Etiology Of Personality Disorders Research Articles

Exploring ethnicity and personality disorder in a UK context: a scoping review of the literature

PurposeThe UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder.Design/methodology/approachA scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable.FindingsTen papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients.Originality/valueThe shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective.

The Relationships between Personality Disorders and Early Maladaptive Schemas and the Moderating Role of Gender.

The aims of this study were to examine the relationship between personality disorders (PDs) and early maladaptive schemas, to determine the early maladaptive schemas that predict PDs, and to investigate the moderating role of gender in the relationship between PDs and early maladaptive schemas. The sample consisted of 654 participants, 368 (56.4%) women and 286 (43.6%) men, aged 18-75 years, determined by the convenience sampling method. Data were collected using Coolidge Axis II Inventory Plus Turkish Short Form and Young Schema Questionnaire-Short Form 3. From regression analysis, it was determined that each PD had a specific early maladaptive schema profile. According to the analysis, the schema that predicts the most for paranoid, schizotypal, schizoid, antisocial, borderline, obsessive-compulsive, and avoidant PDs is social isolation/mistrust; for histrionic and narcissistic PDs, the schema is approval seeking, and for dependent PD, it is failure. The analysis related to the moderating role of gender indicated that for women, the emotional deprivation schema is a risk factor for paranoid PD, and the schemas of self-sacrifice, punitiveness, and unrelenting standards are the risk factors for avoidant PD. This study discovered that some early maladaptive schemas were predictors of PDs and that gender had a moderating role in the relationship between these variables. It is thought that paying attention to the moderating role of gender and considering the specific schema profiles of each PD will be beneficial for intervention programs for early maladaptive schemas and understanding the etiology of PDs.

Mechanisms shaping the development of personality and personality disorders in children and adolescents.

Until the end of the nineties last century personality disorders could not be diagnosed before the age of eighteen. Nevertheless, the results of studies published in the last decade have revealed that personality disorders can be observed in children and adolescents and that personality disorders diagnosed in adult patients had been present as early as in childhood. The knowledge of possible mechanisms shaping personality disorders in childhood is unsatisfactory and needs to be expanded. Developmental psychology explains the development of abnormal personality through inappropriate attachment patterns and abnormal transitions between developmental phases. Genetic and temperamental factors are also important in the aetiology of personality disorders as well as early maladaptive schemas resulting from personal experiences and interactions with others. The aim of this article is to review the current knowledge on the mechanisms shaping the development of personality and personality disorders in childhood and adolescence.

KCNIP4 as a candidate gene for personality disorders and adult ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder in children with striking persistence into adulthood and a high co-morbidity with other psychiatric disorders, including personality disorders (PD). The 4p15.31 region was shown to be associated with ADHD in several genome wide association studies (GWAS). In the present study we also report association of the 4p15.31 locus with Cluster B and Cluster C PD as identified by a pooled genome-wide association study in 400 individuals suffering from PD. The gene coding for the Kv channel-interacting protein 4 (KCNIP4) is located in this region. KCNIP4 is an interaction partner of presenilin and plays a role in a negative feedback loop in the Wnt/β-catenin pathway. Thus, we reasoned it to be a promising candidate gene for ADHD as well as for PD. To clarify the role of KCNIP4 in those disorders, we conducted candidate gene based association studies in 594 patients suffering from adult ADHD and 630 PD patients as compared to 974 healthy control individuals. In the adult ADHD sample, six single markers and one haplotype block revealed to be associated with disease (p values from 0.0079 to 0.049). Seven markers within the KCNIP4 gene showed an association with PD (p values from 0.0043 to 0.0437). The results of these studies suggest a role of KCNIP4 in the etiology of ADHD, PD and other co-morbid disorders.

A systematic review of personality disorder, race and ethnicity: prevalence, aetiology and treatment

BackgroundAlthough psychoses and ethnicity are well researched, the importance of culture, race and ethnicity has been overlooked in Personality Disorders (PD) research. This study aimed to review the published literature on ethnic variations of prevalence, aetiology and treatment of PD.MethodA systematic review of studies of PD and race, culture and ethnicity including a narrative synthesis of observational data and meta-analyses of prevalence data with tests for heterogeneity.ResultsThere were few studies with original data on personality disorder and ethnicity. Studies varied in their classification of ethnic group, and few studies defined a specific type of personality disorder. Overall, meta-analyses revealed significant differences in prevalence between black and white groups (OR 0.476, CIs 0.248 - 0.915, p = 0.026) but no differences between Asian or Hispanic groups compared with white groups. Meta-regression analyses found that heterogeneity was explained by some study characteristics: a lower prevalence of PD was reported among black compared with white patients in UK studies, studies using case-note diagnoses rather than structured diagnostic interviews, studies of borderline PD compared with the other PD, studies in secure and inpatient compared with community settings, and among subjects with co-morbid disorders compared to the rest. The evidence base on aetiology and treatment was small.ConclusionThere is some evidence of ethnic variations in prevalence of personality disorder but methodological characteristics are likely to account for some of the variation. The findings may indicate neglect of PD diagnosis among ethnic groups, or a true lower prevalence amongst black patients. Further studies are required using more precise cultural and ethnic groups.

Minimal emotional dysfunctions (MED) in personality disorders

The concept of minimal emotional dysfunctions (MED) refers to traditional psychopathology in order to describe, classify, and understand personality disorders. Emotional dysfunctions encompass disorders of affect predominance, production, expression, experience, modulation, and regulation. MED can explain the dimensional nature of personality disorders, their multidimensionality and problems with categorical classifications. It can stimulate research on the etiology of personality disorders in reference to modern developmental brain research and trauma psychology. It can guide new developments in pharmacotherapy and psychotherapy. It is suggested to focus on MED in future developments of the description and classification of personality disorders.

Alterações da personalidade no lúpus eritematoso sistêmico

O lúpus eritematoso sistêmico (LES) é uma doença auto-imune de natureza crônica e multissistêmica, podendo afetar de forma importante o sistema nervoso central (SNC). Embora bastante freqüentes, as alterações de personalidade ainda não foram bem estudadas nessa população. Este é o principal objeto de estudo deste artigo de revisão, que verificou a divergência entre os autores quanto à importância dos traços de personalidade e suas alterações no desencadeamento e evolução da doença lúpica. Há controvérsia, ainda, sobre a etiologia das alterações de personalidade no LES, questionando-se se estas ocorreriam pelo estresse psicológico imposto pela patologia, pela atividade da doença no SNC, ou, ainda, pelo uso de medicamentos, como os glicocorticóides. Há necessidade, portanto, de novos estudos que venham a elucidar estas questões.

Practical Management of Personality Disorder

Back to table of contents Previous article Next article Book Forum: Personality and Personality DisordersFull AccessPractical Management of Personality DisorderPAUL S. LINKS, M.D., M.Sc., F.R.C.P.C., PAUL S. LINKSSearch for more papers by this author, M.D., M.Sc., F.R.C.P.C., Toronto, Ont., CanadaPublished Online:1 Aug 2005https://doi.org/10.1176/appi.ajp.162.8.1559AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Dr. Livesley is a prominent researcher in the field of classification, definition, and etiology of personality disorders. He has done very original work on the genetic bases of personality disorders; however, he is less well-known as a contributor on the clinical care of these patients. Dr. Livesley’s intention was to provide a practical evidence-based approach to the care of patients with personality disorders that would be valuable to practitioners and trainees from all mental health disciplines. The treatment approach is founded on the premise that personality disorders have complex etiologies. Dr. Livesley argues that this complexity is also reflected in the “many clinicians [who] have difficulty approaching patients with personality disorder in the same organized and consistent way that they approach patients with other disorders” (p. viii). He criticizes existing theoretical models as “exacerbating” the clinician’s confusion and asserts instead the benefits of a “reasoned eclecticism.”Dr. Livesley’s approach to treatment includes general strategies for managing core self and interpersonal pathology as well as specific strategies drawn from diverse theoretical approaches. The general strategies are centered on the development of a collaborative therapeutic relationship, the use of validation, monitoring and managing therapeutic disruptions, and creating and enhancing motivation. The targets for specific interventions include symptomatic domains such as self-harm behavior, symptoms associated with a concurrent axis I disorder, and the regulation and control of impulses and emotion.The book succeeds because Dr. Livesley’s approach provides a very palatable structure for planning and implementing individual outpatient therapy for personality disorders. In addition, the specific strategies are soundly based on the existing research evidence (for example, his description of how medication should add to the comprehensive care of patients with personality disorders). Particularly unique and valuable in Dr. Livesley’s approach is his focus on conative (volitional) processes, on how essential goals are to developing an integrated self, and on how therapy must assist patients with personality disorders with identifying and obtaining meaningful goals.Certain problems arise because of Dr. Livesley’s approach. First, the text is somewhat repetitive because specific strategies are applied to multiple problem domains; for instance, tackling maladaptive schemata is used to combat traumatic experiences, maladaptive interpersonal and relationship patterns, and maladaptive traits. Second, the text insists on the importance of understanding the process of change when treating patients with personality disorders, but Dr. Livesley makes up his own stages rather than using the well-established model of change of Prochaska and DiClemente (1). The stages are presented as “convenient” but seem more related to problem-solving strategies than the process of change. Finally, emotion-focused therapies are not included in the approach, and the importance and role of emotion in promoting change are given short shrift. Most often, difficult emotional issues are dealt with only by control and containment strategies.Overall, the book is well written, well structured, and well referenced. Although I would not consider this the most inspiring or captivating book on the topic, it does provide a reasoned and systematized approach to the labyrinth of treating patients with personality disorders.By W. John Livesley, M.D., Ph.D. New York, Guilford Publications, 2003, 420 pp., $48.00.Reference1. Prochaska JO, DiClemente CC: Stages of change in the modification of problem behaviors. Prog Behav Modif 1992; 28:183–218Medline, Google Scholar FiguresReferencesCited byDetailsCited byEmotion-Focused Principles for Working with Borderline Personality DisorderJournal of Psychiatric Practice, Vol. 14, No. 2 Volume 162Issue 8 August 2005Pages 1559-1559 Metrics PDF download History Published online 1 August 2005 Published in print 1 August 2005

Schema Therapy: A Practitioner’s Guide

Back to table of contents Previous article Next article Book Forum: PsychotherapyFull AccessSchema Therapy: A Practitioner’s GuideSCOTT D. TEMPLE, Ph.D., SCOTT D. TEMPLESearch for more papers by this author, Ph.D., Iowa City, IowaPublished Online:1 Nov 2003https://doi.org/10.1176/appi.ajp.160.11.2074-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In this highly engaging volume, Young and colleagues offer a robust clinical model and a compelling treatment protocol for the whole spectrum of personality disorders. Young’s work has its roots in Aaron T. Beck’s model of cognitive behavior therapy. Yet Schema Therapy is an integrative approach, one that contains intriguing possibilities for integrating cognitive behavioral, psychoanalytic, and experiential approaches to treatment. Striving to develop “the bible” of schema therapy (p. vii), Young and colleagues have written a rich and important addition to the psychotherapy literature. But it is an addition that is not without its controversial elements.At its heart, the book takes a developmental perspective on the formation and treatment of personality disorders. The lack of a developmental theory in cognitive behavior therapy has long been problematic when cognitive behavior therapy has left the confines of theory and treatment of axis I disorders. Young and his colleagues argue that the core beliefs, affects, and problematic interpersonal and coping patterns that characterize personality disorders frequently have at their center developmental difficulties.Young draws heavily on psychoanalytic developmental models in Schema Therapy. In particular, he develops a theory of “modes” as central to understanding the development and maintenance of maladaptive personality patterns. This theory, and its clinical applications, will look familiar to those with a psychoanalytic background, particularly those acquainted with Paul Federn’s theory of ego states and with Federn’s student Eric Berne, who developed transactional analysis during the 1950s and 1960s. If this derivation is intriguing, there is at least one potentially disturbing implication in basing an ostensibly empirically supported treatment on earlier, psychoanalytically derived models. Young and colleagues make frequent reference to “offending parents” in the etiology of personality disorders, particularly for borderline personality. Although Young speaks of temperament as creating a vulnerability to developing borderline personality, he and his coauthors come close to making parental neglect and abuse an a priori cause of borderline pathology. One is reminded of Fromm-Reichmann’s unfortunate term “the schizophrenogenic mother.” Those steeped in an empirical tradition, and Young is among them, must be vigilant to avoid the excesses of earlier, punitive, and erroneous causal attributions.In terms of treatment, the shortcomings of brief cognitive behavior therapy with personality disorders are addressed through an eclectic blend of standard cognitive therapy, psychoanalytic, experiential, guided imagery, and Gestalt techniques. In addition, the therapy relationship is deemed paramount in creating a climate of safety, in which enduring change becomes possible. Young and colleagues generally maintain the collaborative and respectful stance toward patients that characterizes standard cognitive therapy, as developed by Aaron T. Beck. Young argues that “limited reparenting” may be advised in some cases, a contention that may spark debate within the field. But the volume deals with this issue in a manner that is respectful of patient autonomy and dignity.This is a must-read book for all those interested in personality disorders and in psychotherapy integration. Its strengths are legion, and its controversial contentions should spur much-needed debate and even more-needed research.By Jeffrey E. Young, Janet S. Klosko, and Marjorie E. Weishaar. New York, Guilford Publications, 2003, 407 pp., $45.00. FiguresReferencesCited byDetailsCited ByLimited reparenting as a corrective emotional experience in schema therapy: A preliminary task analysis29 April 2021 | Psychotherapy Research, Vol. 32, No. 2 Volume 160Issue 11 November 2003Pages 2074-a-2075 Metrics History Published online 1 November 2003 Published in print 1 November 2003

Special feature: the etiology of personality disorders: a review and consideration of research models.

In addition to reviewing representative studies of genetic and environmental factors imputed in the etiology of the personality disorders (PDs), a number of models for conceptualizing and conducting etiological research are considered. In particular, it is proposed that research should initially concede a tripartite model (with separate temperament, personality, and disorder components). Such a model would allow identification of etiological factors having specificity to one or more components, and ones that are nonspecific in having relevance to all components.

Special Feature: Etiology of Personality Disorders: A Commentary on Dr. Parker's Tripartite Model

The review of the etiology of personality disorders by Dr. Gordon Parker is critically evaluated. Personality development is considered as a complex adaptive system that is hierarchically self-organizing. This involves three interactive phases, beginning with interactions among emotion-based dimensions of temperament in infancy, next socially molded by the emergence of character or concepts about self-object relationships, and finally vulnerability to psychopathology as a result of modulation of experience by both emotion-based temperament and concept-based character. Accordingly, functional impairment is a predictable property of temperament and character, rather than an independent component of personality disorder as suggested by Parker.

Special Feature: Response to Dr. Gordon Parker's Paper: An Epidemiological Perspective

This article is a response to Gordon Parker's “Etiology of Personality Disorders: A Review and Consideration of Research Models.” His proposal of a three-component model of personality is considered. The utility of epidemiological methods to investigate personality is outlined, and studies supporting a dimensional model of personality with no evidence of a threshold for disorder are described.

Personality disorders: an overview for the physician.

Personality disorders are common clinical syndromes that often go unrecognized in medical practice. Because patients with personality disorders receive care in all clinical settings, physicians could profit from a heightened awareness of the personality psychopathology of their patients and its impact on medical practice. Personality traits are universal and describe the "normal" range of behavior, while personality disorders are characterized by enduring maladaptive patterns. The etiology of personality disorders is multifactorial. Physician awareness of the multiple manifestations of specific personality disorders is helpful in matching the proper interventions to appropriate patients. Although management is symptomatically palliative rather than curative, physicians and patients alike can benefit from appropriate recognition and treatment of personality disorders.

Cognitive Therapy for Personality Disorders: A Schema-Focused Approach

Expanding the Boundaries of Cognitive Therapy Cognitive Therapy for Personality Disorders: A Schema-Focused Approach Young, Jeffrey E. Sarasota, FL: Professional Resource Exchange, Inc., 1990. (79 pp.) $11.70 (paperback). The author's primary aim for this book is to show how cognitive therapy can be adapted and expanded to address the unique challenges presented by clients with personality disorders. In the first section, a rationale for such an adaptation and expansion is provided. Young outlines seven basic assumptions associated with cognitive therapy and shows how many of these assumptions are violated when treating clients with personality disorders. More specifically, he points out that the high degree of rigidity, avoidance, and long-term interpersonal difficulties characteristic of this clinical population are significant obstacles to successful treatment when using the "short-term cognitive therapy" approaches pioneered by Beck and others. Young contends that more effective treatments require an expanded cognitive theory-one which can account for the salient themes and patterns exhibited by clients with personality disorders. The second section of the book is devoted to an outline of the conceptual underpinnings of Young's proposed expansion. Drawing upon schema theory in cognitive psychology, Young contends that any complete understanding of personality disorders must go beyond the three levels of cognitive phenomena identified with short-term cognitive therapy (automatic thoughts, cognitive distortions, and underlying assumptions) and include a focus on the "deepest level of cognition"-what he terms the Early Maladaptive Schema (EMS). According to Young, EMSs are "extremely stable and enduring themes that develop during childhood and are elaborated upon throughout an individual's lifetime. These schemas serve as templates for the processing of later experience." (p. 9) In brief relief, through the EMS construct Young presents a case for the developmental etiology of personality disorders. EMSs are characterized as unconditional and self-perpetuating beliefs about oneself and the world that are presumed to be the consequence of dysfunctional childhood experiences with parents. Young suggests that EMSs are typically activated by current environmental events related to the schema and are often associated with a high level of emotional arousal. In his most recent revised list of specific schemas (found in Appendix B of the book), Young identifies 16 distinctEMSs that are grouped into five categories (Impaired Autonomy, Disconnection, Undesirability, Restricted Self-Expression, and Insufficient Limits). A thorough understanding of the themes and issues associated with these "core" schemas is fundamental to the practice of schema-focused therapy. In the final and perhaps most significant section of the book, Young details the assessment and intervention aspects of his schema-focused model. Because the primary goal of assessment is to determine the predominant EMSs of the client, Young outlines an eight-step evaluation procedure and guides the reader through each step by way of a case example. EMS assessment is multifaceted and includes the use of questionnaire data (Lazarus' Multimodal Life History Questionnaire and Young's own Schema Questionnaire); procedures for "triggering" schemas both within and outside of sessions; ways of educating the client about schemas; techniques for identifying schema maintenance, avoidance, and compensation behaviors; and a methodology for distinguishing among primary, secondary, and associated schemas. Young presents a wealth of applied information at this juncture and does an excellent job of bringing the material to life through the case illustration and accompanying summary tables and appendices. Particularly noteworthy is the "Client's Guide to Schema-Focused Therapy" (Appendix D) which is designed to be used as a handout for orienting clients to the schemafocused approach. …