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PubMed2000

Behind bars: personality disorders.

Individuals with severe, function-impairing personality disorders comprise a large proportion of the difficult-to-manage inmates. Personality disorders are reliably diagnosable using standardized criteria (DSM-IV), and treatment options are now available. Through careful assessment, differential diagnosis, and differential therapeutic selection, clinicians have the opportunity to help these individuals gain more control over unstable affect, impulsive/ irritable aggression, and paranoid perceptual distortions. Appropriate intervention holds the possibility, if not the promise, of reduced morbidity and recidivism, and may reasonably contribute to the public safety mission of corrections and to the primary mission of clinicians, which is improved health.

Behavior Therapy↗
PubMed1994

Validity of the MMPI Personality Disorder scales (MMPI-PD).

The MMPI Personality Disorder scales, developed by Morey, Waugh, and Blashfield (1985), were validated on an inpatient population by comparing 104 patients' MMPI-PD scores with the MCMI and with DSM-III-R diagnosis. Conservative significance levels were used to ensure more valid conclusions. Schizoid, Avoidant, Dependent, Histrionic, and Narcissistic scales were correlated significantly. Passive-Aggressive, Schizotypal, and Borderline scales did not correlate with corresponding MCMI scales. The MMPI-PD nonoverlapping scales were most effective in predicting diagnosis, specifically the Personality Disorder NOS, Eccentric and Borderline groups. The overlapping scales were not as effective in predicting diagnosis, but best predicted the Eccentric and Borderline groups. This study provides support for the validity of specific scales and circumscribed diagnostic utility for both measures.

Adult↗
PubMed2002

A comparative study of the dimensions and facets of the five-factor model in the diagnosis of cases of personality disorder.

Two national samples of psychologists (n = 92, n = 89) rated personality disorder cases using either the five factors (domains) or the 30 facets of the five-factor model (FFM) to examine reliability and clinical utility of the model when used as a diagnostic tool. The cases were prototypic and nonprototypic cases representing the three clusters of personality disorders in the DSM-IV. Although confidence was higher using the factors rather than the facets to rate the cases, interrater reliability was similar and the facets were rated more useful for professional communication, case conceptualization, and treatment. Mean ratings for the prototypic cases supported the theorized relationships between those personality disorders and the FFM. Principal components factor analysis of the facet ratings largely replicated the structure of the FFM with only a few facets failing to load with their superordinate dimension in the model. Implications for use of the FFM with personality disorder are discussed.

Analysis of Variance↗
PubMed1998

Divalproex sodium for impulsive aggressive behavior in patients with personality disorder.

OBJECTIVE: Divalproex sodium, an anticonvulsant and antimanic agent, has recently been studied for its antiaggressive effects in patients with brain injuries, dementia, and borderline personality disorder. Since patients with other personality disorders also exhibit impulsive aggressive behavior, we conducted a preliminary open-label trial of divalproex sodium as a treatment for irritability and aggression in patients with a variety of personality disorders. METHOD: Ten patients meeting DSM-IV criteria for at least one personality disorder were treated with divalproex sodium in an 8-week open clinical trial. All patients had failed a trial of a selective serotonin reuptake inhibitor (SSRI). Divalproex sodium was increased as tolerated using a flexible dosing schedule. Clinician ratings for impulsive aggressive behavior and irritability were made every 2 weeks using the modified Overt Aggression Scale (OAS-M). RESULTS: Six of 8 completers reported significant decreases in irritability (p = .003) and impulsive aggressive behavior (p = .019). For the entire sample, improvement on OAS-M irritability and overt aggression scores was noted by the end of 4 weeks and continued to occur through week 8. CONCLUSION: This study suggests that divalproex sodium is an effective treatment for impulsive aggressive behavior in some patients with personality disorder who fail to respond to other antiaggressive agents (i.e., SSRIs). Controlled studies are needed to determine which patients are most likely to benefit from divalproex sodium and to evaluate the differential effectiveness of various agents in reducing impulsive aggressive behavior.

Adult↗
PubMed1999

Empirical clusters of DSM-III personality disorders in violent offenders.

Violent male offenders in a maximum security hospital and special units in prisons (N = 164) were interviewed with the Structured Clinical Interview for DSM-III Axis II disorders (SCID-II). Cluster analysis of the personality disorder criteria sets identified six diagnostic patterns: (1) antisocial-narcissistic; (2) paranoid-antisocial; (3) borderline-antisocial-passive-aggressive; (4) borderline; (5) compulsive-borderline; and (6) schizoid. Offenders in the first three groups had more extensive criminal careers, and most were identified as psychopaths by the Psychopathy Checklist-Revised (PCL-R). These Groups also had more frequent lifetime histories of substance abuse. A history of affective and anxiety disorders was more common in Groups 3 and 5, and almost two thirds of Group 2 had a history of psychotic disorder. The results emphasize that dangerous offenders are heterogeneous in personality pathology. They also suggest that personality disorder among violent offenders is more commonly represented by recurring patterns of covarying traits than by single categorical entities proposed in the DSM classification.

Adult↗
PubMed1989

How nursing staff respond to the label "borderline personality disorder".

The influence of the diagnostic labels "schizophrenia" and "borderline personality disorder" on the expressed empathy of psychiatric nursing staff was assessed by examining nurses' written responses to a series of hypothetical patient statements. Respondents were more likely to demonstrate affective involvement in response to the schizophrenic patients' statements and were more likely to offer belittling or contradicting responses to the statements of patients with borderline personality disorder. The results corroborate increasing concerns that the diagnosis of borderline personality disorder has become a pejorative label for difficult patients and suggest that staff may provide stereotypic responses and less empathic care to borderline patients than to other patients.

Adult↗
PubMed1993

Incorporating hypnosis into the psychotherapy of patients with multiple personality disorder.

Psychotherapeutic treatment of persons with multiple personality disorder frequently includes judicious use of hypnosis. The author outlines widely accepted essential features of this form of treatment: developing self-soothing techniques, "mapping" the system of alternate personalities, facilitating communication between alters and with the therapist, managing abreaction, and--when possible and appropriate--aiding the process of fusion. The author shows how dissociative processes that originally were used for sheer psychic survival can be drawn on to improve psychological health.

Communication↗
PubMed2005

Using the SWAP-200 in a personality-disordered forensic population: is it valid, reliable and useful?

BACKGROUND: Treatment and risk management of forensic patients relies heavily on diagnosing psychopathology, yet the reliability of clinical diagnoses of personality disorder has been found to be only fair to low. Structured instruments for the global assessment of personality disorder are infrequently used in clinical assessments possibly due to their limited validity and clinical utility. AIMS/METHODS: The Shedler-Westen Assessment Procedure-200 (SWAP-200) was developed in an effort to address these limitations. Although good reliability and validity in relation to clinicians' diagnosis of personality disorder has been reported, to date the validity of this instrument has not been assessed in relation to other standardized instruments or in a personality-disordered, forensic population. This study aims to establish the reliability and validity of the SWAP-200 against other diagnostic instruments and measures of interpersonal functioning in a personality disordered forensic population. RESULTS: This paper reports the results of 30 subjects from a high secure hospital in the UK who were assessed with the SWAP-200, the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), the Adult Attachment Interview (AAI) and the Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE). Preliminary results suggest that the SWAP-200 is a reliable instrument for the diagnosis of personality disorder in forensic patients. CONCLUSIONS: Although the small sample size allows only preliminary conclusions about the validity of this instrument, early results show a reduction of the diagnosis of comorbidity compared with the SCID-II, together with an increased number of expected associations between independent measures of interpersonal functioning and categories of personality disorder.

Adult↗
PubMedDate not supplied

The overlap of depressive personality disorder and dysthymia, reconsidered.

This paper reviews empirical literature examining the diagnostic overlap of depressive personality disorder and dysthymia. Although some articles have suggested that depressive personality disorder lacks distinctiveness from dysthymia and may be one type of affective disorder, a large proportion of the literature may, in fact, support its distinctiveness as a personality disorder. Additional research is needed to determine the features of the two disorders that best distinguish between them, so that depressive personality disorder can be further evaluated for its validity and usefulness in the diagnostic nomenclature.

Dysthymic Disorder↗
PubMed2003

Childhood antecedents of avoidant personality disorder: a retrospective study.

OBJECTIVE: To explore potential risk factors and early manifestations of avoidant personality disorder (AVPD) by examining retrospective reports of social functioning and adverse childhood experiences. METHOD: Early social functioning and pathological childhood experiences were assessed using the Childhood Experiences Questionnaire-Revised. The responses of 146 adults diagnosed with primary AVPD were compared with a group of 371 patients with other personality disorders as a primary diagnosis and a group of 83 patients with current major depression disorder and no personality disorders, using chi2 analyses. Diagnoses were based on semistructured interviews by trained reliable clinicians. RESULTS: Adults with AVPD reported poorer child and adolescent athletic performance, less involvement in hobbies during adolescence, and less adolescent popularity than the depressed comparison group and the other personality disorder group. Reported rates of physical and emotional abuse were higher than the depressed group, but this result was influenced by comorbid diagnoses. CONCLUSIONS: These results suggest that early manifestations of AVPD are present in childhood but that various forms of abuse are not specific to the disorder.

Adolescent↗
PubMed1984

Ego development and DSM-III Axis II: personality disorders.

Investigated the relationship between Loevinger 's levels of ego development and DSM-III Axis II personality disorder diagnoses, with a private psychiatric clinic sample of 400 patients. A breakdown of the ego development levels for each personality disorder is provided. Personality disorders that cluster in the dramatic, emotional and erratic cluster of the DSM-III ( histrionic , narcissistic, antisocial and borderline personality disorders) were found to have the majority of individuals who scored below the conformity level in the sample, with almost half of the individuals in this personality cluster below the conformity level. Another finding was that the psychiatric patient sample was devoid of individuals at the highest levels of ego functioning. Also, individuals who had their personality diagnoses deferred, predominantly due to psychotic mental disorders, typically were at or above the conformity level.

Ego↗
PubMed1998

The persistence of borderline personality disorder in adolescence.

The stability of borderline personality disorder in adolescents is quite uncertain. To determine the persistence of the borderline personality disorder (BPD) and of separate borderline symptoms in adolescents, a follow-up study was conducted of hospitalized adolescents with (n = 14) and without (n = 22) BPD, according to the diagnostic interview for borderline patients (DIB). Of the 14 borderline adolescents, only two cases were again classified as BPD after 3 years, but some of the separate borderline symptoms were still present. In the nonborderline group, no new borderline cases were found after 3 years.

Adolescent↗
PubMed1983

Observations on the handedness preferences of patients with personality disorders.

A new series of patients with personality disorders has provided an opportunity to extend to both sexes an earlier finding that personality disordered women tend to be mixed handed. Eighty-one subjects completed Annett's handedness questionnaire. The frequency of mixed hand preference in both sexes was similar to that found in the previous study, though deviations from consistent preference were small and dependent on the method used to classify handedness. The hysterical, antisocial and explosive personality types were particularly likely to have mixed handedness. These associations were reflected in small but significant trends among several psychometric variables.

Adult↗
PubMed2002

[Borderline personality disorder and attentional biases. Theoretical models and empirical findings].

The purpose of this review is to analyse nature, degree and consequences of attentional biases in patients with borderline personality disorder based on existing literature. The clinical importance of these phenomena in patients with borderline personality disorder is strengthened and the link between theoretical models, empirical findings and therapeutic interventions is elaborated. This link between selective attention and borderline personality disorder is demonstrated on the basis of studies, which indicate a context between borderline pathology, affective disorders, anxiety disorders, and attention-deficit/hyperactivity disorders and also give evidence to neuropsychological deficits in patients with borderline personality disorder. The present article comparatively describes three theoretical models of borderline personality disorder and their possible links to attentional biases. The dialectical behavior approach postulates a pronounced attentional narrowing to emotional stimuli in connection with deficits regarding affect regulation. The cognitive approach assumes that rigid dysfunctional schemata initiate a cognitive-emotional circuit, which leads to a reinforcement of the symptomatology as a result of a biased perception and memory. Additionally the present article specifies the trauma approach which emphasizes the relation between borderline pathology and childhood trauma with recourse to theories of attentional biases in patients with traumatic experiences. Preliminary empiricial findings suggest that patients with borderline personality disorder demonstrate a general attentional bias for any emotional negative stimuli and not a selective attentional bias to borderline-specific stimuli. Further studies should clarify, whether therapeutical interventions with the aim to influence attentional processes represent a useful complement to established therapies in patients with borderline personality disorder.

Attention↗
PubMed2002

DSM-IV axis II comorbidity with borderline personality disorder in monolingual Hispanic psychiatric outpatients.

The authors examined the comorbidity of DSM-IV borderline personality disorder (BPD) with other personality disorders (PD) in a series of adult monolingual (Spanish only) Hispanic psychiatric outpatients with substance use disorders. One hundred outpatients (69 men and 31 women) were assessed with the Spanish version of the Diagnostic Interview for DSM-IV Personality Disorders. PD co-occurrence in the group of patients with BPD (N = 34) was statistically compared with that in the group without BPD (N = 66). Bonferroni-corrected chi-square analysis showed significant diagnostic comorbidity with BPD for antisocial, avoidant, and depressive PD. However, analyses conducted separately by gender showed no significant comorbidity of any PD with BPD in women and significant comorbidity with antisocial, avoidant, and depressive PD in men. These results suggest that in monolingual Hispanic psychiatric outpatients with substance use disorders, gender may play a role in the nature of BPD comorbidity. The BPD diagnosis may represent a broader range of psychopathology in Hispanic men than women.

Adult↗
PubMed1995

Relationship between hypomania and personality disorders before and after successful treatment.

OBJECTIVE: To examine the effect of hypomanic states on maladaptive personality traits and personality disorders, the authors evaluated personality traits and disorders of patients during an episode of hypomania and after successful somatic treatment. METHOD: The authors used the Structured Interview for DSM-III Personality Disorders to study 66 outpatients who had a lifetime diagnosis of bipolar disorder and who met the minimum Research Diagnostic Criteria for hypomania. All patients had a knowledgeable informant separately undergo the Structured Interview for DSM-III Personality Disorders during the patient's hypomanic state. Outpatients who successfully recovered from the hypomanic episode (N = 47) and their informants were read-ministered the interview 4-8 weeks after the initial assessment. RESULTS: During the hypomanic state, informants generally reported higher levels of maladaptive personality traits among patients than patients themselves. For the patients who recovered successfully from the hypomanic episode, a reduction in all maladaptive personality traits except schizoid and dependent traits was reported by both patients and their informants; however, the decrease reported by patients generally was much greater than that reported by informants. In addition, schizoid traits actually increased after successful treatment according to patient reports but were unchanged according to informant reports. CONCLUSIONS: Hypomania may be associated with an exacerbation of maladaptive personality traits, which may be attenuated after successful treatment. Even with the attainment of euthymic mood, however, about 50% of the cohort had at least one personality disorder, which suggests that a high degree of comorbidity may exist between bipolar disorders and maladaptive personality traits or personality disorders.

Acute Disease↗
PubMed1997

Personality disorders in adolescents with major depression, substance use disorders, and coexisting major depression and substance use disorders.

This study examined the presence of personality disorders in adolescent inpatients with major depression (MDD; n = 45), substance use disorders (SUD; n = 27), or both disorders combined (MDD-SUD; n = 42). A consecutive series of patients were given structured diagnostic interviews for Axes I and II disorders. The groups did not differ with regard to age, gender, ethnicity, socioeconomic status, psychiatric history, or global assessment of functioning. Borderline personality disorder was diagnosed more frequently in the MDD-SUD group than in the MDD or the SUD groups.

Adolescent↗