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Personality disorders among the relatives of schizophrenia patients.

In light of current linkage studies in schizophrenia, research on the "schizophrenia spectrum" deserves increased attention for an exact determination of the affected phenotype: Those disorders that have a much higher prevalence among biological relatives of schizophrenia patients are supposed to share common etiological factors with "core" schizophrenia. However, there is controversy over which of the DSM-III-R personality disorders should be included in the spectrum. In a controlled family study of inpatients with a DSM-III-R diagnosis of schizophrenia (n = 101), schizophreniform and schizoaffective disorders (n = 69), and unipolar major depression (n = 160), familial rates of personality disorders were assessed through personal interviews and compared with prevalence rates in 109 control families from the community. As predicted, schizotypal personality disorder occurred more frequently in the nonpsychotic relatives of schizophrenia probands (2.1%) than in the families of unscreened controls (0.3%). Paranoid personality disorder was more frequent in relatives of probands with unipolar depression (2.9%) than in relatives of schizophrenia patients (1.7%), and controls revealed the lowest rate (0.9%). Schizoid personality disorder, however, was extremely rare in all sample groups (between 0.3% and 0.7%), providing no sufficient statistical power for detection of group differences. Further analysis of the DSM-III-R criterion symptoms of schizotypal personality disorder demonstrated that items describing "negative" symptomatology are the main source of familial aggregation, but "psychotic-like" personality features are also contributing factors.

Adult↗

Personality disorders in treatment-seeking combat veterans with posttraumatic stress disorder.

OBJECTIVE: Many patients with posttraumatic stress disorder (PTSD) appear to have co-occurring symptoms of character pathology; however, to date there have been no empirical studies of comorbid clinician-rated axis II personality disorders in war veterans with chronic PTSD. The authors' objective was to assess DSM-III-R personality disorders in treatment-seeking combat veterans with PTSD. METHOD: They used the Personality Disorder Examination, a standardized diagnostic interview for DSM-III-R axis II disorders, to assess DSM-III-R personality disorders in 34 patients with PTSD; 18 of the subjects were inpatients and 16 were outpatients. RESULTS: A high rate of character pathology was observed in both inpatient and outpatient groups. The most frequent disorders for which criteria were met were borderline, obsessive-compulsive, avoidant, and paranoid personality disorders. Inpatients had a higher rate of nearly every personality disorder than did outpatients. Inpatients were significantly more likely to meet diagnostic criteria for paranoid, schizotypal, avoidant, and self-defeating personality disorders. CONCLUSIONS: War-related PTSD in treatment-seeking Vietnam veterans is often accompanied by diffuse, debilitating, and enduring impairments in character. Subtyping patients with PTSD on the basis of specific axis II profiles may aid in the selection of more specific and effective treatments.

Ambulatory Care↗

Impaired startle prepulse inhibition and habituation in patients with schizotypal personality disorder.

OBJECTIVE: Information processing measures that serve as biological markers for schizophrenia can help to define the boundaries of schizophrenia. Prepulse inhibition and habituation of the blink reflex component of startle, which are thought to reflect an individual's ability to screen out or "gate" irrelevant sensory stimuli, are impaired in patients with schizophrenia. These deficits in sensorimotor gating and habituation in schizophrenic patients may lead to sensory overload and, secondarily, cognitive fragmentation, disorganization, and thought disorder. The goal of this study was to test two hypotheses: 1) patients with schizotypal personality disorder would show a loss of sensorimotor gating reflected by impaired prepulse inhibition of the human startle response and 2) patients with schizotypal personality disorder would show deficits in startle habituation consistent with the deficits seen in patients with schizophrenia. METHOD: Prepulse inhibition and habituation were assessed in 12 men and four women who met DSM-III-R criteria for schizotypal personality disorder and in 22 normal comparison subjects. RESULTS: Patients with schizotypal personality disorder had deficits in acoustic prepulse inhibition and habituation similar to the deficits observed in patients with schizophrenia. Although there were no differences between patients with schizotypal personality disorder and normal subjects in latency from acoustic startle stimuli to response, latency facilitation was produced by the prepulse in both groups. CONCLUSIONS: This pattern of changes in amplitude and latency of the startle response suggests that subjects with schizotypal personality disorder perceive the prepulse stimuli but still demonstrate deficient sensorimotor gating of amplitude. These findings support the importance of startle prepulse inhibition and startle habituation as biological markers for schizophrenia spectrum disorders.

Acoustic Stimulation↗

Toward a cultural history of the personality disorders.

Psychiatric categories in general, and the personality disorders in particular, remain problematic and contested. This is no where more clearly evident than in the case of the 'antisocial' and 'histrionic' personality disorders. In part, the problem is related to the observation of differences in gender distribution. Men are more likely to be diagnosed 'antisocial' than women, and women are more likely to be diagnosed 'histrionic' than men. Confusion results partly from the suspicion that these categories may be culturally conditioned and therefore spurious as medical labels true in some 'absolute' sense. This paper argues that the antisocial and histrionic disorders have cultural histories, representing (in extreme form) values strongly congruent with familiar cultural stereotypes: the 'independent' male and the 'dependent' female. The process by which these values were delegated to men and women is examined, and then shown to be at least partly determinative of later developments in the formation of psychiatric categories.

Adult↗

Personality disorders and depressive symptoms in late luteal phase dysphoric disorder.

BACKGROUND: Although many significant studies of late luteal phase dysphoric disorder (LLPD) have been carried out, some conflicting findings on the relationships between personality disorders, depressive symptoms, hostility and LLPD deserve further investigation. METHODS: Forty-three LLPD patients and 85 control subjects, evaluated by prospective daily ratings during two symptomatic cycles, received a detailed psychiatric evaluation, including the sections for psychotic, affective and anxiety disorders of the Structured Clinical Interview for DSM-III-R nonpatient version and the section for personality disorders; the Buss Durkee Inventory for Assessing Different Kinds of Hostility and the Montgomery-Asberg Depression Rating Scale. RESULTS: The odds of suffering from LLPD are about nine-fold (crude odds ratio, OR = 9.23, 95% confidence interval, CI 3.98-21.39) among women with mild or moderate depressive symptoms. When two age strata (below and above 30) are analyzed separately, the association between LLPD and depressive symptoms is strong and positive in both strata, while the association between LLPD and avoidant personality disorder is found only among older women (adjusted OR = 8.26, p < 0.05, 95% CI 1.03-66.35). CONCLUSIONS: The major finding from this preliminary study is the association between LLPD and depressive symptoms. Conversely, the association between LLPD and avoidant personality disorder remains controversial and seems to be dependent on age. Our findings support the hypothesis that LLPD and avoidant personality disorder may be considered as part of the spectrum of recurrent mood disorder rather than as qualitatively distinct nosological entities. Future studies are needed, adopting prospective, longitudinal assessments of personality prior to the onset of LLPD.

Adolescent↗

Objective assessment of personality disorder in chronic fatigue syndrome.

OBJECTIVES: This study aims to objectively assess the prevalence and nature of personality disorders in depressed and nondepressed chronic fatigue syndrome (CFS) patients and compare this to depressed and healthy control groups. METHODS: Sixty-one patients attending a tertiary referral clinic with chronic fatigue syndrome, 40 psychiatric inpatients with depressive disorder and 45 healthy medical students completed the Structured Clinical Interview for DSM-III-R Diagnoses (SCID-II) in addition to providing routine clinical and demographic information. RESULTS: Thirty-nine percent of the CFS group, 73% of the depressed group and 4% of the healthy group were diagnosed with personality disorders. Cluster C disorders were the most common in both the CFS and depressed group. The depressed CFS patients had more Cluster B personality disorders than nondepressed CFS patients. Overall for CFS patients there was no association between mood state and personality disorder. CONCLUSIONS: High levels of personality disorder are found on objective assessment of CFS patients attending a teaching hospital clinic. This cannot be accounted for by comorbid depression.

Adult↗

Assumptions in borderline personality disorder: specificity, stability and relationship with etiological factors.

The specificity and stability of a set of assumptions hypothesized to be characteristic of Borderline Personality Disorder (BPD) was investigated. BPD patients (n = 16) were compared to cluster-C personality disorder patients (n = 12) and to normal controls (n = 15). All subjects were female and diagnosed with SCID-I and -II. Subjects rated a short version of the Personality Disorder Beliefs Questionnaire (PDBQ), with six sets of 20 assumptions each, hypothesized to be characteristic of avoidant, dependent, obsessive-compulsive, paranoid, histrionic and borderline personality disorder. The BPD assumptions (Cronbach alpha = 0.95) proved to be the most specific to BPD patients. Subjects rated the shortened PDBQ again after viewing an emotional video fragment one week later. Despite increased negative emotions, the PDBQ ratings remained relatively stable. Confirming the cognitive hypothesis, regression analyses indicated that the BPD assumptions mediate the relationship between self-reported etiological factors from childhood (sexual abuse and emotional/physical abuse) and BPD pathology assessed with the SCID-II. It is suggested that a set of assumptions is characteristic of BPD, and is relatively stable despite the instability of the behaviour of people diagnosed as having BPD.

Adult↗

Personality disorders in substance abusers: validation of the DIP-Q through principal components factor analysis and canonical correlation analysis.

BACKGROUND: Personality disorders are common in substance abusers. Self-report questionnaires that can aid in the assessment of personality disorders are commonly used in assessment, but are rarely validated. METHODS: The Danish DIP-Q as a measure of co-morbid personality disorders in substance abusers was validated through principal components factor analysis and canonical correlation analysis. A 4 components structure was constructed based on 238 protocols, representing antagonism, neuroticism, introversion and conscientiousness. The structure was compared with (a) a 4-factor solution from the DIP-Q in a sample of Swedish drug and alcohol abusers (N = 133), and (b) a consensus 4-components solution based on a meta-analysis of published correlation matrices of dimensional personality disorder scales. RESULTS: It was found that the 4-factor model of personality was congruent across the Danish and Swedish samples, and showed good congruence with the consensus model. A canonical correlation analysis was conducted on a subset of the Danish sample with staff ratings of pathology. Three factors that correlated highly between the two variable sets were found. These variables were highly similar to the three first factors from the principal components analysis, antagonism, neuroticism and introversion. CONCLUSION: The findings support the validity of the DIP-Q as a measure of DSM-IV personality disorders in substance abusers.

Adult↗

Antisocial and borderline personality disorders: two separate diagnoses or two aspects of the same psychopathology?

Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) have a number of points of overlap: in symptoms, in personality dimensions that underlie their phenomenology, in community prevalence, in risk factors, and in outcome and response to treatment. Both disorders have a common base in impulsive personality traits, but the behavioral differences between them are shaped by gender. Further research is suggested to explore the commonalities and differences between ASPD and BPD.

Affective Symptoms↗

Effects of sex and sex roles on the perceived maladaptiveness of DSM-IV personality disorder symptoms.

This study investigated the influence of sex on the perceived maladaptiveness of DSM-IV personality disorder criteria based on previous findings that inconsistency of symptoms with sex roles affects the perception of personality disorder symptoms. The effects of rater characteristics (i.e., sex, sex role) were also examined. A total of 161 undergraduates (65 men, 96 women) rated the diagnostic criteria according to how maladaptive they were for males (male condition), females (female condition), or without regard to sex (neutral condition that served as a baseline) using a 7-point scale. Participants' sex role was determined using the Bem Sex Role (1981a) Inventory. Dependent and depressive personality disorder criteria (trend for borderline) were rated more maladaptive for females than males, whereas obsessive-compulsive personality disorder criteria were rated more maladaptive for males than females. Participant sex and sex role had little or no significant effects on the ratings. Results are compared with those of previous research. Methodological issues and implications for the diagnosis of personality disorders are discussed.

Adolescent↗

Line bisection performance in patients with personality disorders.

INTRODUCTION: Normal line bisection deviation to the left of the true centre has been interpreted as resulting from relative right hemisphere activation. Right hemisphere involvement has also been associated with the problems in dependency and attachment from infancy to adulthood. This hemispheric association predicts that patients diagnosed with dependent personality disorder will deviate significantly to the left on the line bisection task. METHODS: This hypothesis was tested by comparing the results of the line bisection task obtained respectively from 30 right-handed healthy volunteers and 14, 16, 18, and 26 outpatients with schizotypal, antisocial, borderline, and dependent personality disorders. Subjects completed eight horizontal line bisection tasks and the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ), a self-report measure of 18 traits delineating personality disorder. RESULTS: Patients with dependent personality disorder bisected significantly leftward compared to healthy controls. Dependent personality disorder patients scored significantly higher on DAPP-BQ Insecure Attachment, and lower on DAPP Stimulus Seeking, Callousness, Intimacy Problems, and Conduct Problems compared to the healthy controls and all other patient groups. CONCLUSIONS: Line bisection differentiates dependent personality disorder from other personality disorder diagnoses and healthy controls. This study thus suggests that line bisection can be used to enhance diagnostic specificity of dependent personality disorder and localises the brain areas implicated in the disorder.

Journal Article↗

The suicidal risk in severe personality disorders: differential diagnosis and treatment.

This article describes the clinical approach to patients with severe personality disorders who present suicidal intention and behavior, developed at the Personality Disorders Institute of the Department of Psychiatry at Cornell University Medical College and the Westchester Division of the New York Presbyterian Hospital. It describes the diagnostic evaluation of patients' suicidal potential, personality disorder, and the presence or absence of a spectrum of regressive illness. The analysis of the combined features in these three symptomatic domains determines alternative strategies of psychotherapeutic and psychopharmacological interventions. Within these strategies, transference-focused psychotherapy is described as a specific psychodynamic psychotherapy geared to treat characterologically based suicidal and parasuicidal tendencies in the context of the treatment of the patient's personality disorder.

Major Depressive Disorder↗

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↗

Multiple personality disorder in childhood.

Multiple Personality Disorder (M.P.D.) has been diagnosed in adults and adolescents at an almost exponential rate over the last 10 years in contrast to the previous 100 years. Childhood M.P.D., a more recently recognized entity, has been identified both by retrospective patient reports and actual child case reports, of which we were able to note 12 in total, 4 of which may be more accurately described as "incipient M.P.D." Given the apparently rapid response to treatment compared to adults and the high morbidity caused by the adult form of the disorder, the authors recommend a "high index of suspicion" and the use of screening questionnaires to detect cases of M.P.D. in high risk populations of children. Although the natural history of M.P.D. is not known, early identification and treatment could lower the number of cases of childhood M.P.D. that become established as adult cases and decrease the associated morbidity of the disorder in both children and adults. More research is needed to establish prevalence, etiology and effective treatment methods.

Abreaction↗

Characterizing paranoia in the DSM-III borderline personality disorder.

The relationship between paranoia and the borderline personality disorder continues to be the subject of debate. This study compares the extent and intensity of paranoia in 29 subjects fulfilling DSM-III criteria for borderline personality disorder. The control group consists of 22 subjects with dysthymic disorder. Paranoia was both more prevalent and severe in borderline patients. Results are discussed in light of previous descriptive and research literature.

Adolescent↗

Childhood precursors of borderline personality disorder.

The childhood precursors of borderline personality disorder are largely unknown. High-risk studies of "borderline children," as well as studies of the children of adult borderline patients, can shed light on the issue. Prospective research is needed to address these problems substantively.

Adult↗

Therapists' handling of patients with cluster B personality disorders in individual psychotherapy.

Individual psychotherapy is a recommended treatment of patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , cluster B personality disorders. Due to their pathology, these patients represent a challenge in psychotherapy, and guidelines for practical handling exist. This study examined the attitudes of psychotherapists toward these challenges. Three hundred twenty-four experienced Norwegian therapists filled in a questionnaire on issues relevant to individual psychotherapy of patients with personality disorders. The attitudes toward cluster B patients were examined and compared with those of clusters A and C patients on contract issues, acting out, use of drugs, information to relatives, and contraindications. A considerable gap was found between therapists' attitudes toward cluster B patients and published guidelines. The therapists mostly handled cluster B in the same way as clusters A and C. Empirical investigations of therapists' handling provide an important feedback from everyday clinical practice on divergences in relation to guidelines derived from experts' consensus and research.

Attitude of Health Personnel↗

Clinician diagnoses of personality disorders: evidence of a hierarchical structure.

This study examined whether clinicians employ a hierarchical model in the diagnosis of personality disorders. Using a methodology developed by Morey and Ochoa (1989), the study compared how clinicians diagnose patients (clinical diagnoses) to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria they endorsed for each patient (criterion diagnoses). A national sample of 320 clinicians served as subjects. When cases were examined in which the patients met diagnostic criteria for two or more personality disorders, clinicians used the diagnosis of borderline personality disorder more frequently. They failed to use other diagnoses whose criteria these patients met. Narcissistic personality disorder also appeared to have diagnostic dominance, although somewhat less striking than for borderline. These results suggest that clinicians do view the personality disorders as hierarchical, with borderline clearly identified as the dominant disorder.

Female↗