Conspiracy theories, personality dimensions and personality disorders.

A Young Attorney Presents for Outpatient Treatment of Depression Ms.Bisa32-year-oldsingleCaucasianwomanwhowasreferred byafriend’spsychiatristformentalhealthtreatmentforthe first time after a 4-month period of depression. She reported persistent feelings of “emptiness” and “worthlessness,” increased sleeping with difficulty getting out of bed, impaired concentration, decreased energy nearly every day, slight weight gain, and ruminations about her childhood and family life. The depressionstartedaftershewastoldather firmthatshewasnotgoingto be considered for partnership. Her initial reaction was one of anger, bitter disappointment, and shame, but this gave way to feelingsofdepressionandworryaboutherfuture.Sheadmittedto thoughts of death and dying but denied having any suicidal ideation. Ms. B does notdrink alcoholor use any other substances and she denies ever having felt “manic.” Her physical health is good. Ms. B also reported that she did not consider her life, in general, to be satisfactory or fulfilling. Although she had been highly successful in school, earning excellent grades at a firstrate college and law school, she has had difficulty making friends and now sees the few friends who she believes “like her” only occasionally, for “attention” and “support.” She has only“dated”oneman,brieflyincollege,butshefeltinhibitedin the relationship, afraid and ashamed to let the man know that she cared about him. Even though they drifted apart after only afewmonths,sheoftenthinksofhimandwonderswhetherher life would be better if they had gotten together. She is pessimisticaboutherprospectsforanotherrelationshipinthefuture because she believes that it would be very hard for her to find someone who would live up to her expectations. Ms. B has few interests outside of work. With respect to music, art, or sports, she said that whatever she tried, she was “not very good at it,” quickly lost interest, and gave up.

Alternative DSM-5 Model for Personality Disorders

Personality Disorder Symptomatology and Neuropsychological Functioning in Closed Head Injury

Background and Objectives: There are many reports in the literature on the co-occurrence of somatic diseases and psychiatric disorders. Relatively few have addressed the co-occurrence of corneal cone with anxiety, depression, or personality disorders. Materials and Methods: 99 patients with keratoconus (study group) and 92 patients without keratoconus (control group) participated in the entire study, which was conducted in 2015 and 2020-2023. The Hamilton Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI) were used to assess depressive symptoms, the State-Trait Anxiety Inventory (STAI) to assess anxiety symptoms, and the DSM-IV Personality Disorder Inventory (IBZO-DSM-IV) to identify personality disorders. Results: In the study group, the severity of depressive and anxiety symptoms correlated with all types of personality disorders. In the control group, these symptoms did not correlate with antisocial and narcissistic personalities. In the comparative analysis, there were more patients with antisocial, schizotypal, obsessive compulsive, schizoid, paranoid, and dependent personality traits in the study group. Conclusions: Patients with keratoconus have increased expressions of antisocial personality traits, but no differences in anxiety and depression symptoms were evident. Further research is needed among patients diagnosed with keratoconus in the short term.

Part I: The DSM-IV Classification of Personality Disorders. T. Millon, R. Davis, Conceptions of Personality Disorders: Historical Perspectives, the DSM's, and Future Directions. P. Tyrer, Are Personality Disorders Well Classified in DSM-IV? Part II: DSM-IV Personality Disorder Diagnoses. D.P. Bernstein, D. Useda, L.J. Siever, Paranoid Personality Disorder. O. Kalus, D.P. Bernstein, L.J. Siever, Schizoid Personality Disorder. L.J. Siever, D.P. Bernstein, J.M. Silverman, Schizotypal Personality Disorder. S. Torgersen, Commentary on Paranoid, Schizoid, and Schizotypal Personality Disorders. T.A. Widiger, E.M. Corbitt, Antisocial Personality Disorder. R.D. Hare, S. Hart, Commentary on Antisocial Personality Disorder: The DSM-IV Field Trial. L. Robins, Commentary on Antisocial Personality Disorder. J.G. Gunderson, M.C. Zanarini, C.L. Kisiel, Borderline Personality Disorder. A.A. Dahl, Commentary on Borderline Personality Disorder. S. Taylor, Commentary on Borderline Personality Disorder. B. Pfohl, Histrionic Personality Disorder. H. Merskey, Commentary on Histrionic Personality Disorder: Where Should We Go with Hysteria? J.G. Gunderson, E. Ronningstam, L.E. Smith, Narcissistic Personality Disorder. J. Paris, Commentary on Narcissistic Personality. T. Millon, A. Martinez, Avoidant Personality Disorder. P.A. Pilkonis, Commentary on Avoidant Personality Disorder: Temperament, Shame, or Both? R.M.A. Hirschfeld, M.T. Shea, R. Weise, Dependent Personality Disorder. W.J. Livesley, Commentary on Dependent Personality Disorder. B. Pfohl, N. Blum, Obsessive-Compulsive Personality Disorder. J.M. Pollak, Commentary on Obsessive-Compulsive Disorder. K.A. Phillips, R.M.A. Hirschfeld, M.T. Shea, J. Gunderson, Depressive Personality Disorder. P. McLean, S. Woody, Commentary on Depressive Personality Disorder: A False Start. Part III: Appended and Deleted Diagnoses. T. Millon, J. Radovanov, Passive-Aggressive (Negativistic) Personality Disorder. E. Baerg, Commentary on Passive-Aggressive (Negativistic) Personality Disorder. S.J. Fiester, M. Gay, Sadistic Personality Disorder. S.J. Fiester, Self-Defeating Personality Disorder. T.A. Widiger, Deletion of Self-Defeating and Sadistic Personality Disorders. Part IV: Basic Issues and Alternative Perspectives. R. Davis, T. Millon, The Importance of Theory to a Taxonomy of Personality Disorders. T. Shea, Interrelationships among Categories of Personality Disorders. R.K. Blashfield, R.A. McElroy, Confusions in the Terminology Used for Classification Models. M.A. Schwartz, O.P. Wiggins, M.A. Norko, Prototypes, Ideal Types, and Personality Disorders: The Return to Classical Phenomenology. T.A. Widiger, C.J. Sanderson, Toward a Dimensional Model of Personality Disorders in DSM-IV and DSM-V. D.N. Jackson, W.J. Livesley, Possible Contributions from Personality Assessment to the Classification of Personality Disorders. L.A. Clark, The Challenge of Alternative Perspectives: A Discussion of Basic Issues. W.J. Livesley, Past Achievements and Future Directions.

Numerous authors have theorized that defense mechanisms play a role in personality disorders. We reviewed theoretical writings and empirical studies about defenses in schizotypal, borderline, antisocial, and narcissistic personality disorders, developing hypotheses about these differential relationships. We then examined these hypotheses using dynamic interview data rated for defenses in a study of participants (n = 107) diagnosed with these four personality disorder types. Overall, the prevalence of immature defenses was substantial, and all four disorders fit within the broad borderline personality organization construct. Defenses predicted the most variance in borderline and the least variance in schizotypal personality disorder, suggesting that dynamic factors played the largest role in borderline and the least in schizotypal personality. Central to borderline personality were strong associations with major image-distorting defenses, primarily splitting of self and other's images, and the hysterical level defenses, dissociation and repression. Narcissistic and antisocial personality disorders shared minor image-distorting defenses, such as omnipotence or devaluation, while narcissistic also used splitting of self-images and antisocial used disavowal defenses like denial. Overall, differential relationships between specific defenses and personality disorder types were largely consistent with the literature, and consistent with the importance that the treatment literature ascribes to working with defenses.

There is a paucity of research examining the relationship between personality disorders (PDs) and chronic physical comorbidities. Consequently, we investigated associations between individual PDs and PD Clusters, and various common disease groups [cardiovascular disease (CVD), diabetes, arthritis and gastrointestinal disease (GI)] in a nationally representative survey of adults from the United States. This study utilized pooled data (n = 34,653; ≥20 years) from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. PDs were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule- Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Physical conditions were based on self-reports of being diagnosed by a health professional. Unadjusted and adjusted logistic regressions examined the relationship between PDs and physical conditions. After adjustment (sociodemographic factors, past-year mood, anxiety and substance use disorders), Clusters A, B and C PDs were each associated with physical conditions (all p ≤ 0.01). Of the individual PDs, schizoid, schizotypal, narcissistic, borderline and obsessive-compulsive PDs were associated with CVD (all p ≤ 0.01) among younger adults. Paranoid, antisocial, borderline and avoidant PDs and younger adults with schizoid, schizotypal and obsessive-compulsive PDs were each associated with arthritis (all p ≤ 0.01). Significant associations were seen between paranoid, schizoid and schizotypal PDs and diabetes (all p ≤ 0.01). Finally, schizotypal, antisocial, borderline and narcissistic PDs were associated with GI conditions (all p ≤ 0.01). PDs were consistently associated with physical conditions. Investigation of PDs and their relationship with physical health outcomes warrant further research attention as these findings have important clinical implications.

To present nationally representative data on the prevalence, sociodemographic correlates, and disability of 7 of the 10 DSM-IV personality disorders. The data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version, and associations between personality disorders and sociodemographic correlates were determined. The relationship between personality disorders and 3 emotional disability scores (Short-Form 12, version 2) was also examined. Overall, 14.79% of adult Americans (95% CI = 14.08 to 15.50), or 30.8 million, had at least 1 personality disorder. The most prevalent personality disorder in the general population was obsessive-compulsive personality disorder, 7.88% (95% CI = 7.43 to 8.33), followed by paranoid personality disorder 4.41% (95% CI = 4.12 to 4.70), antisocial personality disorder 3.63% (95% CI = 3.34 to 3.92), schizoid personality disorder 3.13% (95% CI = 2.89 to 3.37), avoidant personality disorder 2.36% (95% CI = 2.14 to 2.58), histrionic personality disorder 1.84% (95% CI = 1.66 to 2.02), and dependent personality disorder 0.49% (95% CI = 0.40 to 0.58). The risk of avoidant, dependent, and paranoid personality disorders was significantly greater among women than men (p <.05); the risk of antisocial personality disorder was greater among men compared with women (p <.05); and no sex differences were observed in the risk of obsessive-compulsive, schizoid, or histrionic personality disorders. In general, risk factors for personality disorders included being Native American or black, being a young adult, having low socioeconomic status, and being divorced, separated, widowed, or never married. Avoidant, dependent, schizoid, paranoid, and antisocial personality disorders (p <.02 to p <.0001) were each statistically significant predictors of disability. Obsessive-compulsive personality disorder was inconsistently related to disability. In contrast, disability was not significantly different among individuals with histrionic personality disorder compared with those without the disorder. Personality disorders are prevalent in the general population and are generally highly associated with disability. This study highlights the need to develop more effective and targeted prevention and intervention initiatives for personality disorders.

Covariance of personality, neurocognition, and schizophrenia spectrum traits in the community

Clarifying associations between psychopathy facets and personality disorders among offenders

Background Personality disorders are commonly found as co-morbid conditions among those undergoing treatment for substance-related disorders. In spite of the growing evidence for the correlation between substance-related disorders and personality disorders in general, it remains unclear to what extent specific personality disorders are uniquely associated with particular categories of substances. Objectives To investigate the association between personality disorders and choice of drug of abuse in an Egyptian sample of substance-dependent patients. Methods This investigation was conducted using a cross-sectional approach. It included 58 male patients, aged 18–55 years, seeking treatment for substance dependence at the outpatient clinic, Helwan University Hospital in Cairo, Egypt. Eligibility required meeting DSM-IV-TR diagnostic standards for opioid, sedative, or alcohol dependence and had been using the same substance predominantly over the last year. Urine screening tests confirmed the presence of only one substance. After obtaining informed consent, participants were assessed using the Arabic version of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-IIP) to diagnose comorbid personality disorders. Results Regarding the prevalence of personality disorders among participants of 58 patients with substance use disorder, narcissistic personality disorder was the most prevalent disorder 37.9% (22 patients), followed by antisocial personality disorder 31% (18 patients), obsessive–compulsive disorder 24.1% (14 patients), and borderline personality disorder 22.4% (13 patients). Regarding association between personality disorders and choice of drug of abuse among participants, choice of heroin as drug of preference was significantly associated with presence of narcissistic and antisocial personality disorders, choice of alcohol was significantly associated with presence of obsessive–compulsive and paranoid personality disorders, while choosing benzodiazepine was significantly associated with dependent personality disorder. Conclusions This preliminary study identified significant associations between specific personality disorders and substance preference in treatment-seeking patients. Narcissistic and antisocial personality disorders were linked to heroin use, obsessive–compulsive and paranoid disorders to alcohol, and dependent personality disorder to benzodiazepine use. These findings should be interpreted cautiously due to the small sample size and male-only cohort, and further research with larger and more diverse samples is needed to validate and extend these results.

Processing of facial expressions of emotions in Antisocial, Narcissistic, and Schizotypal personality disorders: An event-related potential study

Working memory and remediation of Wisconsin card sorting test performance in schizophrenia

This chapter begins by discussing the epidemiology, aetiology, clinical picture, course, differential diagnosis, and treatment of various Cluster A personality disorders (Paranoid personality disorder, paranoid personality disorder, schizotypal personality disorder), Cluster B personality disorders (antisocial personality disorder, borderline personality disorder (BPD), histrionic personality disorder, narcissistic personality disorder) and Cluster C personality disorders (avoidant personality disorder, dependent personality disorder (JLC), and obsessive–compulsive (anankastic) personality disorder). Other personality disorders (not included in DSM-IV) are also covered, including passive–aggressive (negativistic) personality disorder, self-defeating (masochistic) personality disorder, sadistic personality disorder, depressive personality disorder, and personality changes, including enduring personality changes after traumatic experiences and personality change due to a general medical condition (JLC).

The concept of psychopathy has shifted from people who commit crimes to those with a particular personality and deviant behaviors. Although antisocial personality disorder is associated with psychopathy, it also seems common in individuals with narcissistic personality traits. Psychopathy may be the expression of earlier, persistent patterns of individual characteristics as personality. The psychobiological model of personality can be useful for determining whether the expression of psychopathy differs in accordance with personality dimensions and specific personality disorders. The aim was to compare temperament and character dimensions between individuals with psychopathy with comorbid predominant antisocial or narcissistic personality traits and control subjects and to determine which dimensions distinguish these groups. Control subjects (n = 80) and individuals with psychopathy (n = 80) were assessed using the Psychopathy Checklist-Reviewed, the Structured Clinical Interview for DSM-IV Axis II disorders and the Temperament and Character Inventory-Revised. Reward dependence and Self-Directedness distinguish psychopathic individuals with predominant narcissistic personality traits whereas Novelty Seeking and Self-Transcendence characterize those with antisocial personality traits. Individuals with antisocial or narcissistic psychopathy could be identified by their temperament and character traits. The expression of psychopathy differed in accordance with biologically based, environmentally shaped personality traits.