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PubMed2000

A psychometric study of DSM-IV passive-aggressive (negativistic) personality disorder criteria.

The passive-aggressive (negativistic) personality disorder (PAPD) is one of the most controversial personality disorders. In order to assess DSM-IV PAPD psychometric properties and comorbidity pattern in a mixed psychiatric sample, 379 consecutively admitted in- and outpatients were administered SCID-II, Version 2.0. Confirmatory factor analysis showed that DSM-IV PAPD is a unidimensional construct with adequate internal consistency (K-R 20 = .85). A strong, specific association (odds ratio = 10.38, 95% CI = 4.83-22.30) was observed between DSM-IV PAPD and narcissistic personality disorder (NPD). Confirmatory factor analysis showed that DSM-IV PAPD should be considered as a subtype of a broader narcissistic disorder.

Adult↗
PubMed2007

Dysfunctional attitudes and personality disorder comorbidity during long-term treatment of MDD.

A key component of how depression may impact personality pathology involves an understanding of how cognition and dysfunctional attitudes may change as a result of experiencing a depressive state, and how these changes may affect reporting of personality disorder symptoms. This study examines whether dysfunctional attitudes are related to the stability of personality disorder diagnoses. The sample comprised 64 outpatients who were treatment responders following an 8-week acute treatment phase for major depressive disorder (MDD), met criteria for remission throughout a 26-week continuation phase, and completed a personality disorder assessment Structured Clinical Interview for DSM-III-R Axis II Disorders (SCID-II) at the beginning and end of each treatment phase. The Dysfunctional Attitude Scale (DAS) was given to patients at the beginning of the continuation phase. We found that following successful treatment of the MDD, individuals with stable personality disorder diagnoses (e.g., meeting criteria for a personality disorder at both the beginning and endpoint of continuation treatment) had greater severity of dysfunctional attitudes (P =.001) at the beginning of the continuation treatment compared to those who never met criteria for a personality disorder during continuation treatment. Though there was no significant relationship between DAS scores and the stability of a Cluster A or Cluster B personality disorder diagnosis, there was a significant relationship between DAS scores and the stability of a Cluster C personality disorder diagnosis (P <.001). Outpatients who had a stable Cluster C personality disorder diagnosis had higher scores on the DAS at the beginning of continuation treatment compared to outpatients who never met criteria for a Cluster C diagnosis. This finding suggests that dysfunctional attitudes that persist beyond remission of MDD may be a marker for certain personality disorders that are stable across long-term treatment.

Adult↗
PubMedDate not supplied

Personality disorders, history of trauma, and posttraumatic stress disorder in subjects with anxiety disorders.

The purpose of the study was to examine the association of personality disorders, history of trauma, and posttraumatic stress disorder (PTSD) in a large sample of subjects with anxiety disorders. Categorical and continuous indices of personality disorders were compared in three groups from the Harvard/Brown Anxiety Disorders Research Project (HARP): subjects with no history of trauma (n = 403), subjects with a history of trauma but no history of PTSD (n = 151), and subjects with a current or past diagnosis of PTSD (n = 68). Subjects with PTSD were more likely to meet criteria for borderline or self-defeating personality disorder than subjects in the other two groups. PTSD subjects also had higher scores on the continuous measures (total number of criteria met) for borderline and self-defeating personality disorder than the other two groups. The findings suggest that a diagnosis of PTSD rather than a history of trauma is associated with borderline and self-defeating personality disorder features. Alternative conceptualizations of axis II features in individuals with PTSD are discussed.

Adult↗
PubMed2003

Treatment models for those with severe mental illness and comorbid personality disorder.

BACKGROUND: Dual diagnosis of personality disorder and severe mental illness is an important clinical association that has been under-researched with regard to clinical management. AIMS: To compare the outcomes of different treatment models. METHOD: The outcome of patients with this combined diagnosis was compared in a systematic review of three randomised controlled trials in which different forms of community outreach treatment or intensive case management were compared with standard care. RESULTS: The results from the three studies showed that the outcome of comorbid diagnoses was worse than that of single diagnoses. Although assertive approaches reduced in-patient care, they sometimes did so at the expense of increasing social dysfunction and behavioural disturbance. CONCLUSIONS: For those with comorbid severe mental illness and personality disorder, the policy of assertive outreach and care in community settings may be inappropriate for both public and patients unless modified to take account of the special needs of this group.

Community Mental Health Services↗
PubMed2003

Correspondence among observer ratings of Rorschach, Big Five Model, and DSM-IV personality disorder constructs.

Observer ratings were collected using instruments designed to measure the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) personality disorders (Personality Diagnostic Questionnaire-4+ [PDQ-4+]; Hyler, 1994), the Big Five model (B5M; Goldberg's [1999] International Personality Item Pool), and Rorschach-derived constructs. For the latter, we revised the Rorschach Rating Scale (Meyer, Bates, & Gacono, 1999) to lower its reading level and renamed it the Rorschach Construct Scale (RCS) to emphasize its reliance on rated constructs. The RCS consists of 6 factors. Joint factor analysis of RCS, PDQ-4+, and B5M items also resulted in 6 factors: Self-Centeredly Exploitative, Poor Ego Resiliency, Extraversion, Task Conscientiousness, Openness to Ideas, and Emotional and Expressive Constriction. The first 2 factors received high loadings from RCS, PDQ-4+, and B5M variables. The sixth factor received high loadings from just RCS variables.

Adult↗
PubMed1993

Development of personality disorders in children and adolescents with obsessive-compulsive disorder. A 6- to 22-year follow-up study.

Forty-seven people with admissions in childhood for obsessive-compulsive disorder (OCD) and 49 child psychiatric controls were followed up in young adulthood and assessed for DSM-III-R personality disorders with the Structured Clinical Interview for DSM-III-R Personality Disorders. The number of personality disorders in OCD patients did not differ significantly from the number in controls. The most common personality disorder was avoidant personality disorder (significantly more frequent than in controls), whereas obsessive-compulsive personality disorder (OCPD) was not found more often in the OCD group. Subjects with OCD in adulthood seemed to have OCPD more often than childhood OCD patients with no OCD at follow-up. In the whole group, histrionic personality disorders were more common in women than in men and OCPD more common in men than in women, whereas borderline personality disorder was most common among women in the OCD group. The presence of a personality disorder in adulthood could not be correlated with such childhood factors as social background, symptoms or age of onset of OCD.

Adolescent↗
PubMed2006

Integrated wilderness therapy for avoidant personality disorder.

Patients with avoidant personality disorder (APD) are difficult to treat because of their extensive social, emotional and cognitive avoidance. Few studies have addressed outcome in APD and there is no therapy of choice. In this quasi-experimental study, we integrated wilderness therapy in an inpatient group program (integrated wilderness therapy, IWT), in order to enhance outcome for patients with APD. We compared outcome of the IWT group with a similar inpatient group program without wilderness therapy: the comparison condition (CC). The subjects in the IWT-group (n=16) with DSM-IV APD were treated in 11.5 weeks. The subjects in the comparison group (n=37) were selected from our database with the same diagnostic criteria. The participants were examined at pre-care, admission, discharge and 1-year follow-up. Both groups were significantly improved, but there were no significant differences between them. There were some non-significant trends for males to gain most benefit from IWT, whereas females were more improved by the CC. The results indicate that by integrating wilderness therapy we were able to treat more impaired patients at shorter time with almost the same outcome.

Adult↗
PubMed2003

[Diagnostic alertness to patients having a personality disorder with changing symptoms].

The diagnosis of mood disorders in patients with a personality disorder is complex because there may be a significant overlap of symptomatology between both disorders. A 33-year-old man with a borderline personality disorder, for which he had been treated for several years with marginal success, developed a depression that was not recognised and treated until late. Besides the similarity between the two disorders, emotional and personal factors on the part of the physician played an important role in the failure to diagnose the depression. In such complex situations, the use of practice guidelines may be helpful because these prescribe professional attitudes that, in this case, would probably have prevented the non-recognition of the depression.

Adult↗
PubMed1985

Axis II personality disorders: diagnostic and treatment issues.

The placement of personality disorders on a separate axis in DSM-III reflects increased interest in their diagnosis and treatment and encourages clinicians to consider the effects of personality style on axis I clinical syndromes. In this review of axis II personality disorders, the authors discuss methodological issues related to the diagnosis of all personality disorders, review the use of various treatment modalities, and present current issues and controversies related to specific personality disorders. They urge that any revision of DSM-III incorporate more reliable and clinically meaningful criteria, perhaps substituting a multidimensional classification system for the current categorical model.

Behavior Therapy↗
PubMed1987

DSM-III personality disorder clusters in three populations.

DSM-III personality disorder clusters had not previously been tested for their ability to distinguish between different population groups. A major obstacle - different demographic characteristics of different populations - was overcome by using logistic regression. Three out-patient psychiatric referral groups (chronic pain, disability applicants and competency to stand trial) provided subjects; adjustments were made for age, race, sex and education. The groups were significantly different in the adjusted prevalence of DSM-III personality disorder clusters. Clinical association between personality disorder and drug or alcohol abuse was again confirmed.

Alcoholism↗
PubMed1996

Childhood antecedents of adolescent personality disorders.

OBJECTIVE: The purpose of this study was to investigate the childhood antecedents of personality disorders that are diagnosed in adolescence. METHOD: A randomly selected community sample of 641 youths was assessed initially in childhood and followed longitudinally over 10 years. Childhood behavior ratings were based on maternal report; diagnoses of adolescent personality disorders were based on data obtained from both maternal and youth informants. Four composite measures of childhood behavior problems were used: conduct problems, depressive symptoms, anxiety/fear, and immaturity. Adolescent personality disorders were considered present only if the disorders persisted over a 2-year period. For all analyses, personality disorders were grouped into the three clusters (A, B, and C) of DSM-III-R. RESULTS: Logistic regression analyses indicated that all four of the putative childhood antecedents were associated with greater odds of an adolescent personality disorder 10 years later. Childhood conduct problems remained an independent predictor of personality disorders in all three clusters, even when other childhood problems were included in the same regression model. Additionally, depressive symptoms emerged as an independent predictor of cluster A personality disorders in boys, while immaturity was an independent predictor of cluster B personality disorders in girls. No moderating effects of age at time of childhood assessment were found. CONCLUSIONS: These results support the view that personality disorders can be traced to childhood emotional and behavioral disturbances and suggest that these problems have both general and specific relationships to adolescent personality functioning.

Adolescent↗
PubMed2006

[Personality disorders, psychopathy and serial killers].

OBJECTIVE: To illustrate the basic characteristics of several specific personality disorders, focusing mainly in antisocial personality disorder. The differences between antisocial personality disorder and psychopathy are highlighted. Serial killers and its psychopathic aspects are also discussed. METHOD: A bibliographic review was completed in order to outline convergences and divergences among different authors about this controversial issue, especially those concerning the possibility of treatment. RESULTS: While anti-social personality disorder is a medical diagnosis, the term "psychopathy" (which belongs to the sphere of forensic psychiatry) may be understood as a "legal diagnosis". It is not still possible to identify an effective treatment for serial killers. CONCLUSION: Personality disorders, especially of the antisocial type, still represent a formidable challenge to forensic psychiatry today. Questions as yet unanswered include the best and most humane place for patients with this condition and the nature of a standardised treatment recommendation.

Antisocial Personality Disorder↗
PubMed2004

The boundary between borderline personality disorder and bipolar disorder: current concepts and challenges.

OBJECTIVE: The boundary between borderline personality disorder (BPD) and bipolar disorder (BD) is a controversial subject. Clinically, it can be difficult to diagnose patients who present with both affective instability and impulsivity. This paper reviews concepts and challenges related to the overlap of these disorders. METHODS: A Medline search was conducted, using the key words borderline personality disorder, bipolar disorder, affective disorder, and personality disorder. Reference lists from articles generated were also used. Publications from the last 20 years were considered. RESULTS: Studies demonstrate a greater cooccurrence between these 2 disorders than between BPD and other Axis I disorders or between BD and other Axis II disorders. Some authors suggest that many patients diagnosed with BPD are better described as having BD, that the bipolar classification is too narrow, or that BPD should be considered a variant of affective disorders. Others present evidence supporting BPD as a valid construct. Hypotheses about the relation between the 2 disorders and suggestions for clinical practice are offered. CONCLUSIONS: There appears to be sufficient evidence to consider BPD to be a valid diagnosis. Both disorders apply to heterogeneous populations, and their characteristics require further clarification. In diagnostically challenging situations, careful consideration of a patient's longitudinal history is essential. Future research will be important to ensure that our diagnostic classifications reflect clinically useful entities.

Bipolar Disorder↗
PubMed2000

Does the ICD 10 classification accurately describe subtypes of borderline personality disorder?

The aim of the paper is to explore whether the division of borderline personality disorder, as described in the DSM classification, into impulsive and borderline subtypes of emotionally unstable personality disorder in the ICD classification of personality disorder, is a valid division. The self-report questionnaire responses of 288 referrals to a personality disorder service were rated on each of the eight criteria for DSM-III-R diagnosis of borderline personality disorder. Factor analysis identified two factors; factor one closely corresponds with the borderline subtype of ICD10, whilst factor two closely corresponds with the impulsive subtype of ICD10. Criteria common to both factors unstable relationships and identity confusion - were considered core features of borderline personality disorder. The pattern of occurrence of the two factors was similar to the complex binary picture described by ICD10. However there were also differences. Firstly, identity confusion is found to be a core feature of both our factors, and this does not conform to the restriction of identity confusion to the borderline subtypes in ICD10. Secondly, we found a residual pool of undifferentiated borderline patients and a small group of pure non-impulsive borderline patients who are not currently accommodated within the ICD10 emotionally unstable personality disorder. We conclude that future classifications of this disorder should accommodate four subtypes, and suggest these subtypes have implications for treatment and further research.

Adult↗
PubMed2005

Personality disorders in patients with burning mouth syndrome.

Burning Mouth Syndrome (BMS) presents high rates of comorbid Axis I disorders while no controlled studies have addressed the question of Axis II comorbidities. The aim of the present study was to examine DSM-IV (APA, 1994) Axis II comorbidity in BMS patients and to control for the specificity of this association. Seventy BMS patients were compared to a nonpsychiatric population sample and to patients with other Somatoform Disorders for the presence of personality disorders (assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders [SCID-II; First, Gibbon, Spitzer, & Williams, 1997). Prevalence rates were compared using the Pearson's chi square test. At least one personality disorder (PD) was found in 85.7%, 24.3%, and 88.6% of subjects in the three groups, respectively. When examining PD subgroups, significant differences emerged even between the BMS and the somatoform disorder group, with BMS patients showing more Cluster A and fewer Cluster B PDs. Our results suggest that BMS is associated with a specific pattern of Axis II comorbidity.

Aged↗
PubMed1994

Concordance between patients and informants on the personality disorder examination.

OBJECTIVE: Difficulties in the assessment of personality disorders and the burgeoning interest in axis II have led to increased use of informants when studying these conditions. The present study sought to evaluate the correspondence between patients and their informants on symptoms of personality disorders. METHOD: A total of 105 outpatients and knowledgeable informants were independently interviewed by using the Personality Disorder Examination, a widely used instrument for the full range of personality disorders. RESULTS: Diagnostic concordance between interviews was low (median kappa = -0.01), while correlations between dimensional scores were somewhat higher (median kappa = 0.36). Overall, patient interviews showed more pathology than interviews with informants. However, many of the symptoms obtained from informants were not reported by patients. CONCLUSIONS: These data suggest that patient-informant concordance for axis II disorders is poor for diagnoses but somewhat better for dimensional scores. There was no evidence that low agreement can be explained by patients attempting to present themselves in a favorable light. Further work is necessary to elucidate the reasons for discordance and determine which data source provides the most valid information.

Adult↗
PubMedDate not supplied

A comparison of clinical and self-report diagnoses of DSM-III personality disorders in 552 patients.

This report examines the relationship between clinicians' diagnoses of personality disorder and self-report diagnoses of personality disorder obtained from the Personality Diagnostic Questionnaire (PDQ). The results from 552 patients showed general lack of agreement between clinical and self-report diagnoses of DSM-III personality diagnoses. The best agreement obtained was for Borderline Personality Disorder: k = 0.46, and r = .51 for scaled ratings. Possible sources of disagreement including failings of the self-report questionnaire, difficulties in relying upon patients' self-reports, lack of reliability of clinical diagnoses of personality, and possible inherent lack of reliability of several of the DSM-III personality disorders are discussed.

Adolescent↗