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Personality disorders in early adolescence and the development of later substance use disorders in the general population.

Assessments of personality disorder (PD) and conduct disorder (CD) in a random community sample at mean age 13 were employed to predict subsequent substance abuse disorder (SUD), trajectories of symptoms of abuse or dependence on alcohol, marijuana, or other illicit substances, and hazard of initiating marijuana use over the subsequent decade. Personality disorders and conduct disorder were associated with diagnoses and symptoms of SUDs in every model and their effects were independent of correlated family risks, participant sex, and other Axis I disorders. Specific elevated PD symptoms in early adolescence were also associated with differential trajectories of already initiated SUD symptoms as well as elevated risk for future onset of SUD symptoms. For several models the greatest of these effects were shown for borderline PD and for conduct disorder, the predecessor of adult antisocial PD. Passive-aggressive PD also showed independent elevation effects on substance use symptoms for alcohol and marijuana. Analyses over 30 years suggest that Cluster B PD (borderline, histrionic, narcissistic) are independent risks for development of SUD and warrant clinical attention.

Adolescent↗

Personality characteristics of ADHD adults assessed with the Millon Clinical Multiaxial Inventory-II: evidence of four distinct subtypes.

This study compared the personality characteristics of 104 adults diagnosed with attention deficit hyperactivity disorder (ADHD). Personality features were assessed with the MCMI-II (Millon, 1987). Participants were divided into 4 groups based on the presence of persisting oppositional defiant disorder (ODD) or other comorbid diagnoses (ADHD only, ADHD-comorbid, ADHD-ODD, ADHD-ODD-comorbid). Significant differences between these groups were present for 9 of the 13 MCMI-II personality scales, resulting in 4 modal personality styles. ADHD-only adults evidenced mild histrionic traits, whereas the ADHD-comorbid group was more often avoidant and dependent in personality style. ADHD-ODD adults showed histrionic, narcissistic, aggressive-sadistic, and negativistic traits whereas the ADHD-ODD-comorbid group had a combination of avoidant, narcissistic, antisocial, aggressive-sadistic, negativistic, and self-defeating personality features. Implications for treatment are discussed.

Adult↗

Short-interval test-retest interrater reliability of the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) in outpatients.

The short-interval test-retest interrater reliability of the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) was studied in a psychotherapy outpatient group whose main complaint was mostly an Axis I anxiety disorder. Using a test-retest approach to assess interrater reliability, three sources of variance were taken into account (rater variance in the elicitation and interpretation of information and patient variance across interviews). Base rate requirements were established before calculating reliability coefficients. On the whole, interrater agreement on the SCID-II was found to be satisfactory, except for the histrionic personality traits. This is the first study that has estimated short-interval test-retest interrater reliability of the SCID-II in outpatients, and also the first that has studied single SCID-II traits and dimensional diagnoses. The results found support the use of the SCID-II as a diagnostic instrument for clinical and research purposes.

Adult↗

Multiple personality: an issue for forensic psychiatry.

The formulation of Multiple Personality (MP) as a distinctive entity by DSM-III while helpful clinically requires, at best, very rigid evaluatory criteria based on independent verification when used as a defense in a Court of Law. The use of the set of eight criteria developed by specialists are helpful guidelines. A case of MP disorder discovered under hypnosis by a psychiatrist and later on vehemently denied by the patient became the object of legal action as part of a malpractice suit. While some well-known experts consulted during treatment believed that she was a MP, the expert witnesses at the trial felt that the patient was not. As a mixed (borderline-histrionic) personality, the patient possibly might have dissociated under stressful life circumstances. The case raises serious issues about the role of auto-suggestion in mimicking MP. It questions the validity of the use of the diagnosis in Court. Legally only carefully evaluated independent data about incongruent past patterns of behavior suggesting alternate personality, can be considered reliable reference for the diagnosis.

Adult↗

MCMI-III Scores on Substance Abusers With and Without Histories of Suicide Attempts.

Sixty-eight patients with a history of suicide attempt were compared to 340 patients without a history of suicide attempt using the MCMI-III, a frequently used test for measuring personality disorders. Patients with a suicide attempt history scored higher on Schizoid, Avoidant, Depression, Dependent, Passive-Aggressive (Negativistic), Self-Defeating, and Paranoid and significantly lower on Histrionic and Compulsive and scored higher on all clinical syndrome scales except for Drug Dependence and Delusional Disorder. Logistic regression correctly predicted the no-suicide-history group with 97% accuracy, but only accurately predicted 16% of the patients with a suicide attempt history. A discriminant function analysis correctly predicted 90% of the patients with a suicidal attempt history and 63% of the patients with no history of suicide attempt. Results suggest that MCMI-III scores may be able to detect patients with a history of suicide attempt, using multivariate statistics.

Journal Article↗

Comorbidity of obsessive-compulsive disorder and personality disorders. A Brazilian controlled study.

The aim of this study was to evaluate the presence of personality disorders (PDs) in 40 patients with obsessive-compulsive disorder (DSM-III-R criteria) from the Medical School of Botucatu (UNESP), São Paulo, Brazil. It is a case-control study. Patients were 24 women and 16 men, 16-68 years old, referred to our outpatient psychiatric service for treatment. Controls were 40 nonpsychiatric outpatients matched to the cases by sex, age and marital status. The instrument used was the Portuguese version of the Structured Interview for DSM-III-R Personality Disorders (SIDP-R). All interviews (n = 80) were made simultaneously by 2 raters, with independent scoring, so that the interrater reliability of the instrument could also be assessed (kappa statistics). The consensual axis II diagnoses in the OCD group were: avoidant (52.5%, kappa = 0.80), dependent (40%, kappa = 0.84), histrionic (20%, kappa = 0.83), paranoid (20%, kappa = 0.74), obsessive-compulsive (17.5%, kappa = 0.86), narcissistic (7.5%, kappa = 1.00), schizotypal (5%, kappa = 0.65), passive-aggressive (5%, kappa = 0.79) and self-defeating (5%, kappa = 0.55). At least one PD diagnosis was made in 70% of the patients, while only 6 controls had a PD diagnosis (p < 0.01). A great deal of diagnostic overlap was found in the OCD group (57.5% had two or more PDs), especially between avoidant and dependent PDs. The features of these two PDs may be secondary to the OCD. The study also suggests that there is not a close relationship between OCD and obsessive-compulsive personality disorder (OCPD). Patients with OCPD or even 3 or 4 O-C traits had significantly less insight into their obsessions and compulsions (p < 0.01).

Adolescent↗

Disorder concept scales and personality dimensions in a young adult sample.

Previous research has shown correlations between normal personality variables of the Sixteen Personality Factor Questionnaire (16PF) and Axis II personality disorder scales using the Morey, Waugh, and Blashfield Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory. This study (N = 37) compared variables from the adolescent version of the 16PF, the High School Personality Questionnaire, Revised, including the new Clinical Supplement and the MMPI scales of Morey, et al. and yielded results similar to those from earlier studies with other inventories. Extraversion scores correlated positively with those on Narcissistic and Histrionic scales, negatively with scores on Schizoid, Avoidant, and Schizotypal scales; scores on Independence had a similar pattern.

Adolescent↗

Comorbid psychiatric disorders in late life depression.

In late life depression, common comorbid psychiatric disorders are alcohol use, anxiety, and personality disorders. Elderly depressed patients are three to four times more likely to have an alcohol use disorder compared with nondepressed elderly subjects, with a prevalence of 15%-30% in patients with late life major depression. While the presence of a comorbid alcohol use disorder may worsen the prognosis for geriatric depression, limited data suggest that successful treatment of depression combined with reducing alcohol use leads to the best possible outcomes. Most studies show that the overall prevalence of anxiety disorders, particularly panic disorder and obsessive-compulsive disorder, is low in geriatric depression, but generalized anxiety disorder may not be uncommon. It remains unclear if the presence of a comorbid anxiety disorder impacts on the treatment and prognosis of late life major depression. Personality disorders occur in 10%-30% of patients with late life major depression or dysthymic disorder, particularly in patients with early onset depressive illness. Cluster C disorders, including the avoidant, dependent, and obsessive-compulsive subtypes predominate, while Cluster B diagnoses, including borderline, narcissistic, histrionic and antisocial, are rare. Overall, the research database on comorbid psychiatric disorders in major and nonmajor late life depression is relatively sparse. Since comorbid psychiatric disorders affect clinical course and prognosis, and may worsen long-term disability in late life depression, considerably more research in this field is needed.

Aged↗

Patterns of personality disorders in women with chronic eating disorders.

The aim of this study was to describe patterns of personality disorders (PDs) in women with chronic eating disorders (EDs). An index group of nineteen women who have had EDs for an average of 8.5 years was compared with a control group of same-aged women from the general population. At the time of the study the index group received treatment at a tertiary treatment center in Stockholm. The PDs were assessed using the DSM-IV part of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). In the index group, eighteen of nineteen fulfilled the criteria for one or more PD. The number of PD diagnoses for each women ranged from zero (n = 1) to eight (n = 2) with a median of three. Among the controls, only one woman fulfilled the criteria for one or more PD. The most prevalent disorders in the index group were Borderline, Avoidant, and Obsessive-Compulsive. The index group had significantly higher DIP-Q dimensional scores than the controls in the Paranoid, Schizoid, Schizotypal, Borderline, Histrionic, Avoidant, and Dependent scales. Although the assessment of PD symptoms was limited to self-reports, the high prevalence of PD diagnoses and PD symptoms most probably reflects the severe psychiatric impairments in patients suffering from chronic ED.

Adult↗

[Mental disorders after amputation of the extremities].

Analysis of the dynamics of the disorders has shown that in the acute period following trauma, the patients' status was "abnormal personality in nature, being determined by affective and shock reaction in the hyperkinetic and hypokinetic forms. The subacute period was characterized by the predominance of posttraumatic stress disorders (PTSD), whereas the long-term posttraumatic period by personality disorders pertaining to the asthenic (type I) and asthenic (type II) sphere. The clinical characteristics of type I patients was determined by a range of asthenic, psychasthenic, autistic, sensitive, subdepressive, and hystero-conversion disorders, whereas from the clinicopsychological standpoint, by a high level of somatization, anxiety, depressive disorders, with the aggressiveness level corresponding with normal. It has been established that social rehabilitation of such patients requires measures aimed at an increase of the activity and improvement of communicative functions. Hypoparanoic, excitable and ++hystero-histrionic disorders were common to type II cases. Clinical and psychological examinations have revealed a high level of aggressiveness and anxiety, depressive disorders; somatization was found to be within normal. Social rehabilitation of such patients is to be reduced to a great measure to the correction of deformed personality lines.

Amputation, Surgical↗

Relationships between Tridimensional Personality Questionnaire Dimensions and DSM-III-R personality traits in Italian adolescents.

The predictions of Cloninger's neurobiologic learning model on the relationships between novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (P) and the traditional DSM-III-R personality disorders (PDs) were tested on a sample of 2,889 (1,475 males and 1,414 females) Italian high school students aged 16 to 18 years, using the Structured Clinical Interview for DSM-III-R Personality Disorders-self-report (SCID-II) and the Tridimensional Personality Questionnaire (TPQ). All relationships were in the predicted direction for antisocial, narcissistic, avoidant, and obsessive-compulsive PD alone, and at least two were in the predicted direction for schizoid, histrionic, borderline-explosive, dependent, and passive-aggressive PD. Eight of nine relationships were in the predicted direction for NS, but only seven of nine for HA and RD. This study provides substantial support for Cloninger's neurobiologic learning model as a useful tool to describe and classify personality variants and, because of the supposed neurochemical implications, to link personality traits to the underlying neurochemical and neuroanatomic substrate.

Adolescent↗

The prevalence of personality disorders in a community sample.

BACKGROUND: To our knowledge, no previous studies of personality disorders (PDs) in a large representative sample of the common population have been conducted. METHODS: A representative sample of 2053 individuals between the ages of 18 and 65 years in Oslo, the capital of Norway, was studied from 1994 to 1997. Information about PDs was obtained by means of the Structured Interview for DSM-III-R Personality Disorders, in conjunction with an interview recording demographic data. The subjects were interviewed primarily at home, but in some instances, also at the clinic. RESULTS: The prevalence of PDs was 13.4% (SE, 0.7). The prevalence rates (SEs) for specific PDs, irrespective of whether a person had 1 or more PD, were: paranoid, 2.4% (0.3); schizoid, 1.7% (1.6); schizotypal, 0.6% (0.2); antisocial, 0.7% (0.2); sadistic, 0.2% (0.1); borderline, 0.7% (0.2); histrionic, 2.0% (0.3); narcissistic, 0.8; (0.2); avoidant, 5.0% (0.5); dependent, 1.5% (0.3); obsessive-compulsive: 2.0% (0.3); passive-aggressive, 1.7% (0.3); self-defeating, 0.8%, (0.2). The prevalence of PDs was highest among subjects with only a high school education or less, and living without a partner in the center of the city. CONCLUSIONS: Personality disorders were found to be prevalent, with avoidant, schizoid, and paranoid PDs more common, and borderline PD less common than what is usually reported. Personality disorders tend to be more frequent among single individuals from the lower socioeconomic classes in the center of the city. It is impossible to determine what is cause and what is consequence from a cross-sectional study.

Adolescent↗

Comparison of schizotypal relatives of schizophrenic versus affective probands.

In order to investigate possible heterogeneity in schizotypal personality disorder (SPD), two groups of schizotypals, one related to schizophrenic probands (FSPD) (n = 34) and one related to affective disorder probands (NFSPD) (n = 14), ascertained in the same family study, were compared. The FSPD group had more inadequate rapport; the groups did not differ in the frequency of any other symptoms of SPD. NFSPDs had higher rates of comorbid histrionic PD and a trend for higher rates of impulsive/dramatic cluster PDs. FSPDs had a trend for higher rates of anxiety disorders. There was a higher risk of bipolar disorder in the relatives of NFSPDs and higher risk for anxiety disorders in the relatives of FSPDs. The relatives of NFSPDs had higher rates for histrionic, narcissistic, and atypical PDs and for having at least one PD.

Adult↗

Rates of personality disorders in substance abusers: a comparison between DSM-III-R and DSM-IV.

The publication of the DSM-IV represents the first revision in 7 years to the DSM-III-R diagnostic criteria. The purpose of the current study is to evaluate the impact of changes to the Axis II criteria on diagnostic rates in a substance abusing population. We interviewed 370 patients entering treatment using a modified version of the SCID-II, which allowed for the diagnosis of both DSM-III-R and DSM-IV Axis II diagnoses. Prevalence rates for each Axis II disorder are given, as well as kappa statistics showing diagnostic agreement between the two systems. The results of this study indicate good rates of diagnostic agreement between the two systems with a few notable exceptions. Poor rates of diagnostic agreement were obtained for the histrionic and dependent diagnostic categories. No single diagnostic change appears to be responsible for the prevalence rate differences between the two systems.

Adult↗

Alexithymia: relationship to personality disorders.

Previous studies suggested an association of alexithymia with other personality models, as well as with various psychiatric syndromes. However, with regard to current diagnostic systems, the clinical validity of alexithymia remains to be established. In a sample of 182 psychiatric outpatients, the lifetime prevalence of DSM-III-R axis I disorders was determined by Structured Clinical Interview for DSM-III-R (SCID) interviews. In addition, DSM-III-R personality disorders were assessed using the Personality Diagnostic Questionnaire-Revised (PDQ-R). On the Toronto Alexithymia Scale (TAS), 17% of the sample scored in the alexithymic range. A series of stepwise multiple regression analyses were performed, exhibiting no relationship between alexithymia and any of the DSM-III-R axis I lifetime diagnoses. In contrast, schizotypal, dependent, and avoidant personality dimensions, as well as a lack of histrionic features, emerged as significant predictors of alexithymia, which further supports the conceptualization of alexithymia as a personality dimension.

Adult↗

Alcohol and drug abusers subtyped by antisocial personality and primary or secondary depressive disorder.

Our data show that when substance abusers are subtyped simultaneously by antisocial personality disorder and the onset of depression relative to alcohol or drug abuse, groups of people with unique personality and affective profiles are identified. The profiles are represented by measures of affect-related personality variables such as trait anxiety, trait depression, histrionic traits, sensation seeking, and novelty seeking. These measures were chosen in an attempt to show that a "low arousal" personality type may be associated with antisocial personality and may thus indirectly be linked to a certain type (i.e., ASP/nondepressed) of substance abuser. By using a multi-symptomatic typological schema (i.e., a constellation of diagnostic categories rather than just one), we can show that different personality or affective profiles are indeed associated with certain subtypes of substance abusers and that depressed people who use drugs or alcohol are different affectively from antisocial types. We also show that the relationship between "low" and "high" arousal personality profile and subtypes based on co-morbid psychopathology is highlighted even more when we take into account the onset of dysthymia or depression that is primary versus secondary to substance abuse. Our findings are in accord with others' descriptions of the "affective arousal" dimensions of personality and are the first to link these dimensions with subtypes based on ASP and depression.

Adult↗

Change in personality status in neurotic disorders.

Personality disorders are generally thought not to change by much over time. We assessed the personality status of 202 patients who had a defined diagnostic and statistical manual (DSM)-III neurotic disorder, dysthymia, panic disorder, or generalised anxiety. All patients had had drug and psychological treatment in a randomised controlled trial. 12 years after entry to the study, we reassessed the personality status of 178 (88%) of these patients using the same test (personality assessment schedule). The personality traits of patients in the cluster B flamboyant group (antisocial, histrionic) became significantly less pronounced over 12 years, but those in the cluster A odd, eccentric group (schizoid, schizotypal, paranoid), and the cluster C anxious, fearful group (obsessional, avoidant) became more pronounced. The measure of agreement between baseline and 12-year personality clusters was poor or slight (kappa=0.14, 95% CI 0.04-0.23). Our results suggest that the assumption that personality characteristics do not change with time is incorrect.

Adult↗

Personality traits, brief recurrent depression and attempted suicide.

This study investigated the relationship between attempted suicide, personality factors and brief recurrent depression. Over a period of 1 year, the demographic and psychiatric factors of 307 patients who had attempted suicide and subsequently been hospitalised at H. F. Verwoerd Hospital and referred to its Department of Psychiatry were recorded. Their personality traits were evaluated clinically. After 5 years, 205 respondents were traced to complete a follow-up questionnaire and, where possible, a personality assessment was completed on clinical grounds. They were also evaluated for brief recurrent depression. Among the men, antisocial, dependent and histrionic personality traits, in that order, were most commonly noted and among the women, histrionic, dependent and antisocial traits. A clear relationship between suicidal behaviour and the syndrome of brief recurrent depression was established. The latter was also found to be related to histrionic personality traits in women. This underscores the relationship between suicide attempts and histrionic personality traits.

Depression↗