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PubMed1997

Clinical characteristics and biological parameters in temperamental clusters of suicide attempters.

A sample of 215 suicide attempters was categorized in a cluster analysis into four groups according to temperamental trails. Monoamine metabolites in the cerebrospinal fluid were analysed (n = 106). Dexamethasone suppression tests (DST) were performed (n = 154) and the activity of the enzyme monoamine oxidase in platelets (pl-MAO) was assessed (n = 103). Patients belonging to the two clusters with the most deviant temperament profiles (nos 2 and 3) were young and scored high on the Beck Hopelessness Scale and the Suicide Assessment Scale. "Cluster 3" ("neurotic, impulsive, aggressive") patients often had dysthymia and axis II, cluster B diagnoses (e.g. borderline or histrionic personality). "Cluster 2" ("neurotic and introverted") patients often had major depression. The "Cluster 1", with on the whole a normal temperament profile, had significantly higher levels of post-DST cortisol than the other clusters. The "Cluster 4" had a normal temperament profile. Adjustment disorders were most common in "Cluster 1" and "Cluster 4". The monoamine metabolite levels did not differ between the clusters, and the differences in pl-MAO activity disappeared after adjusting for age and gender. The results suggest that temperament profiles in suicide attempters are related to psychiatric diagnoses, suicidality, hopelessness, and post-DST cortisol, but are not predictive of completed suicide.

Adolescent↗
PubMed1992

Panic disorder and hypochondriacal fears and beliefs.

The purpose of this study was to examine correlates of hypochondriacal fears and beliefs in patients with panic disorder (PD) (n = 54). They were evaluated using the structured diagnostic interviews for axis I and axis II disorders (SCID-UP-R and SCID-II). They were administered the Illness Attitudes Scales (IAS) as a measure of hypochondriacal fears and beliefs, the Hopkins Symptom Checklist 90 (HSCL), and the Fear Questionnaire (FQ). One half of the patients rated themselves as having substantial hypochondriacal fears and beliefs. The sample was divided into groups of patients seeking predominantly treatment or relief from symptoms (treatment-oriented), and those who were searching for a cause of their illness (explanation-seeking): the latter had significantly more hypochondriacal concerns. Avoidant, histrionic, and borderline personalities were more common in the hypochondriacal group. The results of several analyses suggest that patients with PD who are also agoraphobic, fear physical disease more and have more false beliefs of having a disease than PD patients without agoraphobia.

Adolescent↗
PubMed1975

The doctor's wife: mental illness and marital pattern.

It is a clinical impression that physicians' wives present in disproportionately large numbers as psychiatric patients; that in the vast majority severe marital problems are present; and that the marital relationships show a similar pattern. The purpose of this paper is to ascertain whether the latter two impressions have any basis in fact. Accordingly, a random sample of twenty physicians' wives who had been in-patients in the University of British Columbia Health Sciences Centre Hospital during the period March 1, 1969 to May 31, 1973, and whose husbands had been interviewed, was selected. The records were reviewed to obtain personal data, pertinent psychiatric history, diagnosis, the personality of husband and wife and information on the marital relationship. These conclusions emerged: 1. Ninety per cent of the patients had a primary diagnosis of depressive neurosis. 2. Ninety-five per cent of the patients had a secondary diagnosis of personality disorder, hysterical personality and passive-aggressive personality in order of frequency. 3. In 90 per cent of the patients there was a history of suicidal preoccupation or attempt. 4. In 55 per cent of the patients there was a history of significant drug and/or alcohol abuse. 5. The patients were more frequently ward management problems. 6. A common marital pattern was noted: a dependent, histrionic wife and an emotionally detached husband. 7. The cases were characterized by their complexity, severity, long duration and difficulties involving the patient and spouse in an appropriate treatment plan. The authors discuss the implications of this study, particularly its significance in provoking examination of what measures might be utilized for early detection and intervention with those physicians and physician-marriages at risk.

Adult↗
PubMed1995

Sex and gender bias in self-report personality disorder inventories: item analysis of the MCMI-II, MMPI, and PDQ-R.

There has been considerable controversy and research regarding sex bias in the diagnosis of personality disorders, but little has involved self-report inventories. Thus this study investigated items from the Millon Clinical Multiaxial Inventory-II (Millon, 1987), the Minnesota Multiphasic Personality Inventory (Morey, Waugh, & Blashfield, 1985), and the Personality Diagnostic Questionnaire-Revised (Hyler & Rieder, 1987). Subjects (N = 189) completed the Histrionic, Dependent, Antisocial, and Narcissistic scales from these inventories, along with the Bem Sex Role Inventory (Bem, 1974) and the Symptom Checklist-90-Revised (Derogatis, 1977). Items were considered to evidence sex or gender bias if they (a) failed to correlate with dysfunction and (b) exhibited sex or gender role differences. At least 13 items evidenced sex bias (76 items using a more liberal threshold). The majority were from Narcissistic scales; few Histrionic items evidenced sex or gender bias. Implications with respect to sex-bias assessment and item construction are discussed.

Journal Article↗
PubMedDate not supplied

DSM-III-R narcissistic personality disorder evaluated by patients' and informants' self-report questionnaires: relationships with other personality disorders and a sense of entitlement as an indicator of narcissism.

Modified versions of the revised Personality Diagnostic Questionnaire (PDQ-R) for DSM-III-R personality disorders (PDs) were completed by 60 patients and their informants. Patients' ratings gave a mean number of 4.5 PDs per subject and narcissistic (NAR) PD in 42%. Informants' ratings gave NAR PD in 38%. For patients and informants, NAR PD scores (i.e., the number of positive NAR PD criteria for each subject) were significantly correlated with histrionic (HIS) and borderline (BOR) PD scores and with scores of some PDs outside DSM-III-R's "cluster B." Also, there were significant correlations between patients' and informants' NAR PD scores and between NAR PD scores and total number of positive criteria (i.e., for all 13 PDs) for patients and informants. For patients' ratings, there were significant associations between NAR PD and HIS, BOR, and passive-aggressive (PAG) PDs and, for informants' ratings, between NAR and HIS PDs. There was no significant association between patients' and informants' diagnoses of NAR PD. Grandiosity, the most characteristic feature of narcissism, is related to NAR PD criteria 3 through 6. The patients' evaluation of criterion 6 (i.e., "Has a sense of entitlement ...") shows satisfactory item-total correlation and endorsement frequency, together with "fair to good" reliability when patients' and informants' ratings are compared (kappa = 0.62). The identification of a sense of entitlement by the patient may be a relatively reliable and valid indicator of narcissism.

Adult↗
PubMed1990

The Copenhagen High-Risk Study. Premorbid and clinical dimensions of maternal schizophrenia.

In a sample of 129 female schizophrenic patients followed for a period of 22 years, an analysis of intercorrelations between background, premorbid, and clinical variables was performed. Poor outcome, as measured by amount of hospitalization, was associated with premorbid psychopathic traits, defective premorbid social adjustment, early onset, and nonparanoid subtype of schizophrenia. Formal thought disorder, positive symptoms, and negative symptoms were positively intercorrelated. Schneiderian first-rank symptoms were predictors of better outcome and they were preceded by premorbid obsessive traits and lack of premorbid psychopathic and histrionic traits. These latter traits were predictive of early onset, nonparanoid schizophrenia. It is postulated that personality dimensions can exert a pathoplastic influence through their capacity to promote adaptive mechanisms. Negative symptoms seem to represent a conglomerate of various phenomena, some of which were preceded by premorbid schizoid traits.

Denmark↗
PubMed1999

Agreement between self- and clinician-rated suicidal symptoms in a clinical sample of young adults: explaining discrepancies.

This study compared self- versus clinician-rated suicide assessment among participants referred for suicidal ideation or behavior, with emphasis on understanding self- versus clinician-rated discrepancies. A total of 328 participants in a suicide-treatment project completed baseline measures of symptoms and personality (including self-report and clinician-rated indexes of suicidal tendency), and portions of the sample completed follow-up assessments at 6, 12, and 18 months. A high rate of discrepancy between self- and clinician ratings of suicidal tendency was noted: the nature of this discrepancy was such that clinicians were likely to see patients as high in suicidal tendency, whereas patients were less likely to see themselves as such. Data on future symptoms indicated that patients' self-ratings contained considerable predictive value. Variables such as history of previous attempts and histrionic personality style may help explain self-versus clinician-rated discrepancies.

Adult↗
PubMedDate not supplied

A twin study of personality disorders.

No twin study has previously investigated the whole range of personality disorders (PDs) recorded by interviews. Based on twin and patient registries, 92 monozygotic (MZ) and 129 dizygotic (DZ) twin pairs were interviewed with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Observed prevalence rates from a normal population study of more than 2,000 individuals were used in combination with data from the present study to generate statistics assumed to be valid for a normal twin population, and these statistics were used for structural equation modeling. The best-fitting models had a heritability of .60 for PDs generally, .37 for the eccentric (A) cluster, .60 for the emotional (B) cluster, and .62 for the fearful (C) cluster. Among the specific PDs, the heritability appeared to be .79 for narcissistic, .78 for obsessive-compulsive, .69 for borderline, .67 for histrionic, .61 for schizotypal, .57 for dependent, .54 for self-defeating, .29 for schizoid, .28 for paranoid, and .28 for avoidant PDs. The best-fitting models never included shared-in-families environmental effects. However, a model with only shared familial and unique environmental effects could not be ruled out for dependent PD. Shared familial environmental effects may also influence the development of any PD and borderline PD. Passive-aggressive PD did not seem to be affected by genes or family environment at all. The low occurrence of antisocial PD in the twin sample precluded any model for this disorder. PDs seem to be more strongly influenced by genetic effects than almost any axis I disorder, and more than most broad personality dimensions. However, we observed a large variation in heritability among the different PDs, probably partly because of a moderate sample size and low prevalence of the specific disorders.

Adult↗
PubMed2002

Cross-system concordance of personality disorder diagnoses of DSM-IV and diagnostic criteria for research of ICD-10.

The aim in this study was to examine the cross-system concordance between the personality disorders (PDs) of DSM-IV and Diagnostic Criteria for Research of ICD-10 Classification of Mental and Behavioral Disorders, 10th rev. (ICD-10) PD diagnoses were made by a structured interview in a clinical psychiatric sample of 138 individuals. Both categorical and dimensional scores for each PD were established. The frequency of patients with a PD diagnosis on either classification who were also positive on the other varied from 26% for the schizoid PDs to 88% for the histrionic PDs. The chance-corrected agreement (Cohen's kappa) ranged from .37 to .94. The dimensional correlation (Pearson's r) between pairs of PD criteria sets was in the range of .79 to .98. In conclusion, when analyzed categorically, some of the PDs of DSM-IV and ICD-10-DCR were only moderately concordant. The reasons appear to be different criteria formulations and arbitrary thresholds for diagnoses. In contrast to categorical diagnoses, dimensional agreement was high, implicating similar trait-concept definitions. The least concordant pair of PD was antisocial (DSM-IV)-dissocial (ICD-10).

Adolescent↗
PubMed2005

Substance use disorders and Cluster B personality disorders: physiological, cognitive, and environmental correlates in a college sample.

Substance use disorders (SUDs) and Cluster B personality disorders (PDs) are both marked by impulsivity and poor behavioral control and may result in part from shared neurobiological or executive cognitive functioning deficits. To examine the potential utility of such models in explaining variance in SUDs and PDs at the lower end of symptom expression and impairment, 123 (73 female) volunteer college students were administered 2 measures of executive cognitive functioning; a task assessing autonomic reactivity to aversive noise blasts; a life events and a peer substance use measure; and structured clinical interviews to assess symptoms of substance abuse/dependence and antisocial, borderline, histrionic, and narcissistic PDs. As expected, symptoms of SUDs and PDs were significantly positively correlated. Antisocial PD, alcohol and cannabis use disorder symptoms were significantly positively related to proportion of friends who use alcohol and drugs regularly and drug use among romantic partners. Number of negative life events was positively related to PD symptoms and to alcohol use disorder symptoms. Executive cognitive functioning was not related to SUD and PD symptoms in the expected direction. Findings suggest that, among higher functioning young adults, environmental factors may be particularly relevant to our understanding of SUDs and certain PDs.

Adult↗
PubMed2004

Assessment and management of personality disorders.

Patients with personality disorders are common in primary care settings; caring for them can be difficult and frustrating. The characteristics of these patients' personalities tend to elicit strong feelings in physicians, lead to the development of problematic physician-patient relationships, and complicate the task of diagnosing and managing medical and psychiatric disorders. These chronic, inflexible styles of perceiving oneself and interacting with others vary widely in presentation. In the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., these styles are categorized into three clusters based on their prominent characteristics: cluster A, the odd or eccentric (e.g., paranoid, schizoid, schizotypal); cluster B, the dramatic, emotional, or erratic (e.g., antisocial, borderline, histrionic, narcissistic); and cluster C, the anxious or fearful (e.g., avoidant, dependent, obsessive-compulsive). Knowledge of the core characteristics of these disorders allows physicians to recognize, diagnose, and treat affected patients. The goal of management is to develop a working relationship with patients to help them receive the best possible care despite their chronic difficulties in interacting with physicians and the health care system. Effective interpersonal management strategies exist for these patients. These strategies vary depending on the specific diagnosis, and include interventions such as the use of specific communication styles, the establishment of clear boundaries, limit setting on the patients' behavior and use of medical resources, and provision of reassurance when appropriate. Additionally, medications may be useful in treating specific symptoms in some patients.

Adaptation, Psychological↗
PubMedDate not supplied

The effects of changing axis II diagnostic criteria.

This study examined whether changes in diagnostic criteria from the DSM-III to the DSM-III for personality disorders (PDs) had the intended effects. Seventy-two subjects at the University of Iowa from three research studies and one clinical sample were administered two structured interviews (the Structured Interview for DSM-III Personality [SIDP] and the revised SIDP [SIDP-R]) to assess DSM-III and DSM-III-R criteria. Major changes in rates of diagnoses were observed between the DSM-III and DSM-III-R criteria with kappas for agreement ranging between -.025 and .571. As expected, the switch from monothetic to polythetic definitions had an effect on which patients were assigned a given diagnosis. However, not all of the other revisions associated with the DSM-III-R had the intended effects. For instance, the frequency of the diagnosis of schizoid PD did not increase, nor did the overlap between borderline and histrionic PDs decrease. In addition, there was an unintended increase in the rate of paranoid PD. An analysis of individual criteria showed how small, apparently minor changes in the wording of criteria can sometimes have major effects on which patients received a diagnosis of PD.

Adult↗
PubMed2003

Classification of frequency distributions of diagnostic criteria scores in twelve personality disorders by the curve fitting method.

The purpose of the present study was to investigate whether each personality disorder (PD) has a different frequency distribution of diagnostic criteria, and to classify the distribution of each PD on the basis of shape by the curve fitting method. A total of 4740 male subjects in early adulthood completed the Korean version of the Personality Diagnostic Questionnaire (4th revision; PDQ-4+). The frequency distribution of scores in each PD was specified to the best fitted model by the curve estimation procedure. Twelve distributions of PD criteria were fitted to three types of curve models (quadratic, cubic, and logistic). The quadratic model included obsessive-compulsive and histrionic PD. The cubic model included borderline, narcissistic, avoidant, passive-aggressive, paranoid, and schizotypal PD. The logistic model contained dependent, depressive, schizoid, and antisocial PD. The results suggest that each PD has a different type of distribution and each distribution of PD might be classified to a specific curve model. Also, the results suggest that the issue of continuities between PD and the normal group could not be generalized to all PD, but should be considered individually for each PD.

Adult↗
PubMedDate not supplied

[Clinical diagnosis and standardized evaluation of borderline personality: preliminary report].

A sample of 36 patients considered by French clinicians as suffering from a borderline personality disorder was evaluated using the International Personality Disorder Examination, the Diagnostic Interview for Borderline-Revised, and the Minnesota Multiphasic Personality Inventory. First, global descriptive analysis of the sample elicited the socio-demographic and standard clinical characteristics of the borderline individuals. After diagnostic evaluation, the sample appeared to be quite homogeneous with 25 of the 36 patients evaluated (69.5%) being defined as borderline by two of the three diagnostic systems: ICD 10, DSM III-R and Gunderson (15/36 = 41.5% of patients were defined as borderline by all three systems). It is the types of BL personality co-diagnoses which differentiated the BL subjects in the sample from those classically described in the international literature, since the most frequent personalities were the Dependent and Avoiding ones, not the Antisocial, Histrionic, Narcissistic or Schizotypic personalities of the DSM III-R. ICD 10 elicited the same significant prevalence of Anxious and Dependent personalities. Lastly, the patients diagnosed as borderline both by clinicians and by all diagnostic systems (forming the sample "core") were compared with the rest of the sample with regard to socio-demographic, clinical and diagnostic characteristics. A few hypotheses are proposed on the type of variables that may permit to discriminate between these two types of patients.

Adult↗
PubMed1999

Mexican-American male batterers on the MCMI-III.

This study examined personality characteristics of Mexican-American male batterers. 60 Mexican-American male batterers (M = 33.6 yr.) in the court system in South Texas took the MCMI-III and their MCMI-III scores were compared with the scores of a community sample of 45 Mexican-American individuals (M = 30.4 yr.). The batterers frequently scored higher than the nonbatterers on the Avoidant and Passive-Aggressive scales, while nonbatterers frequently scored higher on the Histrionic scale. The batterers scored significantly higher on 18 out of 24 MCMI-III scales, while nonbatterers scored significantly higher on two scales.

Adult↗
PubMed2006

Diagnosing bipolar disorder: how can we do it better?

Accurate diagnosis of bipolar disorder is essential for effective treatment. The diagnosis of bipolar disorder is particularly complex, resulting in lengthy delays between first presentation and initiation of appropriate therapy. Inappropriate therapy destabilises the course and outcome of the disease. Although the defining features of bipolar disorder are manic or hypomanic episodes, patients typically present for treatment of depression and commonly deny symptoms of mood elevation. A correct diagnosis can easily be masked by comorbidities, personality issues and complex phenomenology. A diagnosis of bipolar disorder can be assisted by: asking about symptoms of mania or hypomania in every patient presenting with symptoms of depression. recognising mixed states in which manic and depressive symptoms occur simultaneously. identifying the features of bipolar depression that distinguish it from unipolar depression. There is a risk of over-diagnosis of bipolar disorder among patients who are histrionic, show abnormal illness behaviour and/or have issues of secondary gain.

Age of Onset↗
PubMed2006

[A twin study of personality disorder heritability].

OBJECTIVE: To calculate heritabilities of personality disorders (PDs) in twin population. METHODS: Based on informed consent, we used Personality Diagnostic Questionnaire (fourth-version) as our screening tool to study the adult twins (aged 20 - 70 years) in Qingdao city. There were 324 twin pairs whose zygosity had been determined. Structural equation modeling was used to estimate the heritabilities by 242 same-sex twin pairs. RESULTS: The best-fitting models yielded a heritability of 68.26% (60.26 - 74.78) of overall PDs, 59.00% (49.22 - 67.17) of cluster A, 64.99% (56.24 - 72.16) of cluster B, and 63.66% (54.72 - 71.02) of cluster C. There were significant genetic effects for schizotypal, narcissistic and dependent, explaining 49.96% (37.94 - 60.14), 52.89% (41.85 - 62.24) and 68.87% (60.80 - 75.40) of the variance respectively. No genetic effects were found on Histrionic, but common environmental effect accounted for 54.08% (44.50 - 62.43) of the total variances. CONCLUSION: PD was mainly determined by genetic factor. These findings may provide evidence for future research on PD.

Adult↗
PubMed1990

Racial bias and the MCMI.

We studied the scores obtained on the Millon Clinical Multiaxial Inventory (MCMI) by Black and White male psychiatric inpatients to determine the presence or absence of racial bias. In predicting psychopathology for the two races, comparisons of MCMI performance indicated significant differences for all diagnoses except the personality disorders. The subjects were then matched into two groups of 209 patients each, according to DSM-III psychiatric diagnoses. The data were analyzed at the item, scale, and structural levels. At the item level, application of the Mantel-Haenszel Procedure revealed that 45 of the 175 items of the inventory were answered significantly different by the two racial groups. Because this number was higher than what could be expected by chance, the finding suggested possible deficiencies in terms of the culture-fairness of the items used in the test. At the scale level, an analysis of variance (ANOVA) demonstrated that the scores obtained by the Black and White groups were significantly different in 9 of the 20 scales (Histrionic, Narcissistic, Antisocial, Paraphrenia, Hypomania, Dysthymia, Alcohol Abuse, Drug Abuse, and Psychotic Delusion). With the exception of the Dysthymic scale, all of the differences were in the direction of the Blacks obtaining a higher score than the Whites. At the structural level, however, a principal components factor analysis performed on each group resulted in factor structures that looked identical.

Adult↗