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PubMed2002

[Models for understanding personality pathology].

BACKGROUND: The prevalence of personality disorders is high and patients with personality disorders are known to be difficult to treat. The assessment of different types of personality disorders has been facilitated by the development of explicit diagnostic criteria. However, the diagnostic manuals have tended to be atheoretical, defining and classifying personality disorders mainly on a descriptive level of behaviour and symptoms. There is no consensus on a theoretical understanding of personality pathology. The concept of personality disorder is currently under debate and investigation, theoretically as well as empirically. MATERIAL AND METHODS: This paper presents some of the major theories of personality disorders that are currently discussed in the literature. RESULTS: The models represent different schools of thought, lean on different methodological assumptions, and focus on different aspects of personality. The theories are to varying degrees focused on aetiology, classification and treatment. A major trend is to supplement theories developed within the context of clinical psychiatry with models from normal psychology. INTERPRETATION: Personality disorder is a complex phenomenon. Different theories are probably useful for different aspects of personality pathology and for different groups of personality disorders. More empirical research is needed in order to clarify the validity of the different models.

Behavior↗
PubMed2003

Personality pathology and cognitive-behavioral treatment of fear of flying.

Studies have been inconclusive about the influence of personality pathology on treatment outcome in anxiety disorders. In general, it has been presumed that treatment outcome is negatively influenced by the presence of personality pathology. This is a study of the prevalence of personality pathology among persons who were seeking help for fear of flying. Moreover, the effects of personality pathology on the results of a multimodal, standardized, cognitive-behavioral fear of flying treatment program employed by an agency that specializes in treating people with fear of flying were studied. Personality pathology was determined with a self-report questionnaire, which provides ICD-10 diagnoses of personality disorders and dimensional severity scores for personality pathology. Treatment outcome was assessed with three different fear of flying questionnaires. Based on clinical judgment after individual-case conceptualization, participants (N=922) were assigned to a particular treatment for fear of flying. Self-report data for fear of flying were collected at pretreatment and at 3, 6 and 12-month follow-ups in 659 participants who followed the 2-day treatment program. Moreover, the number of flights made in the year following treatment was determined.The results of this study showed that participants with personality pathology, mainly from cluster C (anxiety), report greater fear of flying before treatment than participants without personality pathology. After treatment fear of flying was significantly reduced. Presence of personality pathology was not predictive of the number of flights after treatment and scores on the VAFAS scale at short or long term. Only on two questionnaires for fear of flying collected at short-term participants with personality pathology obtained significantly higher scores, although the size of the differences was relatively small. It was concluded that participants with personality pathology also benefited from fear of flying treatment and that the presence of personality pathology although cannot be regarded as a contra indication for a standardized, cognitive-behavioral group treatment.

Adolescent↗
PubMed1997

Era-related changes in the Japanese cultural and social structure and conformist personality pathology--with a particular emphasis on borderline personality disorder.

We discussed relationship between the change of social structure and the specific conformist personality pathology, that is, Morita shinkeishitsu and borderline personality disorder. Morita shinkeishitsu that has been regarded as a basic pathology of broad range of neurosis is seldom seen in daily practice these days. On the other hand, borderline personality disorder that is a relatively new diagnostic domain is regarded as having a contemporary pathology, for example impulsivity, drug and sex abuse, and fragile interpersonal relationship. We consider that Morita shinkeshitsu corresponds to an industrialized society and that borderline personality disorder corresponds to a post industrialized (information based) society. This assumption should be leaded to the further discussion from a point of view of treatment.

Borderline Personality Disorder↗
PubMed1982

Personality pathology underlying chronic prostatitis.

Personality testing was performed on 56 patients with clinical symptoms of chronic prostatitis. The psychological methods used were RO, TAT, FAM and Beck's Depression Inventory. Q factor analysis of the patients was performed and yielded four factors representing four different personality pathologies, i.e. psychosomatic structure, alexithymic personality, borderline personality and narcissistic personality. The duration of the somatic symptoms correlated positively with the severity of the psychic symptoms. The etiology of the different pathologies expressed by the patients with chronic prostatitis was, according to the researchers, the same. All are disorders of the pregenital level and all can be interpreted as a consequence of disturbance of the first object relationships, the key factor being defective fantasy development.

Adult↗
PubMed2002

Personality pathology and treatment outcome in major depression: a review.

OBJECTIVE: A longstanding belief among many clinicians is that patients with depression and comorbid personality pathology have a worse response to standard depression treatment. This presents potentially significant treatment implications, since personality pathology in depressed patients appears to be common. METHOD: PsycINFO and MEDLINE were systematically searched for studies relating personality to treatment outcome. Over 50 studies were obtained and grouped according to the method used to assess personality pathology. RESULTS: High neuroticism scores generally predicted worse outcome, especially over long-term follow-up. Tridimensional Personality Questionnaire scores did not have a consistent relationship to treatment outcome despite some promising initial findings. Most studies involved patients with comorbid personality disorders; these studies produced conflicting results. Other measures of personality pathology produced an array of findings ranging from a moderately worse outcome to no difference. CONCLUSIONS: Whether or not personality pathology significantly worsens outcome in patients with major depression appears to depend on study design, since the rate of personality pathology varies markedly depending on how it is measured. In addition, depressed patients with personality pathology appear less likely to receive adequate treatment in uncontrolled studies. Finally, studies rarely control for depression characteristics (e.g., chronicity, severity) that may influence outcome and be related to personality pathology. Overall, the best-designed studies reported the least effect of personality pathology on depression treatment outcome. Clinically, this suggests that comorbid personality pathology should not be seen as an impediment to good treatment response.

Comorbidity↗
PubMed2002

Relationship between attachment patterns and personality pathology in adolescents.

OBJECTIVE: To explore the relationship between attachment status and personality pathology in a large clinical sample of adolescents. METHOD: Two hundred ninety-four randomly selected psychiatrists and psychologists were each asked to provide data on a patient (aged 14-18 years) in treatment for maladaptive personality patterns. Clinicians completed several measures including a clinician-report attachment questionnaire, several measures of personality pathology, and a clinician-report version of the Child Behavior Checklist. RESULTS: In both dimensional and categorical analyses, secure attachment was negatively correlated with personality pathology and positively correlated with healthy functioning, whereas disorganized/unresolved attachment was strongly associated with multiple forms of personality pathology. Anxious/ambivalent attachment tended to be associated with measures of withdrawal, internalization, and introversion. Avoidant attachment style was not associated with any single form of personality pathology. CONCLUSION: The marked association between unresolved attachment and more severe psychopathology in adolescents, the lack of construct validity of avoidant personality disorder in adolescents, and the broader relations among attachment, personality, and psychopathology are discussed.

Adolescent↗
PubMed1998

Refining the measurement of axis II: a Q-sort procedure for assessing personality pathology.

The measurement of personality disorders (PDs) has proven to be a difficult enterprise. This article describes two initial studies of the validity and reliability of the Shedler-Westen Assessment Procedure (SWAP), a Q-sort procedure that quantifies clinical judgment, which may be useful both for assessing personality pathology and for empirically refining Axis II categories and diagnostic criteria. In the first study, 153 clinicians from a random national sample used a version of the Q-sort to describe either a prototype or actual patient with either a borderline, antisocial, histrionic, or narcissistic personality disorder. Correlations between aggregated prototype and actual patient profiles provided evidence for convergent and discriminant validity, and a cluster-analytic procedure (Q-factor analysis) produced revised criteria for the four disorders that minimized the problem of comorbidity. In Study 2, a pilot sample of patients were interviewed using a clinical research interview that mirrors the way clinicians assess personality and PDs. The study yielded promising results with respect to the possibility of obtaining reliable Q-sort descriptions based on an interview that resembles a clinical interview rather than the direct-question format used in current Axis II structured interviews. It also produced strong correlations between Q-sort descriptions made by interview and those made independently by the treating clinician, further supporting the validity of the instrument. The findings suggest the potential utility of the SWAP as a measure of PDs and as a method for empirically refining Axis II categories and criteria.

Adult↗
PubMed1999

Dimensional assessment of personality pathology in patients with eating disorders.

This study examined patients with eating disorders on personality pathology using a dimensional method. Female subjects who met DSM-IV diagnostic criteria for eating disorder (n = 136) were evaluated and compared to an age-controlled general population sample (n = 68). We assessed 18 features of personality disorder with the Dimensional Assessment of Personality Pathology - Basic Questionnaire (DAPP-BQ). Factor analysis and cluster analysis were used to derive three clusters of patients. A five-factor solution was obtained with limited intercorrelation between factors. Cluster analysis produced three clusters with the following characteristics: Cluster 1 members (constituting 49.3% of the sample and labelled 'rigid') had higher mean scores on factors denoting compulsivity and interpersonal difficulties; Cluster 2 (18.4% of the sample) showed highest scores in factors denoting psychopathy, neuroticism and impulsive features, and appeared to constitute a borderline psychopathology group; Cluster 3 (32.4% of the sample) was characterized by few differences in personality pathology in comparison to the normal population sample. Cluster membership was associated with DSM-IV diagnosis -- a large proportion of patients with anorexia nervosa were members of Cluster 1. An empirical classification of eating-disordered patients derived from dimensional assessment of personality pathology identified three groups with clinical relevance.

Adolescent↗
PubMed1998

Personality pathology and drinking in young men at high and low familial risk for alcoholism.

OBJECTIVE: Three groups varying in familial alcoholism risk were compared with respect to amount of alcohol consumption, presence of personality pathology, and the relationship between personality pathology and alcohol consumption. METHOD: Research subjects were young adult men recruited from local colleges, a trade school and the community. The risk groups included (1) a group with a biological alcoholic father and significant additional familial alcoholism (n = 106); (2) subjects with an alcoholic father, but without significant additional familial alcoholism (n = 100); and (3) a group with no paternal alcoholism and at most only one second/third-degree alcoholic relative (n = 190). Absolute daily ounces of alcohol was determined using a standard quantity-frequency scale. Prevalence of DSM-III-R personality disorders (PDs) was evaluated using the Personality Disorder Questionnaire-Revised both with and without application of an impairment and distress scale. Familial risk determination was based on agreement between four separate self-report assessments. RESULTS: The first group consumed significantly more alcohol than the other two groups, which did not differ in alcohol consumption. The first group's subjects were more likely to meet criteria for virtually all of the PD diagnoses than were the other two groups. A greater proportion of the second group's subjects qualified for various PDs than did the third group's subjects. Personality pathology was consistently or usually associated with more drinking in the first and third groups, respectively, but associated with less consumption in the second group. CONCLUSIONS: Young men with high-density familial alcoholism are at greater risk for the development of alcoholism than those with alcoholic fathers and little additional familial alcoholism. Relationships between personality pathology and alcohol consumption, and possibly the development of alcoholism, differ for the three risk groups.

Adult↗
PubMed2003

Changes in personality pathology after pharmacotherapy and combined therapy for depressed patients.

The central question addressed by this article is whether courses of treatment consisting of pharmacotherapy or pharmacotherapy combined with psychotherapy (combined therapy) produce different changes in personality pathology at follow-up after 40 weeks. We also examined whether recovery from depression has an influence on outcome. The study population consisted of 128 outpatients in whom personality pathology and severity of depression were determined at the start of the study. For 72 patients, personality pathology and severity of depression were determined again after 40 weeks. Of the group of 72 patients, 25 patients received only pharmacotherapy for 6 months, and 47 patients received combined treatment (pharmacotherapy and psychodynamic supportive psychotherapy). The antidepressant protocol provides for three successive steps in case of intolerance or inefficacy: fluoxetine, amitriptyline, and moclobemide. The combined therapy condition consisted of 16 sessions of Short Psychodynamic Supportive Psychotherapy in addition to pharmacotherapy. In the combined therapy condition there was a significant reduction in personality pathology in patients who recovered from depression but also in patients who had not. In the pharmacotherapy condition the significant decrease was restricted to patients who recovered from depression. The results were most striking for Cluster C psychopatology. Patients with cluster B pathology changed the least. Depressed patients with comorbid personality pathology appear to benefit most from a combination of pharmacotherapy and a form of short, psychodynamic, supportive psychotherapy.

Adult↗
PubMed1998

Limitations of axis II in diagnosing personality pathology in clinical practice.

OBJECTIVE: DSM-IV's axis II is limited to severe personality disturbances, posing difficulty for diagnosing less severe but nonetheless clinically significant personality pathology. The authors examined the percentage of patients treated in clinical practice for personality pathology who are diagnosable with DSM-IV. METHOD: Psychiatrists and psychologists from a random national sample provided diagnostic data on 714 patients treated for enduring, maladaptive personality patterns. RESULTS: Only 39.4% of the patients had diagnosable axis II disorders. This percentage was relatively stable across clinicians' theoretical orientations and did not vary substantially when axis I diagnosis was controlled for. CONCLUSIONS: DSM-IV cannot be used to diagnose most patients being treated for personality problems. The range of axis II should be broadened to encompass the range of personality pathology seen in clinical practice.

Adult↗
PubMed2001

Personality pathology, depression and HPA axis functioning.

Hypothalamic pituitary adrenal (HPA) axis functioning, as measured by the dexamethasone suppression test (DST), has been extensively investigated in major depressive disorder (MDD). Evaluating DST response in MDD patients while simultaneously considering clinically relevant personality disorders may further clarify the contribution of both personality pathology and HPA axis function to depressive symptoms. The present study measured personality pathology by administering the revised version of the Millon Clinical Multiaxial Inventory (MCMI-II) in a sample of 25 patients diagnosed with MDD. Analyses revealed that suppressors (n = 19) scored significantly higher than non-suppressors (n = 6) on six of the 13 MCMI-II personality disorder scales: Avoidant, Schizoid, Self-Defeating, Passive-Aggressive, Schizotypal and Borderline. Increased personality pathology was associated with normal suppression of cortisol following the DST. This suggests that suppression of the DST may be associated with depressive states linked with personality pathology while the more biologically based depression is associated with abnormal HPA pathophysiology. Copyright 2001 John Wiley & Sons, Ltd.

Journal Article↗
PubMed2001

The relationship between traumatic experiences, dissociation, and borderline personality pathology among male forensic patients and prisoners.

In the present study the relationship between traumatic experiences, dissociation, and borderline personality disorder pathology is examined in a group of 39 male forensic patients and 192 male prisoners. Sexual and emotional abuse are significantly more common among forensic patients than among prisoners. Patients also report a broader range of different kinds of traumas. Prisoners report significantly more dissociative symptoms. Analyses of the relationship of type of trauma on the one hand and dissociation and borderline personality pathology on the other show that sexual abuse is significantly associated with borderline personality pathology but not with dissociation among the patients. In the prison sample these associations are found only for familial but not extrafamilial sexual abuse. When the subjects are grouped on account of presence or absence of a borderline personality disorder, highly significant differences on dissociation are found between both groups. The results from this study lend support to the hypothesis that sexual abuse is not related to dissociative symptoms but merely to borderline personality pathology. Because most subjects in this study are not patients, these findings are not likely to be confounded by false memories of traumatic events that are recovered by psychotherapy. Furthermore, dissociative symptoms are found to be related to borderline personality pathology and not to the experience of traumatic events.

Adult↗
PubMed1978

[Variants of postprocess pathological personality development].

The authors consider some cases of postattack conditions in schizophrenia as a result of postprocess pathological personality development. A study of a group of schizoprenic patients (74 cases) made it possible to distinguish 6 variants of postprocess pathological personality (hypochondric, asthenical, development with querulous reactions, of a protracted reaction type, withdrawal from contacts, reaction of an animation type, reactions of protests). The authors propose to indicate the variant of a personality development in the framework of a functional diagnosis in order to make a more definite orientation of the rehabilitative measures.

Adult↗
PubMed1987

[Evaluation of the classification of pathological personality development of exogenous organic origin by the main component method].

The author has tested the developed classification of the pathological personality development of the exogenic-organic genesis using the method of main components. On the basis of the mathematical processing of clinical symptomatology in 348 patients with various types of the pathological development (asthenic, hysteriform, hypochondriac, explosive) the author has defined three main components: "excitability", "inhibition" and "hypochondriac anger". An analysis of the distributional pattern of types of the pathological personality development in orthogonal planes of three main components has made it possible to establish the adequacy of the proposed classification of the internal structure of the disease and identify the variants appearing as "unifying" and "distinguishing" borderlines between individual types.

Borderline Personality Disorder↗
PubMed1999

The relationship between personality pathology and dysfunctional cognitions in previously depressed adults.

Multivariate and univariate regression models were used to examine the relationship between Axis II personality pathology and dysfunctional cognitions in a follow-up study of 40 formerly depressed inpatients. A dimensionalized measure of overall Axis II pathology was significantly and positively related to dysfunctional attitudes (Dysfunctional Attitudes Scale [DAS]) and maladaptive negative event attributions (Attributional Style Questionnaire-Negative Composite [ASQ-N]); the Axis II measure accounted for approximately 29% of the variance in DAS and 14% of the variance in ASQ-N, after controlling statistically for subsyndromal depressive symptoms (Beck Depression Inventory [BDI]). Axis II pathology was not significantly associated with positive event attributions, and no significant Axis II x BDI interaction effects were observed. A secondary canonical analysis of Axis II clusters was largely consistent with a hypothesized general personality pathology factor associated with dysfunctional cognitions, though a more specific association between Axis II Cluster C pathology and dysfunctional attitudes was also observed.

Adult↗
PubMed1994

Assessing aviators for personality pathology with the Millon Clinical Multiaxial Inventory (MCMI).

Psychiatrists independently evaluated 82 aviators referred to an aeromedical consultation service who had been administered the Millon Clinical Multiaxial Inventory (MCMI). The MCMI personality scales of those aviators psychiatrically deemed to be free from personality pathology were compared to the scales of those aviators psychiatrically assessed to have maladaptive personalities. The MCMI personality scales reached statistical significance (p < 0.005) for identifying Diagnostic and Statistical Manual of Mental Disorders (2) Cluster C (dependent or avoidant or both) maladaptive personality traits, but did not reach statistical significance for Cluster B (histrionic or narcissistic or both) traits. Military aviators are a highly selected group who have mastered numerous obstacles and who continually prove their adaptability. The prevalence of personality pathology is likely not as great in this population as would be suggested by the MCMI. An elevation of a Cluster C scale, however, warrants a high index of suspicion.

Adult↗
PubMedDate not supplied

Personality pathology in bulimics versus controls.

The Millon Clinical Multiaxial Inventory (MCMI) was administered to 37 bulimic women, as well as 32 female general psychiatric outpatients and 30 normal women in order to assess contrasts in prevalence of various types of personality pathology among the three groups. Bulimic women displayed significantly greater pathology on scales measuring dependent and avoidant characteristics. However, they were not significantly different from female psychiatric outpatients with regard to most types of personality pathology. Results are discussed within the framework of previous literature on personality characteristics and disorders within the bulimic population.

Adolescent↗