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Personality disorders and features in social phobia and panic disorder.

The hypothesis that there is a specific relationship between social phobia (SP) and avoidant personality disorder (APD) was investigated. Using the Structured Clinical Interview for DSM-III-R Personality Disorders, we screened 32 patients with SP and 85 patients with panic disorder (PD) for the presence of personality disorders. Avoidant features were found significantly more often in SP than in PD, although the diagnosis of APD could not be established significantly more often. On the item level, APD Criterion 6 (fears being embarrassed) discriminated the strongest. Social phobics appeared to be more disturbed on Axis II than PD patients.

Adult↗

Relationship between mood changes and the report of personality disorder symptoms.

The relationship between changes in mood state and the report of personality disorder symptoms was examined in a sample of 44 outpatients. Subjects completed a battery of self-report inventories and a semistructured interview on two occasions separated by 6 months. Although significant changes in depression and anxiety were observed over time, personality disorder scores from self-report inventories and the interview were relatively stable over time. Further, changes in depression and anxiety scores were not significantly related to changes in personality disorder scores. Results suggest that self-report personality disorder scores may be as reliable as those derived from semistructured interviews.

Adult↗

Adolescent personality disorder symptoms mediate the relationship between perceived parental behavior and Axis I symptomatology.

A study was conducted to investigate whether adolescent personality disorder symptoms mediate the relationship between perceived parental behavior and Axis I psychiatric symptomatology. The Parental Behavior Form, Personality Diagnostic Questionnaire-Revised, and Revised Hopkins Symptom Checklist (SCL-90-R) were administered to 187 first-year undergraduate students during their first week of college enrollment. One hundred fifty seven participants were readministered the SCL-90-R two months later. Results of correlational and hierarchical multiple regression analyses indicated that: (1) Adolescents' perceptions of parental acceptance/nurturance and harsh, controlling parental behavior were associated with baseline personality disorder symptom levels. (2) Perceived harsh parental control predicted both baseline and follow-up Axis I symptomatology. (3) In turn, baseline personality disorder symptoms were associated with Axis I symptom levels, both at baseline and at follow-up assessment after baseline Axis symptoms were accounted for. (4) Perceived parental behavior did not predict baseline or subsequent Axis I symptomatology after personality disorder symptom levels were accounted for. The present findings thus indicate that personality disorder symptoms completely mediated the relationship between adolescent perceptions of harsh, controlling parental behavior and Axis I psychiatric symptomatology.

Adolescent↗

Comorbidity of DSM-IV personality disorders in a nonclinical sample.

The issue of comorbidity within the Axis II personality disorders was explored using a large sample of university students who were administered the Coolidge Axis II Inventory (CATI). Comorbidity patterns with this normal sample were compared with recent clinical data reported by several other researchers. The results confirm the high degree of comorbidity within Axis II and the similarity in the comorbidity patterns with clinical and nonclinical samples. With the CATI, a 30.4% comorbidity rate was obtained for Histrionic and Narcissistic Personality disorders (Pd). The paranoid, passive-aggressive and borderline personality disorder traits were comorbid with several other Pds. For Cluster A, there was low comorbidity except for Paranoid Pd and Schizotypal Pd. With Cluster B, the co-occurrence was moderate to strong. A moderate amount of interrelationship was obtained for the Cluster C Pds. The DSM-IV clusters were also strongly interrelated. An additional finding was the similarity between self-report and structured interview methodology in obtained personality disorder comorbidity.

Adolescent↗

Personality disorder, symptoms and dexamethasone suppression in depression.

The presence of Personality Disorder (PD) in depressed patients admitted to the acute wards of a psychiatric hospital was assessed using Tyrer's Personality Assessment Schedule, and its relationship to depressive symptoms, improvement after 2 weeks, and the dexamethasone suppression test was examined. 75.4% of the sample met Tyrer's criteria for a PD diagnosis. The initial symptoms of patients with personality disorder did not differ from those without PD. However patients with PD improved more slowly, and had significantly higher symptom scores after 2 weeks. Patients with PD also showed previous history of more depressive episodes, a younger first age of onset, and more frequent and severe previous suicide attempts, in addition to history of unstable marriage. No difference in dexamethasone suppression was found. These findings suggest that presence of personality disorder is related primarily to course of illness and life history, rather than symptom pattern.

Adolescent↗

Content validity of the DSM-IV borderline and narcissistic personality disorder criteria sets.

This study sought to empirically evaluate the content validity of the newly revised DSM-IV narcissistic personality disorder (NPD) and borderline personality disorder (BPD) criteria sets. Using the essential features of each disorder as construct definitions, factor analysis was used to determine how adequately the criteria sets covered the constructs. In addition, this empirical investigation sought to: 1) help define the dimensions underlying these polythetic disorders; 2) identify core features of each diagnosis; and 3) highlight the characteristics that may be most useful in diagnosing these two disorders. Ninety-one outpatients meeting DSM-IV criteria for a personality disorder (PD) were identified through a retrospective analysis of chart information. Records of these 91 patients were independently rated on all of the BPD and NPD symptom criteria for the DSM-IV. Acceptable interrater reliability (kappa estimates) was obtained for both presence or absence of a PD and symptom criteria for BPD and NPD. The factor analysis, performed separately for each disorder, identified a three-factor solution for both the DSM-IV BPD and NPD criteria sets. The results of this study provide strong support for the content validity of the NPD criteria set and moderate support for the content validly of the BPD criteria set. Three domains were found to comprise the BPD criteria set, with the essential features of interpersonal and identity instability forming one domain, and impulsivity and affective instability each identified as separate domains. Factor analysis of the NPD criteria set found three factors basically corresponding to the essential features of grandiosity, lack of empathy, and need for admiration. Therefore, the NPD criteria set adequately covers the essential or defining features of the disorder.

Adult↗

Circular structure of the MCMI-III personality disorder scales.

Millon's (1987) circular model of personality disorders was examined in a large sample of psychiatric patients (N = 2,366) who completed the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1997) as part of routine assessment after presentation for treatment. Principal components analyses were conducted to identify the first two dimensions in MCMI-III base rate scores, weighted and unweighted raw scores, and nonoverlapping scale scores. Similar analyses were made on these scores when acquiescence was partialled out. Circular plots of the scales were examined against Millon's hypothesized arrangement and the model was tested using confirmatory factor analysis. Results replicated those of Strack, Lorr, and Campbell (1990) with the MCMI-II. Millon's horizontal Impassive-Expressive dimension was recovered in both regular and residual scores but the vertical axis appeared to represent an Impulsivity-Compulsivity dimension rather than the Autonomous-Enmeshed continuum envisioned by Millon. Although scale order followed Millon's predictions for the most part, a number of departures from theoretical expectations were noted and none of the score sets yielded a good fit to the hypothetical structure. Millon's model appears to have promise as a circumplex that can encompass all of the personality disorders but changes are needed to rectify discrepancies between the theory and empirical findings.

Adolescent↗

Personality disorders do not influence the results of cognitive behavior therapies for anxiety disorders.

Two studies are presented in which the presence of personality disorders (PDs) was assessed using a structured clinical interview (Structured Clinical Interview for DSM-III-R Personality Disorders [SCID-II] by an independent rater before the start of treatment. The therapy effect was measured by change scores. In the first study, patients (N = 31) with panic disorder (with or without agoraphobia) received standardized cognitive behavioral treatment protocols. The effect of treatment as assessed by questionnaires and panic frequency was comparable in the groups with and without PD. In a second study, patients (N = 57) with various anxiety disorders were assessed before and after an individually tailored cognitive behavioral treatment. In general, results showed that anxiety patients with PDs have more severe axis I pathology, but show a change parallel to the patients without PD. Thus, if the effect of therapy is measured by change scores, PD is not related to therapeutic failure of cognitive behavioral treatment of anxiety disorders in general and panic disorder in particular.

Adult↗

Personality disorders and coping among anxious older adults.

This study examined the interrelationships among anxiety, personality disorders, and coping strategies in anxious older adults (n = 28; age range = 55-89; mean = 66.0), nonanxious older adults (n = 100, age range = 55-79, mean = 64.6 ), and anxious younger adults (n = 132; age range = 17-30; mean = 20.2). Younger participants were college students and older participants were community-based family members of the students or recruits from local senior centers. Participants completed the Coolidge Axis II Inventory, the Coping Orientations to Problems Experienced scale, and the Brief Symptom Inventory. Results indicated that the prevalence of generalized anxiety states was relatively low and similar in both older and younger groups and dependent on measurement scale and criterion. At least one personality disorder was found in 61% of the older persons group; obsessive-compulsive, schizoid, and avoidant were the most frequently assigned personality disorders. Anxious older adults had elevated rates of dependent and avoidant personality disorder compared with nonanxious older adults. Younger anxious persons were found to have significantly greater personality dysfunction compared with older anxious persons. Finally, coping differences existed between older anxious and older nonanxious adults and between older anxious and younger anxious adults. Implications for diagnosis and treatment of anxiety in older adults were discussed.

Adaptation, Psychological↗

Impulsivity, gender, and response to fenfluramine challenge in borderline personality disorder.

Behavioral impulsivity in borderline personality disorder (BPD) is associated with indices of diminished central serotonergic function, independent of suicidal behavior, depression or alcohol use disorder. Many of these studies have been conducted among males in specialized settings. Studies of BPD females, who constitute the majority of BPD patients, are generally conducted in community settings and report inconsistent findings. We studied gender differences in behavioral impulsivity and the prolactin response to D,L-fenfluramine (FEN) in BPD subjects in a community setting. A FEN challenge study was conducted with 64 BPD subjects (20 male, 44 female), and 57 controls (36 male, 21 female). Axis I and II disorders, including BPD, and suicidal histories were assessed by structured interviews. Controls were free of Axis I and II disorders. Impulsivity and aggression were assessed by the Buss-Durkee Hostility Inventory, Barratt Impulsiveness Scale, Minnesota Multiphasic Personality Inventory-Psychopathic Deviate subscale, and the Brown-Goodwin Lifetime History of Aggression. Male, but not female, BPD subjects had significantly diminished prolactin responses compared to controls. Impulsivity and aggression each predicted prolactin responses. A significant effect of BPD diagnosis on prolactin response was eliminated when impulsivity was co-varied. Impulsivity and aggression were inversely related to delta-prolactin and peak-prolactin responses among male but not female subjects. Gender differences in central serotonergic function may contribute to variations in impulsivity in BPD.

Adult↗

Assessing suicidal youth with antisocial, borderline, or narcissistic personality disorder.

OBJECTIVE: This paper has 3 objectives. First, we review the epidemiologic evidence for the association between suicidal behaviour and suicide in individuals diagnosed with antisocial, borderline, or narcissistic personality disorder. Second, we examine whether any potentially modifiable risk factors are associated with these diagnoses, based on existing empirical evidence. Last, we discuss clinical approaches to assessing youth with antisocial, borderline, or narcissistic personality disorder presenting at risk for suicide. METHOD: We reviewed the English-language literature for the last 12 years (from January 1, 1991, to December 31, 2002), using as search terms the names of the 3 disorders, as well as the key words suicide, suicidal behaviour, youth, and adolescents. RESULTS: Patients with antisocial or borderline personality disorder are likely to be at increased risk for suicidal behaviour when they demonstrate such comorbid disorders as major depressive episodes or substance abuse disorders, when they experience recent negative life events, or when they have a history of childhood sexual abuse. CONCLUSIONS: For patients with antisocial personality disorder, the risk of violence has to be judged in addition to the risk of suicide or self-harm. For patients with borderline personality disorder, interventions are determined by differentiating acute-on-chronic from chronic risk of suicidal behaviour. Finally, patients with narcissistic personality disorder can be at high risk for suicide during periods when they are not suffering from clinical depression. These episodes can seem to be unpredictable.

Adolescent↗

Personality disorder and psychopathology in Tourette's syndrome: a controlled study.

BACKGROUND: Some specialists associate a wide variety of psychopathologies with Tourette's syndrome (TS), while others suggest that there is no psychopathology specifically associated. Few controlled studies have been conducted to address this issue, and none has investigated personality disorder in TS. METHOD: Adults with TS and controls were evaluated using standardised psychiatric rating scales, including self-rated (STPCD) and clinician-rated (SCID-II) assessments of personality disorder, to investigate associations between personality disorder, other psychopathology and TS. RESULTS: Significantly more TS patients (25/39 (64%)) than controls (2/34 (6%)) had one or more personality disorders. TS subjects were also more likely to have more personality disorders. TS patients had significantly more depression, anxiety and obsessionality than controls. The SCID-II and STCPD were moderately well correlated. CONCLUSIONS: TS patients have a high prevalence of personality disorder and psychopathology when compared with controls. These results are the first to suggest a high level of personality disorder in a TS clinic population.

Adult↗

European views on personality disorders: a conceptual history.

A historical account is offered of the European origins of the DSM-III-R category, personality disorder, and a differentiation is made between the history of terms, patterns of behaviors, and concepts. The concept of "disorder of character (personality)" developed in the nineteenth century, and was possible after notions such as character, constitution, temperament, and self received a psychological definition, and after the insanities became transformed into "psychoses." Terms such as "type" and "trait" were in turn ushered into the nineteenth century by faculty psychology and the phrenological tradition. Until the end of that century, "personality" referred to the subjective aspects of the self, and "personality disorder" meant alteration of consciousness (e.g., hysterical dissociation); the behavioral patterns dealt with by DSM-III-R as personality disorders were then called disorders of character and explained as states of volitional failure, or loss of coherence between cognitive, emotional, and conative functions, or of "automatism," i.e., the manifestation of lower (more primitive or animal) forms of behavior escaping the control of higher (human) ones. Character types and disorders were first considered as forms of attenuated insanity, and later on were made into a separate group whose membership could be attained via the visitation of a degeneration taint, neurological disease (e.g., encephalitis), or plain ill-breeding. The relevance of the intellectual background of the nineteenth century to these diagnostic changes is also discussed.

Europe↗

Higher-order dimensions of personality disorder: hierarchical structure and relationships with the five-factor model, the interpersonal circle, and psychopathy.

Two studies examined the higher-order factor structure of DSM-IV personality disorders using the International Personality Disorder Examination in male forensic psychiatric patients. In Study 1 (N = 168), exploratory factor analysis at the level of individual personality disorder criteria indicated nine primary factors. Exploratory and confirmatory factor analyses of these first-order factors supported a hierarchical structure in which two of three second-order factors covaried to yield a third-order factor. The two resulting superordinate factors were labelled Anxious-Inhibited and Acting Out. In Study 2 (N = 160), we used exploratory and confirmatory factor analyses to test hypotheses of common dimensions underlying these superordinate factors of personality disorder and superordinate factors of the five-factor model of personality, dimensions of the interpersonal circle, and psychopathy. Of three common factors, one combined Anxious-Inhibited disorders, "neurotic introversion," and hostile-submission. The other two factors of Acting Out/ psychopathy and antagonism/hostile-dominance covaried to yield a superordinate factor. Possible substrates underlying two superordinate dimensions common to normal and abnormal personality were identified in the theoretical literature.

Adult↗

Soft sign neurological abnormalities in borderline personality disorder and normal control subjects.

Patients with borderline personality disorder were found to have a significantly greater number of soft sign neurological abnormalities when compared with a group of normal control subjects. Sensitivity analysis revealed that the presence of two or more soft signs differentiated the two groups statistically. The authors speculate that nonfocal soft sign neurological abnormalities may reflect underlying central nervous system dysfunction, which may in turn be associated with the development of borderline personality disorders.

Adolescent↗

Some aspects of the DSM-III personality disorders illustrated by a consecutive sample of hospitalized patients.

The main innovations of DSM-III concerning the personality disorders are the assignment of a separate axis and definitions of diagnostic criteria for these disorders. Even with these improvements, diagnosis of the personality disorders shows only moderate interrater reliability. Reasons for this are discussed. Data from a consecutive sample of hospitalized patients are used to illustrate the prevalence of the personality disorders, the coexistence of axis I disorders, and the overlap within the personality disorders. The method of conditional probabilities is presented as a way to get better separation of these disorders.

Diagnosis, Differential↗

Neurobiological substrates of antisocial and borderline personality disorder: preliminary results of a functional fMRI study.

BACKGROUND: Neuropsychological and imaging studies of patients with antisocial (ASPD) and borderline personality disorder (BPD) are suggestive of frontal lobe dysfunction in these individuals. In normal subjects functional brain imaging has been used to investigate the neuroanatomy of impulse control. There are no such imaging studies in personality-disordered populations. AIM: This study aimed to investigate which neuronal networks are involved in response inhibition in Cluster B personality disorders and whether these are different from healthy subjects. HYPOTHESIS: We hypothesized that the personality-disordered sample would have attenuated orbitofrontal cortex responses during performance of a Go/NoGo task compared with healthy controls. METHOD: Eight inpatients with a DSM-IV diagnosis of borderline or antisocial personality disorder and eight healthy controls were scanned using fMRI while performing a Go/NoGo task. Impulsivity was assessed using the Barratt Impulsivity Scale (BIS) and the Impulsiveness-Venturesomeness-Empathy (IVE) inventory. RESULTS: In the control group the main focus of activation during response inhibition was in the prefrontal cortex, specifically the right dorsolateral and the left orbitofrontal cortex. Active regions in the patient group showed a more bilateral and extended pattern of activation across the medial, superior and inferior frontal gyri extending to the anterior cingulate. CONCLUSIONS: fMRI is a useful tool to detect brain activation during response inhibition. ASPD and BPD patients activate different neural networks to successfully inhibit pre-potent responses.

Adult↗

Growth of the literature on the topic of personality disorders.

OBJECTIVE: The authors assessed the growth of the literature on the topic of personality disorders before and after publication of DSM-III. METHOD: A MEDLINE search was conducted for journal articles concerning the personality disorders that were published from 1966 to 1995. RESULTS: Contrary to the authors' prediction, the growth of this literature was slower after the publication of DSM-III in 1980 than it was before that date. Other areas of psychopathology, such as Alzheimer's disease and posttraumatic stress disorder, have literatures whose growth rates since 1980 have exceeded their growth rates before publication of DSM-III. CONCLUSIONS: Over one-half of the individual personality disorders (e.g., histrionic and passive-aggressive) have either very small literatures or literatures with negative growth rates. Only three personality disorders (i.e., antisocial, borderline, and schizotypal) have modestly growing literatures.

Alzheimer Disease↗