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PubMed2001

Co-morbidity of personality disorders in individuals with substance use disorders.

This review summarizes the recent literature about personality disorders among substance abusers. First, it will be shown that personality disorders are highly prevalent co-morbid conditions among addicted individuals. Second, it is argued that this co-morbidity is likely to be accounted for by multiple complex etiological relationships. Finally, the clinical relevance of routine assessment of (maladaptive) personality traits in individuals admitting for substance abuse treatment will be discussed.

Comorbidity↗
PubMed1994

Dissociative phenomena in women with borderline personality disorder.

OBJECTIVE: This study was conducted to determine whether trauma variables and certain behavioral correlates are differentially prevalent in borderline personality disorder patients with greater and those with lesser dissociative experience. METHOD: Subjects were 62 female inpatients, all meeting DSM-III-R criteria for borderline personality disorder, 14 of whom also had a concomitant dissociative disorder diagnosis. Structured interviews and published scales were used to collect data addressing a priori hypotheses. RESULTS: Univariate analyses supported hypotheses that patients with borderline personality disorder and greater dissociative experience are characterized by more self-reported traumatic experiences, posttraumatic symptoms, behavioral dyscontrol, self-injurious behavior, and alcohol abuse. Multivariate analyses suggested that scores on the Dissociative Experiences Scale were predicted particularly by adult sexual assault, behavioral dyscontrol, and both sexual and physical abuse in childhood. CONCLUSIONS: These results support the use of the Dissociative Experience Scale as a brief screening instrument to aid in the identification of borderline personality disorder patients with prominent posttraumatic and dissociative disorders. Patients with borderline personality disorder seem to be characterized by somewhat different life experiences, treatment histories, and behavioral presentations depending on their level of dissociative experience, even though they meet the same DSM-III-R criteria. Neither extreme view of the overlap in diagnostic populations was supported.

Adolescent↗
PubMedDate not supplied

Dual diagnosis: psychoactive substance dependence and the personality disorders.

Research on the relationship between psychoactive substance dependence and personality disorder has been difficult to interpret. Among the reasons for this difficulty are (1) shifts in conceptualizations of these two classes of disorders, (2) markedly different findings related to age, sex, other demographic variables, and stage of illness, (3) overlapping of diagnostic criteria, and (4) instability of Axis II diagnoses over time in these populations. Personality disorder may be preexisting, but not necessarily predisposing. Nevertheless, Axis II diagnoses can be made in alcohol and other drug dependent patients, and are present in these populations at higher prevalence rates than in the general public. Although amelioration of personality disorder will not in itself necessarily correct substance dependence, Axis II diagnoses are of considerable importance in treatment planning and prognosis. Recent and future research on the genetic typology of alcoholism may shed further light on the complex relationship between genetics, physiology, personality, and addiction.

Diagnosis, Differential↗
PubMed2003

A character in search of character: Narcissistic Personality Disorder and Ego State Therapy.

The individual diagnosed with Narcissistic Personality Disorder presents with grandiosity, extreme self-involvement, and lack of interest in and empathy for others. This paper reviews current theories concerning the development and treatment of Narcissistic Personality Disorder, and introduces the use of Ego State Therapy for its treatment. The ego state model of treatment will be described and demonstrated with case material. Initially ego states that reveal the grandiosity will be accessed. As therapy progresses, ego states that hold the underlying feelings of emptiness, rage, and depression are able to emerge. With further treatment, transformation and maturation of the ego states occur, reflecting the changes in internal structure and dynamics as well as improvement in external interpersonal relationships. Issues concerning Ego State Therapy as utilized with personality disorders will be discussed and contrasted with more traditional methods of treatment.

Character↗
PubMed2004

Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders.

OBJECTIVE: This study compared the effectiveness of short-term dynamic psychotherapy and cognitive therapy for outpatients with cluster C personality disorders. METHOD: Patients (N=50) who met the criteria for one or more cluster C personality disorders and not for any other personality disorders were randomly assigned to receive 40 weekly sessions of short-term dynamic psychotherapy or cognitive therapy. The most common axis I disorders in the patient group were anxiety and depression diagnoses. Therapists were experienced, full-time clinicians and were receiving manual-guided supervision. Outcome variables included symptom distress, interpersonal problems, and core personality pathology. Measures were administered repeatedly during and after treatment, and change was assessed longitudinally by means of growth modeling procedures. RESULTS: The overall patient group showed, on average, statistically significant improvements on all measures during treatment and also during a 2-year follow-up period. Significant changes in symptom distress after treatment were found for the group of patients who received short-term dynamic psychotherapy but not for the cognitive therapy patients. Despite these differences in intragroup changes, no statistically significant differences between the short-term dynamic psychotherapy group and cognitive therapy group were found on any measure for any time period. Two years after treatment, 54% of the short-term dynamic psychotherapy patients and 42% of the cognitive therapy patients had recovered symptomatically, whereas approximately 40% of the patients in both groups had recovered in terms of interpersonal problems and personality functioning. CONCLUSIONS: Both short-term dynamic psychotherapy and cognitive therapy have a place in the treatment of patients with cluster C personality disorders. However, factors other than treatment modality may discriminate better between successful and poor outcomes. Such factors should be explored in future studies.

Adult↗
PubMed2001

Differentiating narcissistic and antisocial personality disorders.

The conceptual, clinical, and empirical overlap between the constructs of narcissistic personality disorder (NPD) and antisocial personality disorder (ASPD) is reviewed and their descriptive discriminability is investigated. Twenty-four patients with NPD and 16 patients with ASPD were compared on 33 characteristics for pathological narcissism assessed with the semistructured Diagnostic Interview for Narcissism. The results confirm a sufficiently broad array of similarities that the question of whether these categories should be kept separate (as they are in DSM-IV) is underscored. The results also indicate important areas of difference. The NPD sample was best discriminated from the ASPD sample by their grandiosity, that is, the tendency to exaggerate their talents, and to regard themselves as more unique and superior.

Adolescent↗
PubMed1998

Self-report assessment of the DSM-IV personality disorders. Measurement of trait and distress characteristics: the ADP-IV.

BACKGROUND: Self-report instruments assessing the DSM personality disorders are characterized by overdiagnosis due to their emphasis on the measurement of personality traits rather than the impairment and distress associated with the criteria. METHODS: The ADP-IV, a Dutch questionnaire, introduces an alternative assessment method: each test item assesses 'Trait' as well as 'Distress/impairment' characteristics of a DSM-IV criterion. This item format allows dimensional as well as categorical diagnostic evaluations. The present study explores the validity of the ADP-IV in a sample of 659 subjects of the Flemish population. RESULTS: The dimensional personality disorder subscales, measuring Trait characteristics, are internally consistent and display a good concurrent validity with the Wisconsin Personality Disorders Inventory. Factor analysis at the item-level resulted in 11 orthogonal factors, describing personality dimensions such as psychopathy, social anxiety and avoidance, negative affect and self-image. Factor analysis at the subscale-level identified two basic dimensions, reflecting hostile (DSM-IV Cluster B) and anxious (DSM-IV Cluster C) interpersonal attitudes. Categorical ADP-IV diagnoses are obtained using scoring algorithms, which emphasize the Trait or the Distress concepts in the diagnostic evaluation. Prevalences of ADP-IV diagnoses of any personality disorder according to these algorithms vary between 2.28 and 20.64%. CONCLUSIONS: Although further research in clinical samples is required, the present results support the validity of the ADP-IV and the potential of the measurement of trait and distress characteristics as a method for assessing personality pathology.

Adolescent↗
PubMed2001

The prevalence of personality disorders in a community sample.

BACKGROUND: To our knowledge, no previous studies of personality disorders (PDs) in a large representative sample of the common population have been conducted. METHODS: A representative sample of 2053 individuals between the ages of 18 and 65 years in Oslo, the capital of Norway, was studied from 1994 to 1997. Information about PDs was obtained by means of the Structured Interview for DSM-III-R Personality Disorders, in conjunction with an interview recording demographic data. The subjects were interviewed primarily at home, but in some instances, also at the clinic. RESULTS: The prevalence of PDs was 13.4% (SE, 0.7). The prevalence rates (SEs) for specific PDs, irrespective of whether a person had 1 or more PD, were: paranoid, 2.4% (0.3); schizoid, 1.7% (1.6); schizotypal, 0.6% (0.2); antisocial, 0.7% (0.2); sadistic, 0.2% (0.1); borderline, 0.7% (0.2); histrionic, 2.0% (0.3); narcissistic, 0.8; (0.2); avoidant, 5.0% (0.5); dependent, 1.5% (0.3); obsessive-compulsive: 2.0% (0.3); passive-aggressive, 1.7% (0.3); self-defeating, 0.8%, (0.2). The prevalence of PDs was highest among subjects with only a high school education or less, and living without a partner in the center of the city. CONCLUSIONS: Personality disorders were found to be prevalent, with avoidant, schizoid, and paranoid PDs more common, and borderline PD less common than what is usually reported. Personality disorders tend to be more frequent among single individuals from the lower socioeconomic classes in the center of the city. It is impossible to determine what is cause and what is consequence from a cross-sectional study.

Adolescent↗
PubMed1991

An evaluation of DSM-III-R personality disorders.

This study evaluated the extent to which the features of personality disorders are organized into the 11 diagnoses proposed by DSM-III-R. The traits composing personality disorder diagnoses were identified in earlier studies. Seventy-nine traits were required to represent personality diagnoses. Self-report scales were developed to measure each trait. The factorial structure underlying the trait scales was examined in a sample of 158 patients with a primary diagnosis of personality disorder and a sample of 274 general population subjects. Eleven principal components were extracted from each data set and were rotated to the same oblique criterion. The decision to extract 11 components was based on a priori expectations derived from DSM-III-R. Factor comparability coefficients were computed to quantify the similarity of the 2 solutions. A high degree of similarity was observed between the factor structure in the clinical and general population samples, suggesting that features of personality pathology are continuous dimensions. Although a number of factors demonstrated a degree of resemblance to some DSM-III-R diagnostic categories, the overall correspondence was not strong. A second-order factor analysis failed to reproduce the 3 Axis II diagnostic clusters. The results do not support the categorical model used in DSM-III-R and they provide only limited support for DSM-III-R diagnostic concepts.

Adult↗
PubMed1989

Update on instruments to measure DSM-III and DSM-III-R personality disorders.

In the last 2 years, researchers have revised personality instruments to encompass the DSM-III-R criteria for personality disorders. More recent, innovative instruments undergoing validity work include a self-report instrument that rederives DSM-III personality categories from dimensional measures, a self-report designed to be used in conjunction with a diagnostic interview, an interview designed to be given by trained lay people, and a family history measure of the DSM-III personality disorder clusters. The modifications of older instruments and those instruments more recently developed are described. Clearly instruments require additional validity testing and better test-retest reliability. Discrepancies between different measurement instruments also need to be addressed.

Humans↗
PubMed2006

Early visual information processing deficit in depression with and without Borderline Personality Disorder.

Backward masking is a measure of early visual information processing usually abnormal in psychotic disorders. Previous studies of subjects with Borderline Personality Disorder have been inconsistent regarding their impairment or lack of impairment on backward masking. We examined visual backward masking performance in samples of unmedicated depressed patients with (n=12) and without (n=16) Borderline Personality Disorder, and healthy volunteers (n=18). Accuracy was poorer in depressed BPD patients, relative to both non-BPD depressed and healthy comparison subjects. As in previous studies, no differences in accuracy were found between non-BPD depressed patients and healthy comparison subjects. Differences in BPD subjects' accuracy were most evident at the fastest ISI and were not attributable to intercurrent psychotic symptoms. Beyond these group differences, accuracy at faster ISI's correlated with self-ratings of impulsiveness in all patients, and may be a general correlate of this trait. Poor early information processing appears to be a feature of Borderline Personality Disorder, and may play a role in the impulsive behavior that is characteristic of the disorder.

Adult↗
PubMed2001

Discriminative validity of the MacAndrew Alcoholism Scale with Cluster B personality disorders.

This study was designed to assess the ability of the Minnesota Multiphasic Personality Inventory (MMPI-2) MacAndrew Alcoholism Scale (MAC-R) to differentiate between outpatients with personality disorders with Substance-Related Disorders (SRDs) and without SRDs. MMPI-2 validity, clinical, and MAC-R scale scores were compared in an SRD Cluster B group (comprised of Narcissistic, Antisocial, Borderline, and Histrionic; n = 15), a non-SRD Cluster B group (n = 33), and a non-SRD group with personality disorders from Clusters A and C (n = 18). Results revealed that the substance-abusing Cluster B group scored significantly higher on the MAC-R ( p <.0001) as well as the Psychopathic Deviate scale ( p <.01). Dimensional analyses illustrated that MAC-R scores were related to the presence of an SRD diagnosis (rpb =.70, p <.0001) and diagnostic criteria for Antisocial Personality Disorder (r =.60, p <.0001). Stepwise regression revealed that (in order of magnitude) the presence of a substance-abuse diagnosis followed by diagnostic criteria for Antisocial and Histrionic Personality Disorders were most related to MAC-R scores (R =.78, R(2) =.60). This indicates that the MAC-R may be more related to the presence of an SRD than has been suggested, and when used in outpatient settings as MacAndrew (1965) intended, the MAC-R may be useful as a screening device for assessing SRD among outpatients with Axis II psychopathology.

Adult↗
PubMed1993

Personality disorders in DSM-III-R as categorical or dimensional.

Despite the atheoretical approach of the DSM-III-R, the personality disorders have their roots in specific theoretical schools. Due to clinical tradition, analogies with Axis I and the tradition in psychiatry and medicine, the personality disorders are presented as categories although there is more empirical support for a dimensional approach. This study attempted to determine whether the separate personality disorders meet Kendell's criteria for distinct entities, i.e., bimodality with distinct points of rarity. None of the personality disorders met the criteria for a distinct disease entity. Instead, all of the personality disorders presented as continuous, dimensional personality traits present among healthy subjects and more pronounced in patients with mental disorders.

Adult↗
PubMed2000

Personality and personality disorders in chronic pain.

Personality characteristics and disorders have long been noted in the chronic pain population. Clinicians and researchers alike will attest to the high rates of personality difficulties encountered in these individuals. Historically, it has been found that certain personality styles such as hypochondriasis and hysteria are common in chronic pain suffers. In addition, the prevalence of personality disorders (PDs) is significantly greater in the pain population than in the general population or in medical or psychiatric populations. A diathesis-stress model has been suggested to account for this finding and is discussed in this article, with implications for both treatment and research.

Chronic Disease↗
PubMed1996

The assessment of personality disorders: implications for cognitive and behavior therapy.

This article reviews the comorbidity of personality disorders (PDs) and Axis I disorders and discusses implications for assessment and treatment. Pros and cons of various assessment methods are discussed. The co-occurrence of PDs with Axis I disorders is considerable; roughly half of patients with anxiety disorders, depressive disorders or eating disorders received a PD diagnosis. Comorbidity models are discussed and implications for assessment and treatment are provided. Regarding the impact of PDs on cognitive-behavioral treatment outcome for Axis I disorders, conflicting results are found due to differences in assessment methods, treatment strategies, and patient samples. It is argued that additional Axis I pathology should be taken into account when studying the impact of PDs on treatment outcome for the target Axis I disorders. Finally, it is argued that the interpersonal behavior of the PD patient and the therapeutic relationship deserve more attention in the assessment and treatment of patients with PDs.

Comorbidity↗
PubMed1993

MMPI assessment of the DSM-III-R histrionic personality disorder.

This study investigated the MMPI characteristics of a group of 25 Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) histrionic personality disorder patients, contrasted with a mixed group of 57 other personality disorder patients. All patients were diagnosed by means of a semistructured interview (SCID-II; Spitzer, Williams, & Gibbon, 1987). Effects for diagnostic category were found for MMPI Scales 9 (Ma), 0 (Si) and for the HST scale, developed by Morey, Waugh, and Blashfield (1985) for the diagnosis of the histrionic personality disorder. Further analysis of the results revealed that these MMPI scales, and especially the HST scale, mainly assess a social introversion-extraversion dimension, on which histrionic inpatients can be differentiated from nonhistrionic inpatients. This study does not offer direct empirical support for the use of the HST scale as a measurement of the DSM-III-R histrionic personality disorder concept.

Adolescent↗
PubMed1999

A profile analysis of personality disorders: beyond multiple diagnoses.

The authors applied cluster analysis and multidimensional scaling to the analyses of 59 patients with personality pathology. Cluster analysis yielded eight typologies of patients: detached, anankastic, phobic, dramatic, erratic, emotional, milder emotional, and masochistic negativistic. Multidimensional scaling identified the dimensions of classifying patients: anxious rumination versus behavioural acting out, overall severity of personality pathology, and assertiveness versus withdrawal. Considering the distinction between personality disorder (dysfunctional personality) and abnormal personality (extreme personality), the following changes in current classification system are proposed: use of a hierarchy and exclusion criteria in a categorical-type model or use of a personality profile in a dimensional-trait model, in either case, with a dimensional rating for severity of psychopathology to define personality 'disorder'.

Adult↗