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[Classification of asthenic conditions (reactions, phases) in psychopathy].

Analysis of asthenic reactions and phases that occur periodically in persons suffering from psychopathies of the sthemic pole (33 cases) has demonstrated that the structure of the syndrome is determined by the combination of the two signs: phenomena of irritative weakness and symptomatology of the somatopsychic circle. Two types of asthenic conditions were distinguished: conversion and psychovegetative asthenia. As to the first type, the asthenic manifestations proper were of the demonstrative-exaggerated character, whereas somatopsychic disorders occurred in accordance with the hysterical conversion mechanism. Consequently, the structure of the syndrome is marked by the predominance of characteristic abnormalities in the sphere of somatopsychics (bodily hysterical stigmas, with the intensity of ergic disorders being minimum). As to the second type, asthenia was marked by relatively uniform ergic and somatopsychic manifestations. The latter ones (algias, sleep disturbances, "pseudosomatic" crises) as if masked asthenia proper. The typological differentiation of asthenic disorders provided here is adequate to the nature of the constitutional proneness as a system of factors that determine the clinical differences. Conversion asthenia occurs preferably in persons of the histrionic and excitable mould whereas psychovegetative asthenia in persons showing the predominance of anancastic and expansive schizoid traits.

Adult↗

The MMPI, prototypal typology, and borderline personality disorder.

This study demonstrates inherent features in the DSM-III diagnostic criteria for personality disorders (i.e., overlapping diagnoses and heterogeneous symptomatology) that limit efforts to identify a sensitive and specific MMPI profile for the borderline personality disorder. A sample of 71 inpatients was administered an MMPI and a semistructured interview that systematically evaluated each of 81 symptoms for the 11 DSM-III personality disorders. Interrater reliability was substantially higher than has been obtained with unstructured interviews. The effect on the borderline MMPI profile of variation in the number of borderline symptoms and overlap with the schizotypal, histrionic, and antisocial diagnoses was demonstrated. We discuss implications with respect to a prototypal model of classification.

Adult↗

Personality traits and disorder in depression.

The authors examined the relationship of personality traits and personality disorder to depressive subtype, descriptive characteristics, and outcome in 160 depressed inpatients. Personality disorder was significantly more common in unipolar nonmelancholic depressed patients (61%) than in unipolar melancholic (14%) or bipolar depressed patients (23%). Personality disorder did not affect symptom manifestation but was related to earlier onset of depressive illness and worse outcome within the unipolar nonmelancholic group. Obsessive traits were most common in the unipolar melancholic patients, while histrionic, hostile, and borderline traits predominated in the nonmelancholic patients. The authors discuss the usefulness of a multiaxial diagnostic system and the importance of separating trait and disorder in personality assessment.

Adult↗

Personality disorders in anorexia nervosa and bulimia nervosa.

Two self-report questionnaires (MCMI and BSI) designed to measure personality disorder (PD) according to DSM-III (R) criteria were administered to patients with a diagnosis of anorexia nervosa (AN) (n = 19), bulimia nervosa (BN) (n = 16), or both diagnoses (AN + BN) (n = 9), both before and after treatment for the eating disorder. The main finding was that self-reported Personality Disorder (PD) diagnoses are not stable enduring characteristics among this group of eating disorder patients. A high rate of PD diagnoses occurred in all patient groups at admission (93%) and at discharge (79%). Both MCMI and BSI scales were subject to significant change following treatment. A high prevalence of borderline personality disorder was found in patients with BN. Changes in depression and self-esteem scores correlated most strongly with changes in schizoid, schizotypal, histrionic and narcissistic scales. Assessment of PD using self-report measures should be interpreted with caution in acutely symptomatic patients with eating disorders.

Adolescent↗

Validity of the MMPI Personality Disorder scales (MMPI-PD).

The MMPI Personality Disorder scales, developed by Morey, Waugh, and Blashfield (1985), were validated on an inpatient population by comparing 104 patients' MMPI-PD scores with the MCMI and with DSM-III-R diagnosis. Conservative significance levels were used to ensure more valid conclusions. Schizoid, Avoidant, Dependent, Histrionic, and Narcissistic scales were correlated significantly. Passive-Aggressive, Schizotypal, and Borderline scales did not correlate with corresponding MCMI scales. The MMPI-PD nonoverlapping scales were most effective in predicting diagnosis, specifically the Personality Disorder NOS, Eccentric and Borderline groups. The overlapping scales were not as effective in predicting diagnosis, but best predicted the Eccentric and Borderline groups. This study provides support for the validity of specific scales and circumscribed diagnostic utility for both measures.

Adult↗

Assessing aviators for personality pathology with the Millon Clinical Multiaxial Inventory (MCMI).

Psychiatrists independently evaluated 82 aviators referred to an aeromedical consultation service who had been administered the Millon Clinical Multiaxial Inventory (MCMI). The MCMI personality scales of those aviators psychiatrically deemed to be free from personality pathology were compared to the scales of those aviators psychiatrically assessed to have maladaptive personalities. The MCMI personality scales reached statistical significance (p < 0.005) for identifying Diagnostic and Statistical Manual of Mental Disorders (2) Cluster C (dependent or avoidant or both) maladaptive personality traits, but did not reach statistical significance for Cluster B (histrionic or narcissistic or both) traits. Military aviators are a highly selected group who have mastered numerous obstacles and who continually prove their adaptability. The prevalence of personality pathology is likely not as great in this population as would be suggested by the MCMI. An elevation of a Cluster C scale, however, warrants a high index of suspicion.

Adult↗

Aetiological risk factors for personality disorders.

BACKGROUND: Elucidation of aetiological processes leading to development of Axis II disorders is important in category validation and could lead to new treatments. AIMS: To establish aetiological associations between Axis II disorders and specific risk factors. METHOD: Male and female subjects (n = 260) in maximum security hospitals and prisons were interviewed to determine DSM-III Axis II and lifetime Axis I diagnoses. Aetiological risk factors were obtained at interview and from case files. Independent statistical associations were established by logistic regression. RESULTS: Axis II categories were divided into four groups: (a) disorders of character development, secondary to an adverse early environment: antisocial, self-defeating and paranoid; (b) disorders of temperament, secondary to constitutional aetiology: avoidant, dependent, schizoid and schizotypal; (c) a 'mixed' disorder of constitutional and environmental aetiology: borderline; and (d) aetiological associations not established: narcissistic, histrionic, compulsive and passive-aggressive. CONCLUSIONS: The study validates several Axis II categories but challenges the inclusion of others within Axis II of DSM-IV, in particular schizoid, schizotypal, avoidant and borderline personality disorders. The findings have implications for future treatment interventions.

Adult↗

Sociotropy, autonomy, and personality disorder criteria in psychiatric patients.

Sociotropy and autonomy (Beck, 1983) are sets of beliefs, concerns, and behavioral tendencies that are proposed to create vulnerability to depression and other psychopathology and to influence its manifestation and treatment response. Other theoretical frameworks (Blatt, 1974) have made similar suggestions. We investigated the differential relations of sociotropy and autonomy to dimensional scores for each DSM-III-R personality disorder (PD) in a sample of 188 psychiatric patients, controlling for the other set of characteristics and for the other PDs. Histrionic and dependent PD traits were related specifically to sociotropy. Paranoid, schizoid, schizotypal, and passive-aggressive PD traits were related specifically to autonomy. Borderline, narcissistic, avoidant, and self-defeating PD traits were related significantly and about equally to both sociotropy and autonomy. Obsessive-compulsive PD traits were not related consistently to either. Results were mostly as predicted and suggest that sociotropy and autonomy may be useful constructs for understanding and treating PDs.

Adolescent↗

Neurocognitive deficits and history of childhood abuse in schizophrenia spectrum disorders: associations with Cluster B personality traits.

Cluster B personality traits have been detected in persons with schizophrenia, at a rate exceeding that of the general population. Unclear, however, is how to account for such high rates of Cluster B traits. Accordingly, this study explored the hypothesis that the presence of these traits may be linked to impairments in neurocognition, and childhood abuse history. To test this, we simultaneously obtained an assessment of Cluster B traits using the Millon Clinical Multiaxial Inventory III, along with measures of attention, verbal memory, affect recognition, executive function and childhood abuse history among 37 persons with schizophrenia spectrum disorders in a post acute phases of illness. Pearson correlation coefficients revealed that higher levels of histrionic and narcissistic traits were related to poorer neurocognition while higher levels of narcissistic traits were negatively correlated with childhood physical abuse. Higher levels of borderline traits were uniquely related to the report of childhood sexual abuse while higher levels of antisocial traits were related to higher levels of childhood physical abuse. Theoretical and clinical implications are discussed.

Brain↗

[Bipolar patients in remission: personality disorders and changes in personality].

81 remitted patients with bipolar affective disorder were examined 20 months after the last discharge from hospital, for personality disorders and other personality deviations, which could be important for their way of coping. There was a high frequency of narcissistic, histrionic and borderline traits and, especially in the bipolar schizoaffective subgroup, of schizoid and related traits. Patients with few former episodes seemed to be "syntonic". Bipolar patients with a longer duration of illness showed an increasing resignative and subdepressive change of feelings and attitudes, whereas the schizoaffective patients in the long term showed a hypomanic alteration. The personality changes of bipolar patients occur during the "free intervals" and are mediated by social interaction, whereas the alteration of some bipolar schizo-affective seems to be caused directly by their illness.

Adult↗

Patients' and informants' reports of personality traits during and after major depression.

The influence of major depression on patients' and informants' reports of personality traits was examined using the Structured Interview for DSM-III Personality Disorder, both before and after successful antidepressant or placebo treatment (N = 58). According to patients' reports, Cluster A and C traits decreased significantly from pre- to posttreatment, but Cluster B traits were unchanged, excluding an increase in histrionic traits. According to informants' reports, Cluster A and B traits did not change from pre- to posttreatment, but Cluster C traits decreased significantly after treatment, not including passive-aggressive traits. Moreover, informants generally reported much higher levels of maladaptive personality traits than patients themselves. These results suggest that informants should be used in future research on personality disorders until better assessment techniques are developed.

Adult↗

Comorbidity of bulimia nervosa and personality disorder.

Thirty patients meeting DSM-III-R criteria for bulimia nervosa with at least three bingeing episodes a week were compared with 30 age- and sex-matched controls on DSM-III personality measures. The bulimic patients were more likely to display cluster B (histrionic, narcissistic, antisocial, and borderline) personality abnormalities (odds ratio 15.0) and cluster C (avoidant, dependent, compulsive, and passive-aggressive) personality abnormalities (odds ratio 4.3) than were the community controls. This study supports the finding that personality disorder is a possible risk factor for bulimia.

Borderline Personality Disorder↗

Tonic arousal and activity: relationships to personality and personality disorder traits in panic patients.

Personality theorists have long predicted a relationship between personality traits and autonomic activation. In this study, 48 patients with panic disorder underwent personality assessment by questionnaire (Eysenck Personality Inventory: 48 patients) and by interview (Personality Disorders Examination: 35 patients). Ambulatory heart rate and activity were measured by the Vitalog method and were used as measures of activation and autonomic arousal. There was a significant positive correlation between histrionic traits and activity level and a significant negative correlation between sociability and heart rate. The findings are consistent with previous studies showing a negative relationship between sensation-seeking personality traits and cerebrospinal fluid levels of norepinephrine and a positive relationship between extroversion and cerebrospinal fluid levels of dopamine.

Adult↗

Personality disorders and quality of life. A population study.

The purpose of the study was to investigate the relationship between specific personality disorders (PDs) and specific aspects of quality of life in the common population. The sample consisted of 2053 individuals between 18 and 65 years old. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R), axis I was studied by means of a structured interview (Composite International Diagnostic Interview) and axis II by means of a Structured Interview for DSM-III-R Personality Disorders; sociodemographic variables were taken into account, and broad aspects of quality of life were included. Personality disorders appeared to be more important statistical predictors of quality of life than sociodemographic variables, somatic health, and axis I disorder. Those with avoidant, schizotypal, paranoid, schizoid, and borderline PDs had the strongest and broadest reduction in quality of life, whereas those with histrionic, obsessive-compulsive, passive-aggressive, and sadistic PDs did not show any reduction. A number of specific relationships occurred. Furthermore, the more PDs that existed and the more personality criteria fulfilled, the poorer the quality of life, pointing to the importance of comorbidity and continuity.

Adolescent↗

Normal and pathological narcissism in adolescence.

Narcissistic vulnerability is a central feature of both normal and pathological adolescence. Examining the unfolding of self-esteem regulation against a developmental background, the author proposes a framework to differentiate normal adolescent vulnerability from pathological narcissistic regulation and narcissistic psychopathology. Normal adolescents achieve a partial disengagement from their internalized parents without finding themselves bereft of limit-setting and direction-giving capacities or unable to maintain basically good relationships with both their real and their intrapsychic parents. Normal adolescents can construct an ideal that guides their transition into adulthood. In pathological narcissism, by contrast, youngsters crystallize their reliance on an omnipotent sense of self, refuse to acknowledge their shortcomings and vulnerabilities, project onto others disowned self-experiences, and demand public affirmation of their illusory power. Multiple developmental factors transact, in different proportions, to produce the specific features of narcissistic personality disorder. Several clinical subtypes of narcissistc pathology can be distinguished, representing the predominance of particular sets of developmental forces. In the histrionic-exhibitionistic type, the predominant features are the organization of the sense of self around the adolescent's talents or beauty, coupled with an ongoing need for admiration and attention from others. They feel exhilarated when they find confirmation but become spiteful or feel crushed when ignored. Ruthless psychopathic adolescents dissociate and deny pain, helplessness, and vulnerability; rigidly attempt to maintain an illusion of control and invulnerability; and ruthlessly exploit, intimidate, and manipulate others. They scan constantly for threats or blame and are haunted by the expectation of attack. Self-victimizing, masochistic youngsters organize their sense of self around the experience of being victimized. Their apparent helplessness, however, feeds a secret conviction of power and superiority.

Adolescent↗

The Egocentricity Index as a measure of self-esteem and egocentric personality style for inpatient adolescents.

The Egocentricity Index (EI) was assessed as a measure of self-esteem, egocentric behavior, and a basic statistic in a population of 60 predominantly behavior disordered, inpatient adolescents. Millon Adolescent Personality Inventory (MAPI) scales served as criterion measures. A low mean EI was found in these youngsters but was not mediated by low self-esteem as the Index was uncorrelated with self-esteem/self-concept measures. The Index did correlate with an histrionic type of egocentric personality style. The purported association between the EI components of pair and reflection responses was not observed here.

Adjustment Disorders↗

Posttraumatic stress disorder and the MCMI-II.

This study investigated the MCMI-II profile characteristics of 39 veterans diagnosed with Posttraumatic Stress Disorder. Characteristics of the mean group profile were similar to prior findings reported in the literature on the MCMI and Posttraumatic Stress Disorder with highest mean elevations found on the Avoidant, Passive-Aggressive, Schizoid, and Antisocial basic personality scales, the Borderline and Schizotypal pathological personality scales, and with elevations on the Anxiety, Dysthymia, Alcohol Dependence, Drug Dependence, and Major Depression clinical syndrome scales. A multivariate analysis of variance comparing the group with Posttraumatic Stress Disorder with a non-PTSD comparison group of 39 on the basic personality, pathological personality, and the clinical syndrome scales of the MCMI-II was not statistically significant. Nonetheless, univariate analyses of variance comparing the two groups on the individual modifier scales and the individual personality and clinical syndrome scales of the MCMI-II using a Bonferroni adjusted probability indicated significant differences on the Desirability and Histrionic scales. Response-style bias as a possible factor in MCMI-II profiles for the group with Posttraumatic Stress Disorder is also discussed.

Adult↗

Predicting DMS-IV cluster B personality disorder criteria from MMPI-2 and Rorschach data: a test of incremental validity.

Despite their frequent conjoint clinical use, the incremental validity of Rorschach (Rorschach, 1921/1942) and MMPI (Hathaway & McKinley, 1943) data has not been adequately established, nor has any study to date explored the incremental validity of these tests for predicting Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) personality disorders (PDs). In a reanalysis of existing data, we used select Rorschach variables and the MMPI PD scales to predict DSM-IV antisocial, borderline, histrionic, and narcissistic PD criteria in a sample of treatment-seeking outpatients. The correlational findings revealed alimited relation between Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) variables, with only 5 of 30 correlations reaching significance (p <.05). Hierarchical regression analyses showed that both the MMPI and Rorschach data add incrementally in the prediction of DSM-IV borderline and narcissistic PD total criteria scores. The findings were less clear for the incremental value of Rorschach and MMPI-2 data in predicting the total number of DSM-IV histrionic PD criteria, which were best predicted by Rorschach data, and antisocial PD criteria, which were best predicted by MMPI-2 data. In addition to providing evidence of the incremental validity of Rorschach data, these findings also shed light on the psychological characteristics of the DSM-IV Cluster B PDs.

Adult↗