower serum cholesterol than non-borderline personality disorders. A significant interaction effect was also seen between gender and diagnosis with the male patients having lower cholesterol levels. This study suggests there may be a relationship between borderline personality disorder and low serum cholesterol.

Adult↗
PubMed1990

Personality disorders among depressed outpatients as identified by the MCMI.

Personality disorders frequently are seen among depressed psychiatric inpatients. In a group of 73 depressed psychiatric outpatients, this study identified 85% whose response to the Millon Clinical Multiaxial Inventory (MCMI) suggested a personality disorder. On retest 12 weeks later, only 64% manifested a response style consistent with the DSM-III personality disorders. These findings are discussed in relation to methodology, characteristics of the MCMI, and the response style of the depressed patient, which may lead to an overidentification of personality disorders on a self-report measure. Related aspects of the diagnostic criteria for personality disorders also are discussed.

Adult↗
PubMed1996

Understanding the comorbidity between early-onset dysthymia and cluster B personality disorders: a family study.

OBJECTIVE: A number of studies have documented significant comorbidity between dysthymia and axis II personality disorders, particularly those grouped in cluster B. However, the nature of this comorbidity is poorly understood. The purpose of this investigation was to use the family study method to test five competing models of the comorbidity between early-onset dysthymia and cluster B personality disorders. METHOD: Proband groups consisted of subjects with early-onset dysthymia and a co-occurring cluster B personality disorder (N = 28), subjects with early-onset dysthymia without a cluster B personality disorder (N = 69), and a comparison group of subjects who had never been psychiatrically ill (N = 45). The groups were compared on rates of dysthymia with a cluster B personality disorder, dysthymia without a cluster B personality disorder, and cluster B personality disorders without dysthymia in their first-degree relatives (N = 675). RESULTS: The relatives of both subgroups of dysthymic probands exhibited higher rates of dysthymia with a cluster B personality disorder, dysthymia without a cluster B personality disorder, and cluster B personality disorders without dysthymia than the relatives of the never ill probands. In addition, the relatives of probands with comorbid dysthymia exhibited higher rates of cluster B personality disorders without dysthymia than the relatives of probands with noncomorbid dysthymia. CONCLUSIONS: This pattern of results is consistent with the notion that dysthymia and cluster B personality disorders co-occur because of shared etiological factors. This was the only one of five models of the comorbidity between dysthymia and cluster B personality disorders that was supported by the family data.

Adolescent↗
PubMed1990

Child abuse as an antecedent of multiple personality disorder.

Until recently, few cases of multiple personality disorder were diagnosed in children. Today, the number of cases is increasing at an alarming rate and appears to be most closely associated with repeated sexual and physical abuse. This paper focuses on reports of childhood multiple personality disorder in the literature, the etiology of this disorder, family dynamics, the differences between childhood and adult multiple personality disorder, credibility problems in children, reasons for failure to diagnose multiple personality disorder in children, treatment, and signs and symptoms to look for in the clinical setting.

Adolescent↗
PubMedDate not supplied

State personality disorder in social phobia.

To examine the effects of state on personality disorder characteristics, we compared individuals with social phobia before and after psychological intervention. Administration of the Personality Disorder Questionnaire (PDQ-4) before and after treatment allowed for the identification of three groups of patients: (1) individuals who showed elevated PDQ-4 scores but little changes from intake to post treatment (Trait PD group; n = 28); (2) individuals who showed a decrease in PDQ-4 scores from intake to post treatment (State group; n = 33); and (3) a group with no significant personality disorder characteristics at pre or post-treatment (No PD group; n = 32). There were trend differences between the Trait, State and No PD groups for being single, never married (81.5%, 44.4%, and 56.3%, p < .05) and a significant difference for having the generalized form of Social Phobia (96.4%, 88.9%, and 59.4%, p < .0001). The groups also differed in their level of trait anxiety (61.6, 51.2, 44.5, p < .001). Groups also differed in level of the personality measure Harm Avoidance (26.3, 23.3, 19.8, p < .0002). The reduction of personality disorder traits in the State PD groups from intake to post-treatment was not specific to any particular personality disorder or personality disorder cluster. Trait personality appeared to have a higher risk for suicide compared to the other two groups. A State Personality group was identified in individuals with social phobia by following changes in personality pathology from before and after a psychological intervention.

Adult↗
PubMed2001

Childhood depression and adult personality disorder: alternative pathways of continuity.

BACKGROUND: This study extends previous findings of the risks posed by childhood major depressive disorder and other psychopathological features for later personality disorder (PD) in a random sample of 551 youths. METHODS: Self-reports and mother reports were used to evaluate DSM-III-R (Axes I and II) psychiatric disorders at mean ages of 12.7, 15.2, and 21.1 years. Logistic regression was used to examine the independent effects of major depressive disorder in childhood or adolescence on 10 PDs in young adulthood. RESULTS: Odds of dependent, antisocial, passive-aggressive, and histrionic PDs increased by more than 13, 10, 7, and 3 times, respectively, given prior major depressive disorder. Those effects were independent of age, sex, disadvantaged socioeconomic status, a history of child maltreatment, nonintact family status, parental conflict, preexisting PD in adolescence, and other childhood or adolescent Axis I psychopathological features, including disruptive and anxiety disorders. In addition, odds of schizoid and narcissistic PD increased by almost 6 times and odds of antisocial PD increased by almost 5 times given a prior disruptive disorder, and odds of paranoid PD increased by 4 times given a prior anxiety disorder. CONCLUSION: Personality disorders may represent alternative pathways of continuity for major depressive disorder and other Axis I disorders across the child-adult transition.

Adolescent↗
PubMed2006

A dopamine transporter polymorphism is a risk factor for borderline personality disorder in depressed patients.

BACKGROUND: Borderline personality disorder (BPD) is often co-morbid with major depression and may complicate its treatment. We were interested in differences in genetic and developmental risk factors between depressed patients with or without a co-morbid BPD. METHOD: Out-patients with major depressive disorder were recruited for two treatment trials. Assessment of depressed patients included the assessment of personality disorders, developmental risk factors and DNA samples for genetic analyses. RESULTS: In each study there was a significant association between the 9-repeat allele of the dopamine transporter (DAT1) and BPD, with odds ratios (OR) > 3 and p < or = 0.02. This association remained significant when developmental risk factors for BPD (childhood abuse and neglect and borderline temperament) were also included in the analyses. The OR was even larger in the depressed patients aged > or = 35 years (OR 9.31, p = 0.005). CONCLUSION: This replicated association in depressed patients between the 9-repeat allele of DAT1 and BPD may provide clues to understanding the neurobiology of BPD. The finding that the association is larger in the older depressed patients, suggests that the 9-repeat allele may be associated with a poorer prognosis BPD, rather than a young adult limited variant of BPD.

Adult↗
PubMed2000

Convergent validity of alternative MMPI-2 personality disorder scales.

The Morey, Waugh, and Blashfield (1985) MMPI (Hathaway et al., 1989) personality disorder scales provided a significant contribution to personality disorder research and assessment. However, the subsequent revisions to the MMPI and the multiple revisions to the diagnostic criteria sets that have since occurred may have justified comparable revisions to these scales. Somwaru and Ben-Porath (1995) selected a substantially different set of items from the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) to assess Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) personality disorder diagnostic criteria. In our study, we compared the convergent validity of these alternative MMPI-2 personality disorder scales with respect to 3 self-report measures of personality disorder symptomatology in a sample of 82 psychiatric outpatients. The results suggested that Somwaru and Ben-Porath's scales are as valid as the original Morey et al. scales and might be even more valid for the assessment of borderline, antisocial, and schizoid personality disorder symptomatology.

Adult↗
PubMed1991

The comorbidity of multiple personality disorder and DSM-III-R axis II disorders.

Our ability to differentiate MPD from DSM-III-R Axis I disorders has become increasingly refined. Differentiation of MPD from the Axis II personality disorders is an area of more recent clinical investigation. MPD can be found comorbidity with many other psychiatric conditions. It is found in association with each of the DSM-III-R personality disorders. At the present time, however, we lack research data that define the prevalence of the comorbidity of MPD with the personality disorders. Objective study of this area is complicated by the paucity of instruments available to assess personality dimensions in the presence of a DD. In addition, the currently available personality inventories tend to overdiagnose BPD in patients with a high level of distress and acuity of symptoms. The diagnosis of a personality disorder in a patient with MPD is made on the basis of the assessment of the "whole" human being. It is based on the presence of a pervasive and relatively inflexible pattern of behaviors that reflects the individual predominant mode of being. The diagnosis of a personality disorder is not made on the basis of personality traits contained within any single alternate personality or groups of personalities. The personality disorders defined by DSM-III-R are a heterogeneous group of conditions whose individual etiologies reflect a complex interplay of constitutional, genetic, environmental, interpersonal, and psychodynamic factors. The interplay is variable and diverse between these determinants of the personality disorders and the traumatic forces that result in the development of a DD. For the Cluster A personality disorders (schizoid, schizotypal, paranoid), there is evidence supporting a relationship with specific psychotic illnesses. The combination of dissociative pathology with these personality disorders commonly results in a greater impairment of reality testing than in either condition alone. The Cluster B personality disorders (histrionic, narcissistic, borderline, antisocial) and Cluster C personality disorders (avoidant, compulsive, dependent, passive-aggressive) are believed to be primarily developmental disturbances. Comorbidity of these personality disorders with MPD involves consideration of the interaction of many developmental processes with the psychological impact of severe childhood trauma. Many MPD patients present with an apparent mixed personality profile consisting of an array of avoidant, compulsive, borderline, narcissistic, dependent, and passive-aggressive features. Although this article explores comorbidity of MPD with each of the personality disorders defined in DSM-III-R individually, it seems likely that a number of posttraumatic personality organizations can be defined that commonly coexist with MPD.(ABSTRACT TRUNCATED AT 400 WORDS)

Borderline Personality Disorder↗
PubMed2002

Personality disorders and posttraumatic stress disorder in motor vehicle accident survivors.

This study examined the impact of a co-occurring personality disorder on the development and remission of posttraumatic stress disorder (PTSD) in 158 motor vehicle accident (MVA) survivors followed prospectively for 1 year. Participants were assessed 1 to 4 months after trauma and at 6-month and 1-year follow-up evaluations during 1991 through 1993. These archival data were analyzed in the present study. The prevalence of at least one personality disorder was 13.3%, with the majority (52.4%) presenting with obsessive-compulsive personality disorder. Persons with a personality disorder were significantly more likely to be diagnosed with PTSD at 1-year follow-up evaluation. For persons diagnosed with PTSD at the initial assessment, those with a personality disorder were significantly less likely to remit by 1 year. The presence of a preexisting personality disorder may increase the risk of chronic PTSD and impede remission.

Accidents, Traffic↗
PubMed2001

Pathology versus statistical infrequency: potential sources of gender bias in personality disorder criteria.

The antisocial, narcissistic, dependent, histrionic, and borderline personality disorders often obtain differential sex prevalence rates. One explanation has been that the diagnostic criteria for these personality disorders have different gender implications for maladaptivity (e.g., perhaps the dependent personality disorder diagnostic criteria are considered by clinicians to be more pathological for women than for men). This hypothesis was explored in two studies that obtained judgments by professional clinicians of the maladaptivity and statistical infrequency of personality disorder diagnostic criteria. Significant differences across gender were obtained for the frequency of diagnostic criteria but not for their maladaptivity. The personality disorder diagnostic criteria appear to be gender neutral with respect to their implications for maladaptivity.

Bias↗
PubMed2003

[Personality disorders and "psychopathy" in sex offenders imprisoned in forensic-psychiatric hospitals--SKID-II- and PCL-R-results in patients with impulse control disorder and paraphilia].

In order to clarify differential-diagnostic questions 47 mentally ill sex offenders (with impulse control disorder and paraphilia) were assessed with regard to comorbidity of personality disorders and "psychopathy". For this examination the SKID-II for personality disorders and the Psychopathy Checklist (PCL-R) were used. 72 % of the sex offenders showed at least one personality disorder. The highest prevalence was found for cluster-B disorders, first of all the antisocial personality disorder. Using a PCL-R cut off score of 25 (for Europe) 10 of the 47 subjects (21 %) were diagnosed as "psychopaths", whereas being a "psychopath" is associated with a number of different personality disorders. The importance of structured diagnostic with regard to comorbidity of personality disorders in sex offenders imprisoned in maximum security psychiatric hospitals is stressed, and furthermore there is evidence that the PCL-R is a valid instrument for prognosis, but not a psychological-psychiatric instrument for the assessment of personality disorders.

Adult↗
PubMed1996

Suicide among subjects with personality disorders.

OBJECTIVE: There have been few psychological autopsy studies of suicide among individuals with personality disorders. The possible specificity of characteristics of suicide among such individuals has been little investigated. METHOD: A random sample of 229 subjects who committed suicide, representing all suicide victims in Finland within a 12-month period, were comprehensively examined by using the psychological autopsy method and were diagnosed according to DSM-III-R criteria. Within this random sample the authors investigated all subjects with axis II personality disorders (N = 67) and divided them into clusters B (N = 43), C (N = 23), and A (N = 1). Individuals with clusters B and C personality disorders were separately compared with sex- and age-matched suicide victims without personality disorder, in terms of sociodemographic characteristics, comorbid axis I and III syndromes, treatment histories, previous suicide attempts, communication of suicide intent, and suicide methods. RESULTS: All suicide victims with a personality disorder received at least one axis I diagnosis. In 95% this included a depressive syndrome, a psychoactive substance use disorder, or both. Individuals with cluster B personality disorders were more likely than comparison subjects to have psychoactive substance use disorders (79% versus 40%) and previous nonfatal suicide attempts (70% versus 37%) and were less likely to have axis III physical disorders (29% versus 50%). Subjects with cluster C personality disorders were not found to differ from the control subjects in any of the variables examined. CONCLUSIONS: Suicide victims with personality disorders were almost always found to have had current depressive syndromes, psychoactive substance use disorders, or both. Suicide victims with cluster B personality disorders differed from other suicide victims in several characteristics, while those with cluster C personality disorders did not.

Adult↗