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PubMed1999

Concurrent and predictive validity of the personality disorder diagnosis in adolescent inpatients.

OBJECTIVE: The authors investigated the concurrent and predictive validity of the DSM-III-R diagnosis of personality disorder in adolescents by means of baseline and follow-up assessments of inpatients treated at the Yale Psychiatric Institute. METHOD: One hundred sixty-five hospitalized adolescents were reliably assessed by using a structured interview for personality disorder diagnoses as well as two measures of impairment and distress--the Global Assessment of Functioning Scale and the SCL-90-R. Two years after initial assessment, 101 subjects were independently reassessed with the same measures; their functioning was also assessed at this time. RESULTS: At baseline, adolescents with personality disorders were significantly more impaired than those without personality disorders. At follow-up, adolescents with a personality disorder diagnosis at baseline had used significantly more drugs and had required more inpatient treatment during the follow-up interval. Over time, the scores on the Global Assessment of Functioning Scale and SCL-90-R of adolescents diagnosed with a personality disorder at baseline became more similar to the scores of adolescents without a personality disorder. CONCLUSIONS: The diagnosis of personality disorder in adolescent inpatients has good concurrent validity; however, the predictive validity of the diagnosis is mixed.

Adolescent↗
PubMedDate not supplied

Personality disorders and self-perceived quality of life in an elderly psychiatric outpatient population.

The aim of this work was to assess the impact of personality disorder and traits on the subjective assessment of quality of life by a sample of elderly psychiatric outpatients (60 years or more). Sixty of the total number of subjects interviewed were included in the test sample since they met the Vragenlijst Klinishe Persoonlijkheid (VKP) criteria for personality disorder. A control sample was also formed, composed of 50 subjects without personality disorders or traits. Quality of life was assessed using the LEIPAD questionnaire. Personality disorder diagnoses were prevalently distributed in cluster C (25%) and in cluster A (20%). A total of 48.3% of patients (n = 29) had more than 1 personality disorder. Sixty percent of the sample (n = 36) presented with comorbid Axis I psychiatric disorders, in most cases depressive pathologies. Comparing the case and control groups, worse LEIPAD scores were achieved by subjects with personality disorders. Between clusters of personality disorders, the worst scores were observed in subjects with more than 1 personality disorder diagnosis. Elderly people who presented with a personality disorder were more vulnerable to late-life distress, especially those with more than one diagnosis. In keeping with linear regression analysis, widowhood, divorcehood and living with others appear to be variables able to negatively influence quality of life in this population. While the VKP needs to be adapted to the application in the elderly, it does seem to be a particularly useful screening instrument.

Aged↗
PubMed2005

Major depression in patients with borderline personality disorder: a clinical investigation.

OBJECTIVE: Borderline personality disorder (BPD) is characterized by a high frequency of comorbidity with major depressive disorder (MDD). This study aimed to compare the clinical characteristics of 2 groups of patients with MDD: those with concomitant BPD and those with other concomitant personality disorders. METHODS: We assessed 119 outpatients, using a semistructured interview for demographic and clinical features, the Structured Clinical Interview for DSM-IV, Hamilton anxiety and depression scales, the Zung Self-Rating Depression Scale (ZSDS), the Social and Occupational Functioning Assessment Scale (SOFAS), the Sheehan Disability Scale, and the Revised Childhood Experiences Questionnaire. We performed a regression analysis, using the number of criteria for BPD as the dependent variable. RESULTS: Severity of BPD was positively related to the ZSDS score, to self-mutilating behaviours, and to the occurrence of mood disorders in first-degree relatives; it was negatively related to the SOFAS score and age at onset of MDD. CONCLUSIONS: Patients with comorbid MDD and BPD present differential characteristics that indicate a more serious and impairing condition with a stronger familial link with mood disorders than is shown by depression patients with other Axis II codiagnoses.

Adult↗
PubMed1986

An empirical study of borderline personality disorder and psychiatric suicides.

Borderline personality disorder (BPD) is closely related to suicidal behavior, and suicide attempts per se are considered a diagnostic criterion. However, there has been no previous study of completed suicides and BPD. The present study is based on a population of 134 consecutive psychiatric suicides from 1961 to 1980 in a catchment area of 250,000 inhabitants. Clinical records were retrospectively diagnosed according to the Diagnostic Interview for Borderlines and DSM-III. There was a progressive increase in proportion of borderline suicides during the time period. The overall proportion of BPD, however, was only 12%, indicating that borderline patients are not seriously overrepresented among patients committing psychiatric suicides. Demographic variables, earlier psychiatric care, and suicidal behavior in the borderline group are described and analyzed.

Adult↗
PubMed1983

Relationship between neurosis and personality disorder.

316 psychiatric patients--predominantly out-patients--with a clinical diagnosis of neurosis (International Classification of Disease), were given an interview schedule for assessing personality disorders. Nearly two fifths were rated as having personality disorder, the anankastic type being the most common and sociopathic personality disorder the least. Patients with anxiety, phobic and obsessional neurosis were all significantly more likely to show personality disorder than those with depressive neurosis. Broadly, passive-dependent personalities were linked to anxiety neurosis, anankastic personality disorder to obsessional neurosis, and both anankastic and passive-dependent personalities to phobic neurosis. In a clinical trial of the efficacy of two dosage regimes of phenelzine in 60 patients the presence of personality disorder significantly impaired clinical outcome. The results suggest strongly that the assessment of personality in neurotic disorders is necessary to make an adequate diagnosis and predict the outcome of treatment.

Clinical Trials as Topic↗
PubMed1997

Perceptions of parental bonding in patients with various personality disorders, lifetime depressive disorders, and healthy controls.

The aims of the present study was (a) to examine the relationship between parental bonding and various personality disorders, when the effect of a lifetime depressive disorder was statistically controlled for, and (b) to examine the relationship between parental bonding and a lifetime depressive disorder when the effects of various personality disorders were accounted for. The study included 135 psychiatric outpatients and 41 healthy controls. The patients were diagnosed according to DSM-III-R axis I and axis II. Results indicated that obsessive-compulsive personality disorder was associated with reports of lower levels of paternal care and higher levels of paternal overprotection, while cluster B personality disorder was associated with reports of high parental overprotection. Avoidant, dependent, and cluster A personality disorders were not associated with abnormal parental bonding. Lifetime depressive disorders were associated with reports of low maternal care and high maternal overprotection when the effect of a personality disorder was accounted for.

Adult↗
PubMed2000

[Two cases of HIV infection accompanied with borderline personality disorder].

We report here two cases of HIV infection with a borderline personality disorder. Case 1 was a 25-year-old male patient who was diagnosed with HIV infection 4 years ago. Borderline personality disorder was also diagnosed at that time. Although he was referred to our hospital in 1999, we had to refer him to another hospital for his regular outpatient hemodialysis. Case 2 was a 24-year-old male patient who had borderline personality disorder since 1996. He was diagnosed with HIV infection in 1999 and referred to our hospital. He ignored rules in visiting clinics such as prior reservations and frequently called doctors, case-workers and nurses. After several visit he intentionally took excessive sedative medicines and called a case-workers at our hospital. He was admitted to our hospital for three days. After he was discharged, we set limitations for his behavior not to harm himself and to obey the rules in visiting clinics. In other countries investigators report that borderline personality disorder is more common in HIV-infected persons. It may be because persons with borderline personality disorder are more likely to engage in high-risk sexual behavior, which is also applicable to these two cases. As HIV infection is rapidly prevailing in Japan, it is possible that the chance are that this disorder will be seen more frequently in HIV infected cases.

Adult↗
PubMed2005

Panic attacks and the risk of personality disorder.

OBJECTIVE: The goal of this study is to determine the association between panic attacks in adolescence and the risk of personality disorders during young adulthood. METHOD: Data were drawn from the Children in the Community Study, a longitudinal epidemiological study of psychopathology across the life-course in 717 individuals in the community. Multiple logistic regression analyses were used to determine the association between panic attacks during adolescence in 1983 and the risk of personality disorders during young adulthood in 1993, adjusting for differences in sociodemographic characteristics, adolescent personality disorders, and co-morbid depressive and substance use disorders. RESULTS: Panic attacks during adolescence (in 1983) were associated with an increased risk of any DSM-IV personality disorder (in 1993) during young adulthood, which persisted after adjusting for differences in sociodemographic characteristics, adolescent personality disorders, and co-morbid depressive and substance use disorders. Panic attacks were associated with a statistically significantly increased risk of Cluster A, B, and C personality disorders. CONCLUSIONS: These data provide initial evidence that panic attacks early in life are a marker or risk factor for the development of personality disorders in young adulthood. Replication of these findings is needed, as is more in-depth investigation into the mechanism of this link. If replicated in future research, these results may reveal a novel potential pathway for identifying youth at high risk for personality disorders.

Adolescent↗
PubMed2005

Continuity of axes I and II: toward a unified model of personality, personality disorders, and clinical disorders.

In the current standard psychiatric nomenclature, the DSM-IV-TR (APA, 2000), mental disorders are divided into two groups: Clinical Disorders (CDs) and Personality Disorders (PDs), and CD and PD diagnoses are recorded on two separate axes (Axes I and II, respectively). This article considers evidence regarding putative bases for distinguishing between CDs and PDs, and finds that these constructs are more similar than distinct. Links between the domains may be better understood by focusing on how personality connects CDs and PDs. This perspective underlines the need to work toward a more unified model of personality, PDs, and CDs in research and in future editions of the DSM.

Adult↗
PubMed2000

Psychopharmacology of borderline personality disorder.

Pharmacotherapy for patients with borderline personality disorder is directed against the psychobiology of cognitive-perceptual, affective, and impulsive-behavioral symptoms. A symptom-specific method using current empiric evidence for drug efficacy in each symptom domain is proposed. Drugs in each medication class have some potential utility against specific symptoms in patients with borderline personality disorder.

Algorithms↗
PubMed1988

Recognizing borderline personality disorder in the primary care client.

The nurse practitioner is responsible for the diagnosis and treatment of a great variety of physical and psychological disorders in the ambulatory client. Frequently the diagnosis of personality disorder is missed, ignored or not even considered. This article will introduce the nurse practitioner to the various personality disorders. The main focus, borderline personality disorder, is estimated to affect 5 to 15 percent of the general population. A picture of the borderline client from etiology to treatment as well as recent research findings and suggestions for history taking and physical exam are covered. Borderline has been a difficult and confusing diagnosis to make because in the past the term has had several different meanings. This article will clarify what this diagnosis means, and will assist the nurse practitioner in the recognition, diagnosis and management of all clients with personality disorders.

Adult↗
PubMed2000

Effectiveness of time-limited cognitive analytic therapy of borderline personality disorder: factors associated with outcome.

Most patients with borderline personality disorder receive no formal treatment for their personality disorder and psychotherapy is widely believed to be necessarily intensive, of long duration and of uncertain effect. This study seeks to demonstrate the scope and limits of time-limited outpatient cognitive analytic psychotherapy. Cases were identified by standard diagnostic procedures. Most were referred from psychiatrists and were typical of inner city patient populations. At an assessment 6 months after therapy the 27 patients completing therapy were divided into 'improved' and 'unimproved' groups. The patients classified as improved no longer met diagnostic criteria for borderline personality disorder. The two-thirds still traceable were re-tested at 18 months. These groups were compared in terms of a number of pre-therapy measures and features. Poorer outcome was associated with greater severity of borderline features, a history of self-cutting, alcohol abuse and unemployment.

Adult↗
PubMedDate not supplied

The relationship between DSM-III personality disorders and the five-factor model of personality.

Two hundred twenty-four first-degree relatives of patients with psychotic disorders were administered the Structured Interview for DSM-III Personality Disorders (SIDP) and completed a self-report instrument to assess dimensions of the five-factor model of personality. All of the DSM-III personality disorders were related to one or more dimensions of the five personality factors; however, the correlations were generally low. It seems that the five personality factors describe important features of DSM-III personality disorders, but are not sufficient to completely explain their characteristics. Future use of the five-factor model in conjunction with personality disorder diagnoses may provide useful information for clinical work and research purposes.

Adolescent↗
PubMed2006

Dimensional representations of DSM-IV cluster A personality disorders in a population-based sample of Norwegian twins: a multivariate study.

BACKGROUND: The 'odd' or 'Cluster A' personality disorders (PDs) - paranoid, schizoid and schizotypal PDs - were created in DSM-III with little empirical foundation. We have examined the relationship between the genetic and environmental risk factors for dimensional representations of these three personality disorders. METHOD: These personality disorders were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV) in 1386 young adult twin pairs from the Norwegian Institute of Public Health Twin Panel. Using Mx, a single-factor independent pathway twin model was fitted to the number of endorsed criteria for the three disorders. RESULTS: The best-fit model included genetic and unique environmental common factors and genetic and unique environmental effects specific to each personality disorder. Total heritability was modest for these personality disorders and ranged from 21% to 28%. Loadings on the common genetic and unique environmental factors were substantially higher for schizotypal than for paranoid or schizoid PD. The proportion of genetic liability shared with all Cluster A disorders was estimated at 100, 43 and 26% respectively for schizotypal, paranoid and schizoid PDs. CONCLUSION: In support of the validity of the Cluster A construct, dimensional representations of schizotypal, paranoid and schizoid PD are all modestly heritable and share a portion of their genetic and environmental risk factors. No evidence was found for shared environmental or sex effects for these PDs. Schizotypal PD most closely reflects the genetic and environmental liability common to all three Cluster A disorders. These results should be interpreted in the context of the limited power of this sample.

Adult↗
PubMed2001

Self-concept correlates of the personality disorders.

This study investigated the extent to which the DSM personality disorder dimensions are associated with discrete patterns of self-concept. Participants were 366 men and women who were receiving mental health services and who completed the Wisconsin Personality Disorders Inventory to assess the personality disorders and Benjamin's INTREX questionnaire to describe their "typical" self-concepts. Although there was some overlap between categories, most were associated with fairly distinct patterns of self-concept. The disorders also clustered together in meaningful ways along the major axes of Benjamin's interpersonal model of the self-concept.

Adolescent↗