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PubMed1989

The relationship between borderline personality disorder and anxiety disorders.

Eleven "pure" borderlines, ten borderlines with depression, 16 "pure" depressives, and 31 normal subjects were compared on a number of standardized inventories of anxiety. While patient groups experienced more anxiety of all types than did normals, borderlines did not emerge as more anxious than other patient groups. Qualitative differences in the anxiety experienced by borderlines and nonborderlines are discussed.

Adult↗
PubMed1982

[Phenomenon of visualized images in children and adolescents].

The authors examined clinically and psychopathologically, and followed up 39 children and adolescents with various borderline nervous and psychic disorders in whom a super-worship fantasy or other psychic formations were accompanied with visualized imagination that consisted in fancying bright, sensual images localized within the patient's subjective space and having a dynamic subject character corresponding to the fantasies and other experiences subjectively important for the patient. The visualized imagination is regarded as an independent productive-dysontogenetic syndrome.

Adolescent↗
PubMed2000

Borderline personality and obsessive-compulsive symptoms.

Diagnostic criteria for borderline personality disorder (BPD) are diverse, covering a broad range of symptoms. One criterion, self-mutilation, is a behavioral excess that may be considered a predictor of other psychopathological states. The present study sought to determine the extent to which two groups of BPD patients, those who mutilate and those who do not, differed on measures of general psychopathology, depression, anxiety, and obsessive-compulsive symptoms. Results indicate that the only source of significant variation was the level of obsessive-compulsive symptoms, with mutilators exhibiting greater symptomatology. The findings from this study support the idea that self-mutilation is a more severe form of psychopathology relative to the rest of the BPD population. These results are interpreted based on the affect regulation model of self-mutilation, and contrasted with contemporary models of impulse control in relation to obsessive-compulsive disorder.

Adult↗
PubMed1996

Platelet serotonergic markers and Tridimensional Personality Questionnaire measures in a clinical sample.

A group of patients with major depressive disorder, with and without comorbid obsessive-compulsive disorder, completed the Tridimensional Personality Questionnaire (TPQ). Harm Avoidance scores were found to be high compared to published age-matched norms and to display a significant positive correlation with Hamilton Depression Rating Scale scores. Platelet 125I-lysergic acid diethylamide (125I-LSD) and 3H-paroxetine binding Bmax values were measured to test Cloninger's hypothesis that Harm Avoidance scores would correlate significantly with measures of serotonergic function. A significant inverse correlation was found between Harm Avoidance scores and 125I-LSD Bmax values. Correlations between 3H-paroxetine Bmax values and TPQ scale scores were not significant. These results suggest an alternative view of the literature relating platelet 5-hydroxytryptamine-2a receptors and mood disorders in that the temperament dimension, Harm Avoidance, may explain prior inconsistencies involving links with depression and suicidality.

Adult↗
PubMed2004

Serotonin function, personality-trait variations, and childhood abuse in women with bulimia-spectrum eating disorders.

BACKGROUND: Across populations, findings associate impulsivity, behavioral disinhibition, or hostility with reduced central serotonin (5-hydroxytryptamine: 5-HT) activity and increased likelihood of childhood abuse. Inconsistently, findings associate compulsivity, behavioral inhibition, or anxiousness with elevated 5-HT neurotransmission. We explored relationships among measures of 5-HT system functioning, behavioral inhibition/disinhibition, and childhood abuse in women with bulimia-spectrum eating syndromes. METHOD: In 73 bulimic (body mass index [kg/m2] under 30, binge eating at least once weekly) and 50 normal-eater control women, we obtained indices of platelet paroxetine binding and 5-HT agonist (m-CPP)-stimulated neuroendocrine responses. Cluster analysis was used to classify the bulimic women according to 5-HT "profiles." Resulting groups were then compared on symptom and trait measures. RESULTS: Measures of paroxetine-binding density (Bmax) and affinity (Kd) contributed significantly (p < .001 and p < .02, respectively) to a classification of bulimic women into groups with "low density/high affinity" (N = 52) or "high density/low affinity" (N = 21) binding. The 5-HT based classification did not predict eating-symptom severity. However, the "high density" pattern was associated with increased perfectionism and compulsivity, reduced risk of childhood sexual abuse, and (to some extent) reduced probability of borderline personality disorder. DISCUSSION: In women with bulimic syndromes, serotonergic factors, personality-trait variations, and developmental typologies converge in principled fashion. Our findings corroborate (with neurobiological evidence) the concept of underregulated and overregulated subtypes within the bulimic population.

Adolescent↗
PubMed1998

Psychopathological considerations on the relationship between bulimia and obsessive-compulsive disorder.

The relationship between eating disorders, impulse control disorders and obsessive-compulsive disorder as part of a so-called 'obsessive-compulsive spectrum' is discussed, with particular emphasis on the relationship between eating disorders (particularly bulimia) and obsessive-compulsive disorder. The empirical studies on comorbidity, personality and familiarity are briefly reviewed. Both similarities and differences found in personality, body image, mental rumination, fears, physical exercises, rituals, impulses (bulimic binging and obsessive impulses) and purging behaviors of these patients are discussed from a psychopathological point of view. In particular the importance of distinguishing between obsessive thoughts and prevalent (dominant) thoughts is underlined; the distinctions between repetitive weight controls, physical exercises and purging behaviors of eating disorder patients on the one hand and compulsions on the other, and the distinction between binge impulses and obsessive impulses, are also stressed.

Anorexia Nervosa↗
PubMed1993

DSM-III-R personality disorders in a mood and anxiety disorders clinic: prevalence, comorbidity, and clinical correlates.

This study examined the prevalence, comorbidity, and clinical correlates of personality disorders in an outpatient sample (N = 352) with anxiety and depression. Subjects were diagnosed using the Structured Clinical Interview for DSM-III-R (SCID) on Axes I and II, and they also completed interview and self-report measures of symptoms. Subjects with a personality disorder were less likely to be married, more likely to be single or divorced, had lower family incomes, had more severe symptoms of both anxiety and depression, and had a greater number of lifetime Axis I diagnoses. Subjects with dysthymic and bipolar disorders were more likely, and subjects with panic disorder uncomplicated by agoraphobia were less likely to have a personality disorder compared to the rest of the sample. The most prevalent personality disorders were Avoidant, Obsessive-Compulsive, Paranoid, and Borderline. Paranoid co-occurred with Narcissistic, and Borderline co-occurred with Histrionic personality disorder significantly more often than chance and base rates would predict.

Adolescent↗
PubMed2005

Development of scales to screen for eight common psychiatric disorders.

The present study was designed to create a group of scales from the items on the Symptom Checklist 90 (SCL-90) to identify common psychiatric diagnoses. Subjects were 1457 adult psychiatric outpatients who completed the Symptom Checklist-90 and a structured diagnostic interview at the time of their initial evaluation. A combination of rational and empirical test construction methods was used to create the SCL-90 Diagnostic Scales, item sets that identify eight common psychiatric conditions: major depression, bipolar disorder, schizophrenia, antisocial personality disorder, somatization disorder, obsessive-compulsive disorder, panic disorder, and agoraphobia. These specially constructed scales were found to possess good internal reliability. These scales were also shown to differentiate patients positive for each of the eight psychiatric disorders from other psychiatric patients who did not have that disorder. Sensitivities and specificities are reported for each item set. In addition to their utility at the time of initial assessment as an aid in identifying diagnosis, the SCL-90 Diagnostic Scales may have other potential uses, such as in monitoring the symptom course of the patient's disorder or disorders over time.

Ambulatory Care↗
PubMed1995

Defense mechanisms in severe adolescent anorexia nervosa.

OBJECTIVE: To compare ego defense mechanisms in adolescents with anorexia nervosa and other major psychiatric disorders, to defenses in healthy adolescents. METHOD: Thirty-seven patients with anorexia nervosa, 30 with major depressive disorder, 20 with obsessive-compulsive disorder, 53 with borderline personality disorder, 60 with schizophrenia, and 81 healthy controls were assessed with Pfeffer's Ego Defense Scale. RESULTS: Regression, denial, projection, repression, introjection, and total defenses were common to all psychiatric patients and distinguished them from normal adolescents. In addition to these defenses, anorectic patients also used intellectualization more frequently than normal adolescents and psychiatric patients. They used sublimation more than other psychiatric patients. Patients with disorders, apart from obsessive-compulsive disorder, that are considered to be often comorbid with anorexia did not have different defense than schizophrenic patients. CONCLUSIONS: Anorectic adolescents overutilize relatively more mature defenses than do psychiatrically ill adolescents, and they overutilize immature defenses compared with normal adolescents. This combination of mature and immature defenses may be related to the uniquely heterogeneous ego functioning seen in anorectic patients, and it may provide insight into the nature of the psychopathology of anorexia nervosa. It also could have important psychotherapeutic and prognostic value.

Adolescent↗
PubMed1984

Volitional disability and physician attitudes toward noncompliance.

We develop the concept of a volitional disability as an aid in understanding those patients who behave in ways that are harmful to themselves in spite of their desire to do otherwise. Using this concept enables us to describe their behavior as intentional but 'involuntary'. We demonstrate the clinical reality of such behavior by giving clinical examples of the behavior of those with phobic, compulsive, and addictive disorders. We then attempt to show how some kinds of self-harming behavior of noncompliant patients are similar to phobic and compulsive behavior. We propose use of the concept of volitional disability to make it easier for physicians to work with these noncompliant patients and thus to improve their ability to provide better care for them.

Adolescent↗
PubMedDate not supplied

[Pharmacotherapy in personality disorders: methodological issues and results].

The pharmacotherapy of personality disorders is less developed than are psychological treatments in this area, but they are a logical prolongation of psychobiological models of personality and temperament, and respond to the need of many clinicians in front of difficult patients. The assessment of drugs effects in personality disorders includes some important conceptual and methodological issues. Categorical or dimensional instruments evaluating baseline personality and under-treatment changes are now available. Such studies are necessary of long duration, with difficult patients, and use specific outcome criteria. The results obtained in the field of pharmacotherapy of personality disorders can be classified according to DSM IV axis-II categorization. In anxious personalities (cluster C), some isolated studies suggest a favourable effect of antidepressants on obsessive-compulsive dimension, on avoidant personality disorder, and on inhibition and trait-anxiety, especially when serotoninergic agents are used. Few studies have been conducted in cluster A personality disorders, and some are in favour of the interest of low doses of antipsychotic drugs in this group. Most studies have been conducted in cluster B, and especially in antisocial and borderline personality disorders. Partial positive results have been obtained using various classes of drugs for dealing with aggression and impulsive behaviors, including lithium, beta-blockers, carbamazepine, valproate, antipsychotic drugs, and also SSRIs. Self-harm and suicidal behaviors seem to be partially but significantly improved by antidepressants and low doses of antipsychotics. Opioid antagonisms may be helpful for these indications in the future. Other symptom-oriented strategies for psychopharmacology have been conceptualized, focused on depressive personality, emotional lability, cognitive and perceptual disturbances, or interpersonal sensitivity. Overall, the pharmacotherapy of personality disorder remains to date one of the less explored in psychiatry research. Nevertheless, it may lead in the future to the development of effective treatments, in complement to psychotherapy, for actually severe, chronic, and disabling disorder.

Antidepressive Agents↗