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PubMed2004

Comorbidity of DSM-IV Personality Disorders in unipolar and bipolar affective disorders: a comparative study.

The aim of this study was to compare the prevalence of Personality Disorders assessed by Structured Clinical Interview for Axis-II in 155 inpatients diagnosed with Unipolar Disorder vs inpatients with Bipolar Disorder (39). The most frequent Axis II diagnoses among Unipolar inpatients were Borderline (31.6%), Dependent (25.2%), and Obsessive-Compulsive (14.2%) Personality Disorders. Among Bipolar inpatients, the most prevalent personality disorders were Borderline (41%), Narcissistic (20.5%), Dependent (12.8%), and Histrionic disorders (10.3%). Using chi squared analysis, few differences in distribution emerged between the two groups: Unipolar patients had more recurrent Obsessive-Compulsive Personality Disorder than Bipolar patients (chi(1)2=6.24, p<.005). Comorbid Narcissistic Personality Disorder was significantly more frequent in the Bipolar than in the Unipolar group (chi(1)2=6.34, P<.01). Considering the three clusters (DSM-IV classification), there was a significant difference between the groups, Cluster C (fearful, avoidant) diagnoses being more frequent in the Unipolar than in the Bipolar group (48.4% vs 20.5%, respectively). Cluster B (dramatic, emotionally erratic) diagnoses were found more frequently in patients with Bipolar Disorders (71.8% vs 45.2% in Unipolar patients, chi(2)2=10.1, p<.006). The differences in the distribution and prevalence of Personality Disorders between the two patient groups are discussed.

Adult↗
PubMed1996

Patients with personality disorders: functional status, health care utilization, and satisfaction with care.

BACKGROUND: Personality disorders are believed to occur in approximately 10% of the adult population, yet they are rarely diagnosed in primary care settings. This study compares the functional status, health care utilization, and satisfaction with care for patients who were at high risk for a personality disorder with those who were at low risk. METHODS: Patients at high risk for personality disorders were identified using a standardized psychometric instrument, the Structured Clinical Inventory for DSM-III Axis II (SCID-II). After assigning patients to risk categories, responses were compared on the Medical Outcomes Study Short Form-36, the Beck Depression Inventory, the CAGE alcohol use questionnaire, and an adapted version of the RAND Patient Satisfaction Questionnaire. RESULTS: Patients who were at high risk for any personality disorder had lower functional status, higher risk for depression or alcohol abuse, and lower levels of satisfaction with care. These differences could not be explained by demographic or socioeconomic differences between high- and low-risk patients. Being at high risk for specific personality disorders, such as borderline, schizoid, and dependent disorders, was associated with higher degrees of functional impairment and greater risk for depression and alcohol abuse. Patients at high risk for other disorders, such as obsessive-compulsive, narcissitic, and schizotypal, consistently showed no appreciable degree of impairment as compared with patients at low risk for any personality disorder. Medical care utilization was no higher when personality disorders were examined in aggregate, but a marked increase in utilization was noted among patients at high risk for histrionic and dependent disorders. CONCLUSIONS: Among primary care patients, having a personality disorder is associated with lower functional status, lower satisfaction with health care, and higher risk for depression and alcohol abuse.

Adult↗
PubMed1997

Characteristics of 36 subjects reporting compulsive sexual behavior.

OBJECTIVE: The authors describe the sociodemographic features, phenomenology, and psychiatric comorbidity of 36 subjects reporting compulsive sexual behavior. METHOD: Twenty-eight men and eight women who responded to advertisements for "persons ... who have a problem with compulsive sexual behavior" completed structured and semistructured assessments, including the Diagnostic Interview Schedule for DSM-III-R disorders (axis I) and the Structured Interview for DSM-III-R Personality Disorders, Revised (axis II). RESULTS: The typical subject was a 27-year-old man who reported experiencing compulsive sexual behavior for nearly 9 years. Sexual behavior was described as excessive and poorly controlled and was associated with either subjective distress or impairment in interpersonal or occupational functioning or as overly time-consuming. Fourteen subjects (39%) reported a history of major depression or dysthymia, 15 (42%) a history of phobic disorder, and 23 (64%) a history of substance use disorder. Personality disorders were quite frequent, particularly the paranoid, histrionic, obsessive-compulsive, and passive-aggressive subtypes. The compulsive sexual behavior was quite varied and included both paraphilic (e.g., cross-dressing) and nonparaphilic (e.g., compulsive masturbation) types. CONCLUSIONS: Compulsive sexual behavior may be a clinically useful concept, but it describes a heterogeneous group of individuals with substantial psychiatric comorbidity and diverse behavioral problems.

Adolescent↗
PubMed1995

Reliability of observer ratings in the assessment of personality disorders: a preliminary study.

A 200-item, self-report personality disorder inventory (Coolidge Axis II Inventory; CATI) was administered to 52 married target subjects. Their spouses and a close friend completed a significant-other form about the targets. The mean correlation across all personality disorder scales was .51 for the targets-spouses, .36 for the targets-friends, and .41 for the spouses-friends. Twenty-eight target-spouse correlations were significant and ranged from .99 to -.40. The mean correlation for the individual 13 personality disorder scales was .46 for target-spouses and ranged from .63 for the histrionic scale to .27 for the paranoid scale. The results were interpreted as establishing a basis for significant other assessment of personality disorders.

Adult↗
PubMedDate not supplied

Temperament and personality features in patients with major depression, panic disorder and mixed conditions.

METHOD: Forty-two patients with Panic Disorder (P), 18 with Major Depression (MD), 35 with both conditions (MIX) and 45 healthy subjects (C) were tested with the Tridimensional Personality Questionnaire and the Structured Interview for DSM-III-R Personality Disorders. RESULTS: A different prevalence of Dependent (P = 16.7%, MD = 5.6%, MIX = 41.4%, C = 2.1%) (P < 0.001), Obsessive-Compulsive (P = 4.8%, MD = 27.8%, MIX = 3.4%, C = 0%) (P < 0.001) and Histrionic (P =23.8%, MD = 0%, MIX = 31%, C = 4.2%) (P = 0.001) personality disorders (PD) was found among groups. Harm Avoidance (HA) (P < 0.001) and Reward Dependence (RD) (P <0.001) were higher in patients than in controls. As expected the patients with comorbid conditions (MIX) showed higher HA levels (P < 0.01) and a greater prevalence of PDs, particularly of Cluster C compared to patients with pure disorders. CONCLUSIONS: This study suggests that high HA and RD scores are associated with P, MD and MIX, and the former dimension is even higher in MIX patients.

Adolescent↗
PubMedDate not supplied

Correlates of DSM-III personality disorder in panic disorder and agoraphobia.

One hundred eighty-seven patients meeting DSM-III criteria for panic disorder (n = 26) or agoraphobia with panic (n = 161) were assessed with the Personality Diagnostic Questionnaire (PDQ), a self-rating scale designed to assess Axis II personality disorders and traits. Results replicated our earlier findings of a preponderance of dependent, avoidant, and histrionic features and the finding that patients exhibiting a greater number of personality traits were also significantly more symptomatic. Patients with the diagnosis of panic disorder did not differ on any personality disorder variables from patients with the diagnosis of agoraphobia with panic. Furthermore, none of the specific symptom dimensions, i.e., panic, anxiety, or agoraphobia, was selected as a unique predictor of any personality variables in the regression analyses. Rather, the most important correlates of personality disorder in these patients consisted of general factors such as dysphoric mood, social phobia, or interpersonal sensitivity, and Eysenck's neuroticism dimension. The results are discussed in light of recent findings suggesting a nonspecific link between panic disorder or agoraphobia and personality disorder.

Adult↗
PubMed2001

[Psychiatric disorders in juvenile myoclonic epilepsy].

Mild personality problems have been described in patients with juvenile myoclonic epilepsy (JME), but clinical practice shows that JME can be diagnosed in patients with more or less severe psychiatric disorders (PD). The presence in JME patients of personality disorders has been described repeatedly, but never quantified. We thus decided to evaluate, using the DSM IV, the current prevalence and types of PD in a large series of consecutive, newly referred patients with JME. Among 170 consecutive JME cases referred to two departments of epileptology (Marseilles and Nice) between 1981 and 1998 (66 males, 104 females; aged 11.7-70; mean+/-SD 32.4+/-10.4 follow-up 12.7+/-10 [0.5-52]), we found 45 patients (26.5p.100) with PD. According to the DSM IV, they could be classified as severe mental retardation (main diagnosis) (one case); pervasive developmental disorders (2 cases); tic disorder (1 case); enuresis (1 case); psychotic disorders (5 cases, including schizophrenia paranoid type (1 case), disorganized type (1 case), delusional disorder (1 case), unspecified (2 cases)); depressive disorders (3 cases); generalized anxiety (6 cases); anorexia nervosa (2 cases); personality disorders (24 cases, including borderline personality (11 cases), dependent personality (5 cases), histrionic personality (2 cases), obsessive-compulsive personality (1 case), not specified (5 cases)). Sudden unexplained death occurred in 2 cases (borderline personality and pervasive developmental disorder not otherwise specified, respectively) and death due to pneumonia in 1 cases (anorexia). Although uncommonly severe cases of JME may have been selected in our referral centers, it appears that JME may be associated with PD. Comparatively mild personality disorders are the most common finding, and may be part of the clinical picture to some extent, while severe PD are less common, and probably coincidental. The presence of PD does not exclude the diagnosis of JME, and PD may represent a further challenge in the comprehensive care of these patients.

Adolescent↗
PubMed1991

Major depression and personality disorder.

The authors examined an interview and paper-and-pencil assessment of the DSM-III personality disorders (PDs) in depressed inpatients, and depressed relatives of psychiatric patients and never-ill controls who had a lifetime history of major depression. The rates of PDs according to the Structured Interview for DSM-III Personality Disorders (SIDP) were similar in the two groups, except for borderline PD which was more frequent in the inpatients. Of the individuals with a PD, the patients were more likely than the relatives to have two or more PDs, and the borderline and histrionic patients were more prototypic of these disorders than were the borderline and histrionic relatives. In contrast to the SIDP results, the rates of PDs according to the Personality Disorders Questionnaire (PDQ) were higher in the patient sample. These results thus extend the previously described high rates of PDs in depressed patients to a sample of individuals with a lifetime history of treated or untreated depression, and they suggest that interview assessments of personality may be less sensitive to the state effects of depression than are questionnaires.

Adult↗
PubMedDate not supplied

Personality disorders in recent-onset bipolar disorder.

The frequency and types of DSM-III personality disorders (PDs) were investigated in a sample of 26 recent-onset bipolar-disordered (BD) patients. Results showed that 62% of BD patients had PDs according to the Structured Interview for DSM-III Personality Disorders (SIDP). The most frequently diagnosed PDs were the histrionic, borderline, passive-aggressive, and antisocial categories. A comparison between the BD patients and a sample of 35 recent-onset schizophrenic patients showed significant differences for two PDs. Schizotypal PD was more frequently diagnosed in the schizophrenic group, while the BD group had a higher frequency of histrionic PD.

Bipolar Disorder↗
PubMedDate not supplied

Stability and predictive value of self-report personality traits pre- and post-electroconvulsive therapy: a preliminary study.

The accuracy and value of personality assessment for depressed patients receiving electroconvulsive therapy (ECT) is an underexplored and controversial area. However, there are data suggesting that personality traits and personality disorders affect the ultimate outcome of depressed patients receiving a variety of somatic treatments including ECT. Despite these data, controversy continues regarding the advisability of evaluating personality functioning in patients with severe depression. This study sought to explore the stability and predictive value of self-reported personality traits in depressed patients undergoing ECT. Sixteen subjects completed a self-report test of personality functioning and the Beck Depression Inventory (BDI) before and after ECT treatment. The results showed that the majority of self-report personality traits were stable pre- and post-ECT treatment. However, major depressive disorder did significantly affect the report of avoidant, histrionic, aggressive-sadistic, and schizotypal personality traits. Treatment did not change the overall personality profile of these subjects. Furthermore, regression analysis controlling for pretreatment depression showed pretreatment borderline personality traits to be significantly related to the posttreatment depression scores (response to treatment). These findings suggest that routine administration of a standard self-report measure of personality may aid in the evaluation of and treatment planning for patients receiving ECT.

Depressive Disorder↗
PubMed1989

Comparison between personality disorder diagnoses in DSM-III and DSM-III-R: reliability, diagnostic overlap, predictive validity.

97 nonpsychotic consecutive day patients were diagnosed by the axis 1 and 2 in the DSM-III and DSM-III-R system, and their treatment response during their stay was measured by the Health Sickness Rating Scale. The interrater reliability was equally good for both diagnostic systems. On axis 1, there were only minor differences between DSM-III and DSM-III-R. On axis 2, the frequency of schizotypal disorder was reduced by 40% and the frequency of histrionic disorder by two-thirds. The number of schizoid disorders increased from zero to five. Of the DSM-III schizotypals who lost this diagnosis in DSM-III-R (n = 8), 4 got a new diagnosis of schizoid personality and 4 maintained their borderline diagnoses. In DSM-III-R there was a sharper demarcation between patients with severe and nonsevere personality disorder with regard to treatment outcome, indicating an increased validity of these categories. There was also a sharper demarcation between borderline versus histrionic and schizotypal, and between schizotypal and schizoid diagnoses.

Adult↗
PubMed2003

[A case report of factitious disorder with hallucinations].

Although factitious disorder has been known for a long time, its diagnosis and treatment continue to be a problem. It is an uncommon condition associated with considerable morbidity and health care expenditure. We present a case of factitious disorder with hallucinations. A 37 year-old single woman has had auditory and olfactory hallucinations for six years. She had been diagnosed with schizophrenia, hospitalized for a short term, taking classical antipsychotic drugs for years. She has been performing her job as a teacher and living with her family. A suitable dose of atypical antipsychotic drugs was administered at a convenient time for her illness (Psychotic Disorder NOS) in psychiatric outpatient clinic of Kocaeli University. She was admitted to inpatient clinic twice in order to allow a clear diagnosis to be made. Psychotic disorder and temporal lobe epilepsy were ruled out. Borderline and histrionic personality traits were determined. Her complaints were unchanged over the course of treatment taking three years. She later started to come into the emergency department with anxiety symptoms, conversion like fits and suicide attempts; hospitalized for these complaints in another hospital. She was diagnosed with factitious disorder because of her unchanged complaints, her adding new complaints to the old ones, her complaints unrelated to psychosocial stressors, her ambitions to come to hospital, her increasing hospital dependence and having no prominent secondary gain. This case emphasizes the need for the careful observation of patients to prevent unnecessary investigations at the diagnosis and treatment stage and to establish a specific management strategy for the patients.

Adult↗
PubMed2004

Dimensions of personality pathology: an alternative to the five-factor model.

OBJECTIVE: Researchers have advocated replacing the DSM-IV classification of personality disorders with an alternative diagnostic system based on the five-factor model. This study evaluates the clinical comprehensiveness of the five-factor model and addresses the broader question of how many factors, and which factors, are necessary to understand personality pathology. METHOD: A national sample of 530 psychiatrists and clinical psychologists used the Shedler-Westen Assessment Procedure (SWAP-200) to provide detailed psychological descriptions of patients with personality disorder diagnoses. The SWAP-200 is a 200-item instrument designed to capture the richness and complexity of clinical observations while also providing quantifiable data for research. We used factor analysis to identify dimensions of personality relevant to understanding personality pathology. RESULTS: The five-factor structure replicated in a content-restricted subset of 60 SWAP-200 items. However, factor analysis of the full SWAP-200 yielded a conceptually richer factor solution that did not resemble the five-factor model. The analysis identified 12 clinically relevant personality dimensions labeled psychological health, psychopathy, hostility, narcissism, emotional dysregulation, dysphoria, schizoid orientation, obsessionality, thought disorder, oedipal conflict (histrionic sexualization), dissociation, and sexual conflict. CONCLUSIONS: The five-factor model represents a sound distillation of the personality constructs used by laypersons. However, it omits key clinical constructs and may not capture the complexity of personality syndromes seen in clinical practice. The SWAP-200 factors may provide a framework for studying personality pathology that is both empirically grounded and clinically relevant.

Adult↗
PubMed1991

PDQ-R personality disorders in bipolar patients.

The prevalence of personality traits and disorders in bipolar patients as reported in the literature varies widely. The Personality Diagnostic Questionnaire-Revised (PDQ-R) is a self-report instrument for DSM-IIIR personality disorders found to have validity, but with high sensitivity and moderate specificity. This study was designed to assess personality disorders in bipolar patients using the PDQ-R. Fifty bipolar patients in a long-term lithium treatment program completed the PDQ-R. Over one half the patients (58%) scored for one or more personality disorders. A total of 71 diagnoses was made among the 50 patients, or a mean of 1.42 per patient. The majority of the axis II diagnoses were from cluster B, with borderline the most prevalent, followed by histrionic. The PDQ-R has high sensitivity but moderate specificity and may overdiagnose personality disorders in bipolar patients. The PDQ-R may register subclinical aspects of affective disorder as personality.

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↗
PubMed2003

Bipolar II with and without cyclothymic temperament: "dark" and "sunny" expressions of soft bipolarity.

BACKGROUND: In the present report deriving from the French national multi-site EPIDEP study, we focus on the characteristics of Bipolar II (BP-II), divided on the basis of cyclothymic temperament (CT). In our companion article (Hantouche et al., this issue), we found that this temperament in its self-rated version correlated significantly with hypomanic behavior of a risk-taking nature. Our aim in the present analyses is to further test the hypothesis that such patients-assigned to CT on the basis of clinical interview-represent a more "unstable" variant of BP-II. METHODS: From a total major depressive population of 537 psychiatric patients, 493 were re-examined on average a month later; after excluding 256 DSM-IV MDD and 41 with history of mania, the remaining 196 were placed in the BP-II spectrum. As mounting international evidence indicates that hypomania associated with antidepressants belongs to this spectrum, such association per se did not constitute a ground for exclusion. CT was assessed by clinicians using a semi-structured interview based on in its French version; as two files did not contain full interview data on CT, the critical clinical variable in the present analyses, this left us with an analysis sample of 194 BP-II. Socio-demographic, psychometric, clinical, familial and historical parameters were compared between BP-II subdivided by CT. Psychometric measures included self-rated CT and hypomania scales, as well as Hamilton and Rosenthal scales for depression. RESULTS: BP-II cases categorically assigned to CT (n=74) versus those without CT (n=120), were differentiated as follows: (1). younger age at onset (P=0.005) and age at seeking help (P=0.05); (2). higher scores on HAM-D (P=0.03) and Rosenthal (atypical depressive) scale (P=0.007); (3). longer delay between onset of illness and recognition of bipolarity (P=0.0002); (4). higher rate of psychiatric comorbidity (P=0.04); (5). different profiles on axis II (i.e., more histrionic, passive-aggressive and less obsessive-compulsive personality disorders). Family history for depressive and bipolar disorders did not significantly distinguish the two groups; however, chronic affective syndromes were significantly higher in BP-II with CT. Finally, cyclothymic BP-II scored significantly much higher on irritable-risk-taking than "classic" driven-euphoric items of hypomania. CONCLUSION: Depressions arising from a cyclothymic temperament-even when meeting full criteria for hypomania-are likely to be misdiagnosed as personality disorders. Their high familial load for affective disorders (including that for bipolar disorder) validate the bipolar nature of these "cyclothymic depressions." Our data support their inclusion as a more "unstable" variant of BP-II, which we have elsewhere termed "BP-II 1/2." These patients can best be characterized as the "darker" expression of the more prototypical "sunny" BP-II phenotype. Coupled with the data from our companion paper (Hantouche et al., 2003, this issue), the present findings indicate that screening for cyclothymia in major depressive patients represents a viable approach for detecting a bipolar subtype that could otherwise be mistaken for an erratic personality disorder. Overall, our findings support recent international consensus in favoring the diagnosis of cyclothymic and bipolar II disorders over erratic and borderline personality disorders when criteria for both sets of disorders are concurrently met.

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↗
PubMed1996

The morbidity of DSM-III-R dependent personality disorder.

Dependent personality has long been discussed by clinicians, and by empirical researchers more recently. Little empirical evidence so far has been presented as the type and degree of disability with which it is associated. This report provides some empirical data in that regard. To examine this question, those with and without DSM-III-R dependent personality were compared in male veterans drawn from an outpatient psychiatry clinic (dependent and nondependent groups). Standardized interview assessments were used to determine axes I and II disorders and family history. The dependent personality disorder group had significantly lower socioeconomic status and poorer functioning in the family/home sphere. They had significantly more social phobia, borderline traits, and histrionic traits. In relatives, there was significantly more generalized anxiety disorder, simple phobia, drug abuse, and dramatic personality disorder cluster. There are clearly documentable vulnerabilities and morbidities associated with dependent personality disorder.

Ambulatory Care↗