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PubMed1988

Lies and liars: psychiatric aspects of prevarication.

The authors discuss the phenomenon of lying, a common psychic process that has received remarkably little scrutiny. The ubiquity of lying and others forms of deception suggests that they have "normal" aspects, but lying which is persistent or destructive to the quality of a person's life becomes pathological. Lying has many determinants, including developmental, biological, social, and psychodynamic. Antisocial, histrionic, narcissistic, borderline, and compulsive personalities have been associated with lying. The treatment of lying needs to be individualized according to the overall symptom complex in which it is embedded.

Adolescent↗
PubMed1985

An examination of the relationship between personality patterns and symptom/mood patterns.

Relationships between various personality styles measured by the basic and pathological personality scales of the Millon Clinical Multiaxial Inventory (MCMI) and mood or symptom states measured by the Profile of Mood State scales were examined. The MCMI personality scale-POMS symptom/mood scale relationships found in this study are compared with MCMI personality scale-MMPI and SCL-90 symptom/mood scale relationships reported in the MCMI manual. Consistent associations of moderate strength were found between: (a) the MCMI Compulsive-Conforming and Passive-Aggressive (Negativistic) scales (negative and positive associations, respectively) and various measures of depression, anxiety and hostility; (b) the MCMI Avoidant, Schizotypal and Borderline-Cycloid scales and various measures of depression and anxiety; (c) the MCMI Schizoid-Asocial scale and various measures of depression; and (d) the Histrionic-Gregarious scale and various measures of high energy-activity. These MCMI personality scale-symptom/mood scale relationships are generally consistent both with the underlying theory of personality and psychopathology upon which the MCMI is based and with the personality-symptom scale relationships found within the MCMI.

Alcoholism↗
PubMed2005

Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: results from the national epidemiologic survey on alcohol and related conditions.

The objective of this study was to determine the prevalence and co-occurrence of DSM-IV personality disorders (PDs) among individuals with current DSM-IV mood and anxiety disorders in the US population and among individuals who sought treatment for such mood or anxiety disorders. Face-to-face interviews were conducted with 43,093 individuals, 18 years and older, in the National Institute on alcohol abuse and alcoholism's 2001-2002 National epidemiologic survey on alcohol and related conditions (NESARC). Odds ratios (ORs) were calculated to determine the prevalence and associations between current DSM-IV axis I and axis II disorders. Associations between mood, anxiety and PDs were all positive and statistically significant. Avoidant and dependent PDs were more strongly related to mood and anxiety disorders than other PDs. Associations between obsessive-compulsive PD and mood and anxiety disorders were significant, but much weaker. Paranoid and schizoid PDs were most strongly related to dysthymia, mania, panic disorder with agoraphobia, social phobia and generalized anxiety disorder, while histrionic and antisocial PDs were most strongly related to mania and panic disorder with agoraphobia. Results of this study highlight the need for further research on overlapping symptomatology, factors giving rise to the associations and the treatment implications of these disorders when comorbid.

Adolescent↗
PubMed2004

Two-year stability of personality disorder in older adolescent outpatients.

The 2-year stability of categorical and dimensional personality disorder (PD) in an older adolescent psychiatric outpatient sample was examined. One hundred and one 15-18-year-old participants were assessed using the Structured Clinical Interview for DSM Axis II Disorders (SCID-II) at baseline and 97 were re-interviewed, face-to-face, at 2 years. Of those with a categorical PD diagnosis at baseline, 74% still met criteria for a PD at follow-up, with marked gender differences (83% of females and 56% of males). Kappa for specific PDs was low for all except antisocial. Rank order and mean level dimensional stability ranged from high (antisocial, schizoid) to moderate (borderline, histrionic, schizotypal) to low (other PDs), with no decline in PD scores over the 2 years. There was no substantial influence upon stability of dimensional PD from the presence of Axis I disorder at baseline or from outpatient or inpatient treatment. However, categorical PD endured in 100% of those receiving inpatient care. The study supports that, in late teenage outpatients, the 2-year stability of the global category of PD is high and the stability of dimensionally rated PD appears to be similar to that found in young adults in a variety of settings, especially for some cluster A and B PDs. Diagnosis and early intervention appears to be justified in this age group.

Adolescent↗
PubMed2005

The relationship between attachment styles and Cluster B personality disorders in prisoners and forensic inpatients.

The relationship between attachment styles and Cluster B personality disorders were examined among prisoners, forensic inpatients and controls from the general population. Forensic inpatients and prisoners reported significantly less frequently the secure attachment style (Relationship Questionnaire) and significantly more the fearful attachment style compared to the normal controls. Both forensic groups could not be distinguished from each other. Further, prisoners, forensic inpatients and controls could not be differentiated on the basis of the dismissing nor the preoccupied attachment style. With respect to personality pathology, almost all relationships between Cluster C pathology, on the one hand, and attachment styles, on the other, were significant. Cluster A pathology was clearly related to the secure and fearful attachment style. With respect to cluster B pathology, the results were more specific but also less clear. The results were strongly dependent on the way the personality pathology variables were treated, as either categorical or dimensional. None of the cluster B personality pathology variables were associated with the fearful attachment style and histrionic personality pathology was negatively associated with the dismissing attachment style. Antisocial personality features were associated with a dismissing attachment style. Borderline personality pathology, when treated as a categorical variable, was significantly related to the preoccupied attachment style. These results show that (1) cluster A and cluster C pathology are more strongly associated with attachment than cluster B, (2) treating personality data as either dimensional or categorical is of major importance to the conclusions that can be drawn, (3) it is important to control for the influence of co-morbid personality pathology when examining the relationship between (Cluster B) personality pathology and attachment.

Adult↗
PubMed2004

Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND: Very little information is available on the co-occurrence of different personality disorders (PDs) and alcohol and drug use disorders in the US population. OBJECTIVE: To present national data on sex differences in the co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol and drug use disorders and 7 of the 10 DSM-IV PDs. DESIGN: Face-to-face interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43 093). SETTING: The United States and the District of Columbia, including Alaska and Hawaii. PARTICIPANTS: Household and group-quarters residents, aged 18 years and older. RESULTS: Among individuals with a current alcohol use disorder, 28.6% (95% confidence interval [CI], 26.7-30.6) had at least 1 PD, whereas 47.7% (95% CI, 43.9-51.6) of those with a current drug use disorder had at least 1 PD. Further, 16.4% (95% CI, 15.1-17.6) of individuals with at least 1 PD had a current alcohol use disorder and 6.5% (95% CI, 5.7-7.3) had a current drug use disorder. Associations between PDs and alcohol and drug use disorders were overwhelmingly positive and significant (P <.05). Overall, alcohol use disorders were most strongly related to antisocial (odds ratio [OR], 4.8; 95% CI, 4.1-5.6), histrionic (OR, 4.7; 95% CI, 3.8-5.8), and dependent (OR, 3.0; 95% CI, 1.9-4.8) PDs. Drug use disorders also were more highly associated with antisocial (OR, 11.8; 95% CI, 9.7-14.3), histrionic (OR, 8.0; 95% CI, 6.0-10.7), and dependent (OR, 11.6; 95% CI, 7.1-19.1) PDs. Associations between obsessive-compulsive, histrionic, schizoid, and antisocial PDs and specific alcohol and drug use disorders were significantly stronger (P <.04) among women than men, whereas the association between dependent PD and drug dependence was significantly greater (P <.04) among men than women. CONCLUSIONS: The co-occurrence of PDs with alcohol and drug use disorders is pervasive in the US population. Results highlight the need for further research on the underlying structure of these disorders and the treatment implications of these disorders when comorbid.

Adolescent↗
PubMed1990

Personality status: changes through adolescence.

1. Forty-two percent of a nonclinical sample of urban 18 year olds displayed some degree of personality dysfunction. This rate of disturbance is similar to a previously reported rate for 13 year olds, but higher than the prevalence rate for 16 year olds. Thus, early and late adolescence seem to represent "at risk periods" for the genesis of character pathology. 2. In late adolescence, the form of this disturbance is as follows: 40% fall into a histrionic, borderline, narcissistic cluster, whereas nearly 30% demonstrate an atypical or mixed picture. This differs markedly from the distribution of dysfunction in earlier subphases. 3. Thirty-eight percent of the disturbed sample showed evidence of dysfunction at all three subphases (early, middle, and late), whereas 62% fluctuated in or out of disturbance at one subphase or another. 4. There was a notable lack of consistency with respect to type of personality dysfunction from both a group and individual perspective, except for paranoid, schizoid, and schizotypal disturbance. This particular cluster retained both group and individual stability from age 13 to 18. 5. Two trends were evident however: teenagers who initially presented as avoidant, dependent, compulsive, or passive-aggressive seemed to grow out of their dysfunction. By age 18, hardly any of the original subjects remained in this cluster, and most had become clear. Secondly, most of the adolescents identified as antisocial in early or middle adolescence migrated into the histrionic, narcissistic, borderline cluster in late adolescence. This latter group showed a steady increase throughout the time span studied, suggesting the importance of developmental factors.

Adolescent↗
PubMed1991

Psychopathology and substance abuse as predictors of program completion in a therapeutic community for drug abusers: a prospective study.

A total of 144 substance abusers entering consecutively a hierarchical therapeutic community, Phoenix House, Oslo, were followed prospectively 18 months through the entire program. Thirty percent completed the 1-year inpatient phase and 20% completed the total program. Using a structured interview and 3 self-report instruments, the Millon Clinical Multiaxial Inventory, Basic Character Inventory and Symptom Checklist-90, significant differences between dropouts and completers were found in 3 areas of pre-admission characteristics: gender, substance abuse and psychopathology. Completers were characterized by a greater percentage of females, a higher frequency of amphetamine use and a lower frequency of alcohol use and a higher frequency of histrionic and a lower frequency of schizotypal traits than dropouts. The study indicates the importance of paying closer attention to these factors during treatment.

Adult↗
PubMedDate not supplied

The Spanish-Language Version of the Diagnostic Interview for DSM-IV personality disorders: development and initial psychometric evaluation of diagnoses and criteria.

We describe the development of the Spanish-Language Version of the Diagnostic Interview for DSM-IV Personality Disorders (S-DIPD-IV). Initial descriptive (frequency and gender distribution of personality disorders [PDs]) and psychometric findings (inter-rater reliability of diagnoses, internal consistency, and criteria inter-relatedness) are reported based on administration of the S-DIPD-IV to 95 adult monolingual Hispanic patients. The S-DIPD-IV had adequate inter-rater reliability for most PD (mean kappa =.83). Except for the significantly greater proportion of males diagnosed with antisocial PD, no significant gender differences in the distribution of PD were observed. Within-category inter-relatedness of PD criteria was evaluated by coefficient alpha and mean intercriterion correlations (MIC). Between-category criteria overlap was evaluated by intercategory mean intercriterion correlations between all pairs of PD (ICMIC). For PD criteria, alpha ranged .36 to .99 (mean =.75, median =.81), MIC ranged .07 to .95 (mean = .36), and ICMIC ranged.09 to.45 (mean = .24). Six PD (borderline, antisocial, narcissistic, avoidant, obsessive-compulsive, and depressive) had no instances in which their criteria sets correlated higher with those of other PD than their own. Two PD (histrionic and dependent PD) had some instances of overlap, and four PD (paranoid, schizotypal, schizoid, and passive-aggressive) had pervasive overlap with other PD criteria sets. These findings suggest the utility of the S-DIPD-IV for assessing PD in Spanish-speaking Hispanic outpatients. Our initial findings for this patient group suggest that, except for antisocial PD in males, specific PD diagnoses are not differentially distributed by gender. Moreover, except for cluster A PD, the criteria for specific PD tend to be more highly correlated within than across PD. The S-DIPD-IV appears to have utility to facilitate PD research with Hispanic groups.

Adult↗
PubMedDate not supplied

Development of infants born to cocaine-abusing women: biologic/maternal influences.

This study investigated the influence of gestational age, birthweight, caregiving, and maternal personality characteristics on the development of 51 six-month-old infants born to and being reared by cocaine-abusing mothers. Two self-report measures were administered to the pregnant women at intake: the ASI (quantifying drug use) and the MCMI (describing DSM-III Axis II personality characteristics and Axis I clinical syndromes). Infants' biologic vulnerability was assessed by gestational age and birthweight. Caregiving was assessed 6 months later in the home, using the HOME Inventory and maternal caregiving behavior rating scales. Infant development was assessed in the laboratory at 6 months using the Bayley Scales of Infant Development. Higher Bayley scores were associated with heavier birthweight and increased maternal sensitivity. Furthermore, mothers of infants with shorter gestations were found to be more sensitive caregivers, whereas mothers who reported more histrionic-gregarious, narcissistic, borderline-cycloid, and/or paranoid personality characteristics during pregnancy were less sensitive caregivers. Surprisingly, mothers who reported more depressive symptoms during pregnancy provided more sensitive care.

Adult↗
PubMed1994

Psychopathology and anger in interpersonal violence offenders.

The current literature on psychopathology and anger suggests that both contribute to interpersonal violence. The present study examined psychopathology and anger expression with two objectives: to confirm previous distinctions of personality type among abusive individuals and to examine the relation between these types and anger. Cluster analysis was conducted with data gathered from 40 subjects. Results suggested confirmation of four clusters of interpersonal violence offenders. Furthermore, the most pathological cluster type reported the highest level of total anger experience, while the histrionic cluster type reported the lowest anger expression. These results provide tentative support for a positive relationship between psychopathology and anger, as well as for the distinction between overcontrolled and under-controlled anger as subtypes of interpersonal violence offenders.

Adolescent↗
PubMed2005

Assessing adolescent personality pathology.

BACKGROUND: Personality pathology constitutes a major form of psychopathology in adolescents. AIMS: To examine the reliability and validity of a Q-sort instrument for assessing adolescent personality pathology designed for clinically experienced informants. METHOD: A sample of 294 randomly selected psychiatrists and psychologists each provided data on a current patient, aged 14-18 years. Clinicians completed several measures, including the Shedler-Westen Assessment Procedure for Adolescents (SWAP-200-A). RESULTS: Factor analysis identified II dimensions of adolescent personality: psychopathology/malignant narcissism, dysphoria/inhibition, psychological health, histrionic sexualisation, schizotypy, sexual conflict, emotional dysregulation, anxious obsessionality, peer rejection, delinquent behaviour and attentional dysregulation. These correlated in predicted ways with a range of criterion variables, including measures of adaptive functioning, Axis II pathology, the Five Factor Model and the Child Behavior Checklist. CONCLUSIONS: The SWAP-200-A shows promise as an instrument for assessing personality pathology in adolescents. Trait dimensions such as delinquent behaviour and emotional dysregulation may prove useful additions to a classification of personality.

Adolescent↗
PubMed1995

Alpha-theta brainwave neurofeedback training: an effective treatment for male and female alcoholics with depressive symptoms.

This was an experimental study of 14 alcoholic outpatients using the Peniston and Kulkosky (1989, 1991) brainwave treatment protocol for alcohol abuse. After temperature biofeedback pretraining, experimental subjects completed 20 40-minute sessions of alpha-theta brainwave neurofeedback training (BWNT). Experimentally treated alcoholics with depressive syndrome showed sharp reductions in self-assessed depression (Beck's Depression Inventory). On the Millon Clinical Multiaxial Inventory-I, the experimental subjects showed significant decreases on the BR scores: schizoid, avoidant, dependent, histrionic, passive-aggression, schizotypal, borderline, anxiety, somatoform, hypomanic, dysthmic, alcohol abuse, drug abuse, psychotic thinking, and psychotic depression. Twenty-one-month follow-up data indicated sustained prevention of relapse in alcoholics who completed BWNT.

Adult↗
PubMed2001

Gender-related differences in the onset of panic disorder.

OBJECTIVE: To investigate gender-related differences in premorbid conditions and in the role of triggering events in the onset of panic disorder (PD). METHOD: One hundred and eighty-four out-patients with a principal diagnosis of PD (DSM-IV) were evaluated with a semi-structured interview to generate Axis I and Axis II diagnoses according to DSM-IV, to collect family history of psychiatric disorders and life events. The statistical analysis was performed comparing men and women. RESULTS: Men and women showed similar age at onset of PD. A family history of mood disorders characterized females. Men had higher rates of cyclothymia, body dysmorphic disorder and depersonalization disorder preceding PD, while women had higher rates of bulimia nervosa. Dependent and histrionic PDs were more common among women, while borderline and schizoid PDs were more common among men. Life events showed a significant role in precipitating PD onset in women. CONCLUSION: Premorbid clinical conditions of PD seem to differentiate between males and females in the role of precipitating events.

Adult↗
PubMed2002

The association between axis I and II psychiatric symptoms and high-risk sexual behavior during adolescence.

This study was conducted to investigate the association between psychiatric disorders and high-risk sexual behavior among adolescent primary care patients. Interviews assessing anxiety, conduct, depressive, eating, substance use, and personality disorders (PDs), as well as histories of sexual behavior were administered to 119 male and 284 female adolescent primary care patients. Results indicated that, after co-occurring psychiatric disorders were controlled statistically, adolescents with elevated PD symptom levels were more likely than adolescents without elevated PD symptom levels to report a high number of sexual partners during the past year and during their lifetime. Adolescents with a history of conduct disorder were more likely than adolescents without such a history to report a high number of lifetime unsafe sexual partners. Elevated antisocial, dependent, and paranoid PD symptom levels were associated with high-risk sexual behavior after co-occurring psychiatric disorders were controlled. Further, certain specific antisocial, borderline, dependent, histrionic, narcissistic, obsessive-compulsive, paranoid, and schizotypal PD symptoms were independently associated with high-risk sexual behavior after co-occurring psychiatric disorders and overall PD symptom levels were controlled. The association between overall PD symptom levels and the number of sexual partners was significantly stronger among the females than among the males in the sample. Increased recognition and treatment of PDs, coupled with increased recognition of high-risk sexual behavior may facilitate the prevention of sexually transmitted diseases and teenage pregnancy among adolescents.

Adolescent↗
PubMed1998

The MCMI-II and race.

In this study, we investigated MCMI-II profile differences in a sample of 65 Black and 164 White psychiatric inpatients. A multivariate analysis of variance (MANOVA) yielded a significant multivariate effect associated with race, with Black patients scoring significantly higher on the Histrionic, Narcissistic, Paranoid, Drug Dependent and Delusional Disorder scales. A second MANOVA was conducted on these 5 scales with a smaller sample of 46 Black and 46 White patients, who were matched for primary Axis I discharge diagnosis and matched for substance abuse comorbidity. This MANOVA did not yield a significant multivariate effect associated with race, and scale differences were attenuated.

Adult↗
PubMed1999

Maternal antenatal attachment style and potential fetal abuse.

OBJECTIVE: Maternal antenatal emotional attachment (MAEA) to the fetus has been proposed as an important factor for the emergence of harm to the unborn child. The present study investigated whether MAEA was associated with self-reported intent to harm the fetus. METHOD: Forty pregnant women, referred for psychological evaluation, completed a self-report measure of MAEA, the Millon Clinical Multiaxial Inventory-2 (MCMI-2) and confidential self-report questions on irritation with the fetus, urge to harm the fetus and predicted future loss of control with the child. Interview data was used to determine the mothers' adult attachment styles. RESULTS: (1) Negative preoccupied MAEA was associated with increased likelihood of reported irritation with the fetus, preoccupied adult attachment, borderline, histrionic, paranoid personality dimensions and symptoms of anxiety, mood disturbances and depression. (2) Negative disinterested MAEA was associated with a dismissing adult attachment, narcissistic, antisocial, aggressive-sadistic and passive-aggressive personality dimensions, alcohol dependence, but not self-report intention to harm the fetus. CONCLUSION: The findings are discussed in terms of their implications for understanding difficulties which may emerge in mother-fetus bonding and the identification of and interventions for mothers who report an intention to harm the fetus.

Adolescent↗
PubMed2005

Clinician reports of personality pathology of patients beginning and patients ending psychoanalysis.

OBJECTIVES: The purpose of this work was to use a clinician Q-sort procedure to describe the personality pathology and adaptive functioning of patients beginning and ending psychoanalysis. DESIGN: With a cross-sectional design, we compared a group of patients beginning and a group of patients ending psychoanalysis. METHODS: Twenty-six psychoanalysts described a patient beginning psychoanalysis and 26 described a patient ending psychoanalysis using the Shedler-Westen Assessment Procedure 200 (SWAP-200). Each clinician also completed questions about themselves, the patient, and the treatment. The most characteristic SWAP-200 items describing patients beginning and patients ending psychoanalysis provide a meaningful picture of the two groups. RESULTS: Among patients at the end of psychoanalysis, scores were significantly lower on the SWAP-200 Paranoid, Schizotypal, Borderline, Histrionic, and Dependent scales and scores were significantly higher on the SWAP-200 High functioning scale and the DSM-IV GAF scale. Common characteristics of patients beginning psychoanalysis were anxiety, guilt, and shame. Common characteristics of patients ending psychoanalysis were conscientiousness and responsibility, striving to live up to moral and ethical standards, and enjoyment of challenges. CONCLUSIONS: The findings demonstrate the usefulness of a clinician report measure for the study of psychoanalytic psychotherapy and psychoanalysis.

Adult↗