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PubMedDate not supplied

[Personality disorders prevalence study among inpatients with mood disorders, psychoactive use disorders and anxiety disorders].

OBJECTIVE: The aim of this study was to asses type and prevalence of Personality Disorders (PDs) and their patterns of comorbidity with Axis I disorders in a sample of psychiatric inpatients. SETTING: The sample consisted of 300 subjects admitted to a psychiatric unit on a voluntary bases for an index episode. The study was conducted over a period of 12 months, from 1.11.1997 to 31.10.1998. MAIN OUTCOME MEASURES: The Italian version of SCID-II-PQ (Structured Clinical Interview for DSM-III-R personality disorders, with Personality Questionnaire--PQ--a self report questionnaire). RESULTS: More than half the patients had at least one personality disorder. The mean of disorders per patient was 2.83 +/- 1.93 (+/- SD). The most prevalent Axis II disorders were Borderline PD (30.7%), Obsessive-compulsive PD (30.7%) and Avoidant PD (25.3%). Women were significantly more likely than men to meet criteria for Dependent PD and Avoidant PD. Man showed significantly more frequently than women Antisocial PD. Significant associations (p < 0.05) were found for comorbidity of Mood Disorders and Avoidant PD, and for Psicoactive Use Disorders and Antisocial PD. CONCLUSIONS: Our study confirms the high prevalence of PDs in psychiatric inpatients and showe some interesting associations between Axis I and Axis II disorders. These results can't be generalized to outpatients because our clinical sample involved mainly severely ill inpatients, but they raise questions about the exact nature of PDs and of the relationship with Axis I disorders. Further research involving outpatients and general population is needed to examine factors that could affect development and course of Personality Disorders.

Adult↗
PubMedDate not supplied

Personality disorder as a contraindication for liver transplantation in alcoholic cirrhosis.

Severe personality disorder has been proposed as a contraindication for liver transplantation. Seventy-three subjects with alcoholic-related liver disease were evaluated for personality disorder and followed for 6 months. The subjects with severe personality disorder had higher rates of divorce, higher rates of comorbid drug abuse or dependence, lower Weschler Adult Inventory Scale IQ estimates, and higher scores on indicators of emotional impairment. Personality disorder was not associated with a higher rate of return to alcohol use during the follow-up period. Three subjects with personality disorder underwent liver transplantation without behavioral or substance abuse complications. This study does not support routine exclusion of subjects based solely on a diagnosis of a severe personality disorder.

Adult↗
PubMed1991

Posttraumatic stress disorder among children clinically diagnosed as borderline personality disorder.

Using the Diagnostic Interview for Children and Adolescents, Revised Version (DICA-C-R), the authors evaluated 19 children ages 7 to 14 who had recently been clinically diagnosed as borderline personality disorder by DSM-III-R criteria. The results reveal that 78.9% of these children reported significant traumatic experiences, with 36.8% fitting DICA-C-R criteria for posttraumatic stress disorder. These findings raise the possibility that a diagnosis of borderline personality in childhood can often represent posttraumatic stress disorder.

Adolescent↗
PubMed2003

Personality traits and personality disorders in early onset versus late onset major depression.

BACKGROUND: We aimed to determine the relationship between certain personality disorders and/or personality traits and early onset major depression. METHODS: A total of 400 depressed primary care patients were assessed for personality disorders using the SCID screen and for personality traits using the Karolinska Scales of Personality (KSP) questionnaire. Early onset was defined as onset of the first episode before the age of 26. Logistic regressions were performed to reveal relationships after adjustment for sex, age and number of previous episodes. RESULTS: Both groups had a similar severity of current illness determined by the Montgomery-Asberg Depression Rating Scale. Those with an early onset presented with a more debilitating course, seen in the form of more depressive episodes and previous hospitalisations in spite of their younger age. Early onset was also an independent predictor for avoidant, borderline and paranoid personality disorders. It also predicted increased scores on the KSP scales Psychic anxiety, Psychasthenia, Muscular tension, Suspicion and Irritability, and decreased Socialisation. LIMITATIONS: The evaluation was performed as a self-assessment, subjects had a superimposed major depressive episode when assessed, and subgroups of individuals were not eligible. CONCLUSIONS: Early onset major depression is a predictor for personality pathology and deviant personality traits. A better understanding of the interplay between genetics and environment that underlies this phenomenon will help to improve the long-term course in afflicted individuals.

Adult↗
PubMed1993

The impact of mother-child interaction on the development of borderline personality disorder.

OBJECTIVE: Two major psychodynamic theories of the etiology of borderline personality disorder posit two aspects of mother-child interaction as uniquely pathogenic: maternal over-involvement with the child and mismanagement and inappropriateness of maternal guidance and support of the child. This study is an attempt to examine these putative risk factors empirically, using epidemiologic methods. METHOD: Mother-child interaction, father-child interaction, maternal personality, and adolescent diagnoses of personality disorders were measured on two occasions, 2.5 years apart, in a random sample of 776 adolescents. RESULTS: Maternal inconsistency in upbringing of the child predicted a persistence or an emergence of borderline personality disorder, but not of any other axis II disorder. However, this effect occurred only in the presence of high maternal overinvolvement. Neither maternal overinvolvement nor maternal inconsistency alone predicted emergence of borderline personality disorder. Pathological features of maternal personality did not account for the combined effect of maternal overinvolvement and inconsistency on borderline personality disorder. CONCLUSIONS: The two child-rearing risk factors hypothesized to be important by two psychodynamic models of borderline personality disorder were found to be pathogenic only when they coexisted. Their effect could not be accounted for by the biological or environmental vulnerability represented by maternal borderline personality traits.

Adolescent↗
PubMed2005

Borderline personality disorder, impulsivity, and the orbitofrontal cortex.

OBJECTIVE: Orbitofrontal cortex lesions produce disinhibited or socially inappropriate behavior and emotional irregularities. Characteristics of borderline personality disorder include impulsivity and affective instability. The authors investigated whether aspects of borderline personality disorder, in particular impulsivity, are associated with orbitofrontal cortex dysfunction. METHOD: Measures of personality, emotion, impulsivity, time perception, sensitivity to reinforcers, and spatial working memory were administered to patients with borderline personality disorder (N=19), patients with orbitofrontal cortex lesions (N=23), patients with lesions in the prefrontal cortex but not in the orbitofrontal cortex (N=20), and healthy comparison subjects (N=39). RESULTS: The patients with orbitofrontal cortex lesions and the patients with borderline personality disorder performed similarly on several measures. Both groups were more impulsive and reported more inappropriate behaviors, borderline personality disorder characteristics, and anger and less happiness than the two comparison groups, and both groups were less open to experience and had a faster perception of time (underproduced time) than the healthy comparison subjects. The patients with orbitofrontal cortex lesions and the borderline personality disorder patients performed differently on other measures. The borderline personality disorder patients were less extraverted and conscientious and more neurotic and emotional than all other groups. Patients with orbitofrontal cortex lesions had deficits in reversing stimulus-reinforcer associations and a faster perception of time (overestimated time) than the healthy comparison subjects. CONCLUSIONS: Orbitofrontal cortex dysfunction may contribute to some core characteristics of borderline personality disorder, in particular impulsivity. Other characteristics of borderline personality disorder, such as high levels of emotionality and personality irregularities, do not appear to be related to the type of dysfunction produced by orbitofrontal cortex damage. The similarities and differences found between the borderline personality disorder patients and the patients with orbitofrontal cortex lesions may lead to a better understanding of the etiology of borderline personality disorder and the functions of the orbitofrontal cortex.

Adolescent↗
PubMed1993

[Personality disorders and adult behavior according to ICD-10].

Diagnostic criteria for Personality Disorders and Adult Behavior according I.C.D.-10 are reviewed. The authors point out that I.C.D.-10 considers the Personality Disorders as an entity in constant interaction with the environment. This fact allows to include the adult traumatic perturbations within this category. So the range becomes a wider one the traditional which locates the Personality Disorders only in young ages. The authors consider important that the Schizotypic and Cycloid Personality Disorders are left out since they both exceed the criteria for Personality Disorders. Developmental Disorders and Sexual Orientation presents conceptual inconsistencies that deserve further reflections. It is of interest that Borderline Disorders be considered a subtype of Emotional Disorders differentiating them from Impulsive type which agrees with clinic and neurobiological studies. They also think that incorporation of flexible quantitative cut off would be important to allow the clinician to ponder and value according to clinical evidences. They conclude that this chapter orders and propose clear and discriminative criteria for the Diagnosis of Personality Disorders and Adult Behavior.

Adult↗
PubMed2005

Neuropsychological performance in schizotypal personality disorder: importance of working memory.

BACKGROUND: Cognitive deficits consistently have been reported in schizophrenia patients and in patients with schizotypal personality disorder. For this study, the authors wanted to identify which of the domains of cognitive impairment represent "core" deficits of schizophrenia, comparing subjects with schizotypal personality disorder to two comparison groups: healthy volunteers and patients with personality disorders unrelated to schizophrenia. METHOD: Three groups completed a neuropsychological battery: patients with DSM-III-R schizotypal personality disorder (N=82); patients with DSM-III-R personality disorders unrelated to schizophrenia (i.e., a personality disorder other than schizotypal, schizoid, or paranoid [N=44]); and healthy volunteers (N=63). The battery included the California Verbal Learning Test, Trailmaking Test parts A and B, the Dot test of working memory, the Stroop Color and Word Test, the Paced Auditory Serial Addition Test, the WMS visual reproduction test, and the WAIS-R vocabulary and block design. RESULTS: Normative standards for performance that controlled for age, gender, and education were created from the scores of the healthy volunteers. Overall, schizotypal personality disorder patients performed significantly worse than the healthy volunteers and those with personality disorders unrelated to schizophrenia. Specifically, patients with schizotypal personality disorder demonstrated impaired performance on the Paced Auditory Serial Addition Test, WMS visual reproduction test, Dot test, and California Verbal Learning Test. In addition, in a regression analysis, performance on the Paced Auditory Serial Addition Test demonstrated the largest effect size. Indeed, it accounted for unique variance above and beyond all other cognitive measures, since controlling for Paced Auditory Serial Addition Test performance abolished group differences across all other measures. CONCLUSIONS: Patients with schizotypal personality disorder demonstrated moderate cognitive impairment compared with healthy volunteers (significant for seven out of 11 measures). These differences reached statistical significance for tasks of working memory, episodic memory, and delayed recall. Working memory performance accounted for the group differences. This study supports the view that working memory represents a core deficit of schizophrenia spectrum disorders.

Adult↗
PubMed1990

Effect of DSM-III personality disorders on outcome of tricyclic antidepressant-treated nonpsychotic outpatients with major or minor depressive disorder.

This is the first outcome report of the effect of a personality disorder on nonhospitalized major depressive patients that used a standardized DSM-III measure and did not prescreen to eliminate certain personality disorders. Six-month outcome was compared for nonpsychotic patients with major depression and a DSM-III personality disorder (n = 26) and those who did not have a personality disorder (n = 11). Patients without a personality disorder had significantly better outcome as measured by the Global Assessment Scale and employment status. There was also a trend for less physician utilization in this group.

Adjustment Disorders↗
PubMed1997

Attentional functioning in schizotypal personality disorder.

OBJECTIVE: Previous research has shown biological, phenomenological, and cognitive similarities between schizophrenic patients and individuals with schizophrenia-related personality disorders and features. Evidence further suggests that of these common dysfunctions, abnormal attention is one of the most promising indicators of a biological susceptibility to schizophrenia-related disorders. Although attentional dysfunctions have been reliably detected in schizophrenic patients as well as in a variety of populations at risk for schizophrenia, few studies have investigated attention in clinical patients with schizotypal personality disorder. In this study, the extent of attentional impairment was assessed in subjects with schizotypal personality disorder, normal comparison subjects, patients with other personality disorders, and schizophrenic patients. METHOD: Thirty subjects with schizotypal personality disorder, 35 subjects with other personality disorders (i.e., clinic patients with non-odd cluster personality disorders), 36 subjects with schizophrenia, and 20 comparison subjects who did not meet criteria for any axis I or axis II disorder participated in this study. All subjects were diagnosed according to DSM-III criteria. Attention was assessed by using the Continuous Performance Test, Identical Pairs Version. RESULTS: Analyses indicated that subjects with schizotypal personality disorder, like schizophrenic subjects, performed significantly worse than comparison subjects on both the verbal and spatial tasks of the Continuous Performance Test, Identical Pairs Version. In contrast, patients with other personality disorders performed similarly to comparison subjects across conditions. CONCLUSIONS: These results suggest that patients with schizotypal personality disorder are impaired in their attentional functioning relative to normal comparison subjects and that they display deficits that are similar to the pattern characterizing schizophrenic patients.

Adult↗
PubMed1993

Personality disorders diagnosed at intake at a public psychiatric facility.

OBJECTIVE: The purpose of the study was to determine the prevalence of personality disorders among a large population of persons seeking treatment in a public psychiatric facility and to examine the role of personality disorders in the clinical conditions of persons frequenting such facilities. METHODS: Clinical and demographic data were retrospectively examined for 18,179 adults who visited a walk-in clinic of a public psychiatric facility between 1983 and 1989. Patients who received a diagnosis of personality disorder were compared with those who did not. RESULTS: A total of 2,344 patients (12.9 percent) were diagnosed as having a personality disorder, a lower prevalence rate than generally found in treatment populations. The most frequent diagnoses were atypical, antisocial, and borderline personality disorders. Compared with other subjects, those with a personality disorder were significantly more likely to be men, to be 35 years old or younger, to have a higher level of social impairment, and to have more symptoms and more severe symptoms. CONCLUSIONS: The relatively low prevalence rate was attributed in part to underdiagnosis, largely due to the need for making rapid assessments in a public intake setting. The authors conclude that clinicians in such facilities may be likely to diagnose personality disorders when patients with certain axis I disorders such as substance use, affective, and adjustment disorders present with an overall greater level of symptomatology and social impairment.

Adult↗
PubMed2006

Adult social attachment disturbance is related to childhood maltreatment and current symptoms in borderline personality disorder.

We characterized borderline personality disorder (BPD) along two fundamental dimensions of adult social attachment and evaluated attachment associations with childhood maltreatment and current symptoms using self-report measures in 40 outpatients with DSM-IV BPD. The BPD group had significantly greater dimensional attachment impairment and rate of fearful attachment type compared with a healthy control group. Among BPD subjects, dimensional attachment-anxiety was specifically associated with sexual abuse, whereas attachment-avoidance was associated with all five maltreatment types. The two attachment dimensions showed divergent associations with current interpersonal problems, impulsivity subtypes and mood symptoms. We conclude that (1) BPD is characterized by adult attachment disturbance; (2) these attachment problems are strongly related to childhood maltreatment, and to current interpersonal problems and clinical symptoms that are considered core features of BPD; and (3) the diverse problems of BPD patients may arise from two basic mechanisms, each tied to a different type of attachment disturbance, developmental history, and clinical outcome.

Adolescent↗
PubMed2001

Personality disorders in offenders: categorical versus dimensional approaches.

The present study focused on the consequences of cut-off scores in personality disorder diagnoses for their association with criminal behavior. Using ICD-10 personality disorder criteria eliminating offence-related symptoms, we studied the distributions of categorically diagnosed personality disorders and of dimensional personality disorder scores in a group of offenders and a noncriminal control group. Whereas the dimensional scores of the offender group differed significantly from those of the control group for all personality disorders under study, the frequency of categorical diagnoses differed significantly for two personality for two personality disorders only. Moreover, prediction of group membership (offenders vs. nonoffenders) from personality disorder scores was substantially more precise than prediction from categorical diagnoses. It is concluded that a dimensional approach to personality disorder diagnosis is not only superior theoretically but also yields more precise information about the specific associations with criminal behavior.

Adult↗
PubMed1991

Epidemiology of borderline personality disorder.

The limited epidemiological data available on borderline personality disorder suggest that the prevalence of the disorder is between .2 and 1.8 percent in the general community, 15 percent among psychiatric inpatients, and 50 percent among psychiatric inpatients with a diagnosis of personality disorder. No data on the incidence--the rate of new cases--of the disorder have been reported, and inferences about incidence based on prevalence rates are complicated by differences in the formal designation of personality disorders before and after DSM-III was issued. Current findings suggest that about 76 percent of borderline patients are female. Epidemiological study of borderline personality disorder has been hindered by the lack of a brief semistructured interview that can be used with large population samples and that does not require substantial clinical expertise. The authors discuss alternative research methods, including use of lay interviewers, recoding of existing data, telephone interviews, and self-report inventories.

Borderline Personality Disorder↗
PubMed1998

Axis I comorbidity of borderline personality disorder.

OBJECTIVE: The purpose of this study was to assess the lifetime rates of occurrence of a full range of DSM-III-R axis I disorders in a group of patients with criteria-defined borderline personality disorder and comparison subjects with other personality disorders. METHOD: The axis I comorbidity of 504 inpatients with personality disorders was assessed by interviewers who were blind to clinical diagnosis and who used a semistructured research interview of demonstrated reliability. RESULTS: Four new findings emerged from this study. First, anxiety disorders were found to be almost as common among borderline patients (N=379) as mood disorders but far more discriminating from axis II comparison subjects (N=125). Second, posttraumatic stress disorder (PTSD) was found to be a common but not universal comorbid disorder among borderline patients, a finding inconsistent with the view that borderline personality disorder is actually a form of chronic PTSD. Third, male and female borderline patients were found to differ in the type of disorder of impulse in which they "specialized." More specifically, substance use disorders were significantly more common among male borderline patients, while eating disorders were significantly more common among female borderline patients. Fourth, a lifetime pattern of complex comorbidity (i.e., met DSM-III-R criteria for both a disorder of affect and a disorder of impulse at some point before the patients' index admission) was found to have strong positive predictive power for the borderline diagnosis as well as a high degree of sensitivity and specificity. CONCLUSIONS: These results suggest that the lifetime pattern of axis I comorbidity characteristic of borderline patients and distinguishing for the disorder is a particularly good marker for borderline personality disorder.

Adolescent↗
PubMed1993

[Childhood trauma and personality disorders].

The influence of the model of object relations on modern psychodynamic research has led to increased emphasis on the importance of relations and traumatic events in the genesis of some psychic disorders, especially with regard to personality disorders. The development of axis II in the DSM-III system has increased the number of empiric studies in this field. In this paper, the Authors report data relating to a sample of 49 subjects with personality disorders (DSM-III-R) in which the presence of sexual abuse, physical maltreatment and negative family atmosphere was examined using a self-administered questionnaire (CAT). The results suggest a significant presence of these events throughout the sample and reveal a correlation between some personality disorders and specific traumatic events. It may therefore be hypothesized that the presence of these events represents an important factor from the point of treatment, both in technical and in prognostic terms.

Adolescent↗
PubMed1988

Personality disorders and alcoholism treatment outcome.

The relationship existing between personality disorders (classified according to DSM III) and alcohol treatment outcome was evaluated in 404 alcoholics admitted to the Psychiatric Clinic of the University of Trieste, Italy. One quarter of the subjects had personality disorders, mainly of the 'antisocial', 'dependent', and 'borderline' subtypes. Alcohol abuse was specifically related to 'antisocial' personalities. Marked differences in treatment outcome among personality disorders were found. Group therapy for alcoholism was not beneficial to 'antisocial' personalities; it was most useful among 'dependent' subjects.

Alcoholism↗
PubMedDate not supplied

Variations on the family resemblance hypothesis as applied to personality disorders.

Diagnosis and classification of the personality disorders is controversial and problematic. Diagnostic reliability is uneven because of overlapping of traits and the lack of clear boundaries between categories. This study demonstrates that personality disorder diagnosis is dependent on the total number of defining features. Clinicians tend to ignore the presence of conflicting features when making a diagnosis. A new research instrument, artificially created case histories that allow the specific manipulation of defining features (i.e., diagnostic criteria), is described.

Diagnosis, Differential↗