Changes In Personality Disorders Research Articles

Illuminating ipsative change in personality disorder and normal personality: A multimethod examination from a prospective longitudinal perspective.

Research suggests that both personality disorder (PD) and normal personality change as systems of variables (e.g., the general factor of PD), rather than as individual variables (e.g., neuroticism). Consequently, understanding PD and normal personality as multidimensional systems may yield additional insights over traditional single-variable approaches. Normal personality change has been attributed to increase across adaptive traits (i.e., the maturity principle), suggesting that shifts in the overall magnitude of construct expression plays a role in systemic change. We examined the extent to which total ipsative, system-level change was accounted for by shifts in the overall level of constructs (i.e., severity/maturity) as well as shifts in the configuration of PD and normal personality (i.e., style) across self-report and structured interview. Results demonstrated that overall change in PD and normal personality measured via self-report reflected both stylistic and severity change, whereas structured interview of PD primarily reflected shifts in profile severity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Supplemental Material for Illuminating Ipsative Change in Personality Disorder and Normal Personality: A Multimethod Examination From a Prospective Longitudinal Perspective

Supplemental Material for Illuminating Ipsative Change in Personality Disorder and Normal Personality: A Multimethod Examination From a Prospective Longitudinal Perspective

Examining changes in personality disorder and symptomology in an adolescent sample receiving intensive mentalization based treatment: a pilot study

ObjectiveTo examine changes in personality disorders and symptomology and the relation between personality disorder variables and treatment outcomes in an adolescent sample during partial residential mentalization based treatment.MethodsIn a sample of 62 (out of 115) adolescents treated for personality disorders, assessment was done pre- and post-treatment using the Structured Clinical Interview for DSM personality disorders and the Symptom Check List 90.ResultsSignificant reductions in personality disorder traits (t = 8.36, p = .000) and symptoms (t = 5.95, p = .000) were found. During pre-treatment, 91.8% (n = 56) of the patients had one or more personality disorders, compared to 35.4% (n = 22) at post-treatment. Symptom reduction was not related to pre-treatment personality disorder variables.ConclusionDuring intensive psychotherapy, personality disorders and symptoms may diminish. Future studies should evaluate whether the outcomes obtained are the result of the treatment given or other factors.

Stability and Change in Personality Disorder Symptoms in 1-Year Follow-up of Depressed Adolescent Outpatients

We investigated stability and change in personality disorder (PD) symptoms and whether depression severity, comorbid clinical psychiatric disorders, and social support predict changes in personality pathology among adolescent outpatients. The 1-year outcome of PD symptoms among consecutive adolescent psychiatric outpatients with depressive disorders (N = 189) was investigated with symptom count of depression, comorbid psychiatric disorders, and perceived social support as predictors. An overall decrease in PD symptoms in most PD categories was observed. Decreases in depression severity and in number of comorbid diagnoses correlated positively with decreases in PD symptoms of most PD categories. Social support from close friends predicted a decrease in schizotypal and narcissistic, whereas support from family predicted a decrease in paranoid symptoms. Our results suggest that among depressed adolescent outpatients, PD symptoms are relatively unstable, changes co-occuring with changes/improvement in overall psychopathology. Social support seems a possibly effective point for intervention efforts regarding positive outcome of PD symptoms.

A psychoanalytically informed hospitalization‐based treatment of personality disorders

This study presents a model of psychic change in personality disorders focusing on three dimensions: felt safety, mentalization and self‐object relations. Based upon this model a hospitalization‐based therapy program was created. Four scales to measure these three dimensions on the Object Relation Interview are discussed: the Felt Safety Scale, the Reflective Functioning Scale and the Bion Grid Scale and the Differentiation‐Relatedness Scale.A naturalistic symptom outcome study of the program showed a large effect on both symptoms and personality functioning. Furthermore, trajectory based on pre‐treatment patient characteristics (i.e., anaclitic versus introjective personality styles). Importantly, we also found a relation between symptomatic and personality change and change in felt safety and object relations. At 5‐year follow‐up, patients showed sustained improvement in symptomatic distress and further improvement in terms of personality and interpersonal functioning.

Personality disorders and aging

Personality disorder can be defined as an enduring pattern of inner experience and behavior that markedly deviates from the expectations of the individual's culture. With aging, personality disorders may improve or worsen. Their prevalence in the elderly is slightly lower than the prevalence in young adult. Furthermore, their comorbidity and co-occurrence are the rule with an increased risk of late decompensation. Categorical approach used in the current international classifications (ICD-10 and DSM-5) is not adapted to the specificities of the elderly with consequent overrepresentation of "unspecified personality disorder". However, a pathological personality tends to complicate all interventions for somatic or psychological care in the elderly. Thus, this review describes changes in personality disorders related to aging in order to help the clinician to better identify these disorders. Indeed, recognizing a pathological personality in the elderly improves its management both in the field of mental health and in somatic disorders in which the role of personality must be evaluated. Personality and its disorders should therefore be taken into account in all geriatric practices, in particular in the context of cognitive disorders.

Stability and Change in Personality Disorders

Stability is thought to be one of the major distinguishing features between personality disorders (PDs) and other forms of psychopathology. The development of more reliable PD assessments and the implementation of four major longitudinal studies on PD stability have provided critical data with which to evaluate the stability of PD features. Results from these and other studies reveal significant complexity in the interpretation of PD stability because of several issues that can impact stability estimates. Such estimates will vary as a function of the type of constructs being assessed, the type of stability being considered, the modality and reliability of the assessments being used, and the impacts of sampling. In this article, longitudinal research on PD stability is reviewed in the context of these issues. It is concluded that no single answer can be given to the question, "How stable are PDs?" and that future research and classification need to consider carefully and account for the complexity of this question.

Changes in natural language use as an indicator of psychotherapeutic change in personality disorders

Word use has been shown to reflect various psychological processes and psychological change. This study examines the self-view in personality disorders (PDs) and its change over the course of therapy using the Linguistic Inquiry and Word Count analysis procedure. A sample of 299 participants with PDs and 108 community control participants wrote short essays about their lives. Patients repeated the assignment three times over two years and completed assessments of PD-pathology, general psychopathology, PD-beliefs, and quality of life. Results show that as hypothesized the use of words in the 1st Person Singular Pronouns, Negative Emotion, Causation, Past and Future Tense Verbs categories significantly declines over the course of treatment, while the use of Present Tense Verbs and Positive Emotion increases. These categories tend to distinguish patients from non-patients prior to treatment. We also found 12 additional word categories changing over time, including Word Count and Negations. Change in word use statistically predicts better treatment outcome on all outcome measures (p < .001). Reductions in the use of Negative Emotion Words and Negations are the strongest predictors of outcome. The non-hypothesized role of Negations was explored and seemed to reflect that PD-patients miss a lot in their lives. Reduction of what they miss seems central to recovery. This issue seems relatively neglected in theoretical and treatment models of PDs. An increased focus on what patients miss in their lives might improve our understanding and treatment of PDs. In sum, Negative Emotion and Negation word categories appear to reflect key treatment targets.

Current Status of the Scientific Study of the Personality Disorders: an Overview of Epidemiological, Longitudinal, Experimental Psychopathology, and Neurobehavioral Perspectives

Research on the nature and development of personality disorders has grown immensely over the past thirty years. A selective summary overview is given of the current status of the scientific study of the personality disorders from several perspectives, including the epidemiological, longitudinal, experimental psychopathology, and neurobehavioral perspectives. From this research, we now know that approximately 10 percent of the general population suffer from a diagnosable personality disorder. Moreover, contrary to nearly a century of theory and clinical pedagogy, modern longitudinal studies clearly suggest that personality disorders decrease in severity over time. The mechanisms by which this change occurs are not understood at present, though it is not likely that change in underlying normal personality systems drives the change in personality disorder. The methods of the experimental psychopathology laboratory, including neuroimaging approaches, are being brought to bear on the nature of personality disorders in efforts to relate neurobiological and neurocognitive functions to personality disorder symptomatology. A model that links personality disorder feature development to underlying, interacting brain-based neurobehavioral systems is reviewed in brief. Current issues and findings illustrative of these developments are given using borderline personality disorder as an exemplar. Finally, areas of intersection between psychoanalytic treatment approaches and the growing science of personality disorder are highlighted.

Stability and Change in Personality Disorder

The standard view of personality disorder is that it is a maladaptive expression of personality traits, which are relatively stable and unchanging. Thus, personality disorder has been considered to have its roots in childhood and adolescence, to persist in adulthood, and to be difficult to change. However, recent research has challenged this view, revealing that personality continues to change, albeit more slowly, well into adulthood, and that the maladaptive manifestations of personality disorder are much less stable than previously believed. These research findings are described, and factors that influence stability and change in personality disorder are discussed. The emerging view of personality disorder has important implications for diagnosis, assessment, and treatment of personality pathology.

Natural course of bulimia nervosa and of eating disorder not otherwise specified: 5-year prospective study of remissions, relapses, and the effects of personality disorder psychopathology.

To examine prospectively the natural course of bulimia nervosa and eating disorder not otherwise specified (EDNOS) and to test for the effects of personality disorder psychopathology on remission and relapse. Subjects were 92 female patients with current bulimia nervosa (N = 23) or EDNOS (N = 69) at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study. Axis I psychiatric disorders (including eating disorders) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Version, and personality disorders were assessed with the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). The course of eating disorders was assessed with the Longitudinal Interval Follow-Up Evaluation and the course of personality disorders with the Follow-Along version of the DIPD-IV at 6 and 12 months and then yearly through 60 months. The study was conducted from July 1996 through June 2005. Probability of remission by 60 months was 74% for bulimia nervosa and 83% for EDNOS, and probability of relapse among those with a remission was 47% for bulimia nervosa and 42% for EDNOS. Patients with and without personality disorders did not differ in probability of remission. Cox proportional hazards regression analyses revealed that bulimia nervosa and EDNOS did not differ significantly in time to remission and that personality disorder comorbidity did not significantly predict time to remission. Analyses using proportional hazards regression with time-varying covariates revealed that dimensional changes in personality disorders were minimally related to either remission or relapse in these eating disorders. The 5-year natural course of bulimia nervosa and EDNOS differed little with both eating disorder categories showing similar patterns of remissions and relapses. These findings suggest the clinical significance of EDNOS and the need for further research on this most common but least studied eating disorder. The natural course of bulimia nervosa and EDNOS does not appear to be influenced significantly by the presence, severity, or time-varying changes of co-occurring personality disorder psychopathology.

The Longitudinal Relationship of Personality Traits and Disorders

Personality disorders are presumed to be stable because of underlying stable and maladaptive personality traits, but while previous research has demonstrated a link between personality traits and personality disorders cross-sectionally, personality disorders and personality traits have not been linked longitudinally. This study explores the extent to which relevant personality traits are stable in individuals diagnosed with 4 personality disorders (schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders) and examines the assumption that these personality disorders are stable by virtue of stable personality traits. This assumption was tested via the estimation of a series of latent longitudinal models that evaluated whether changes in relevant personality traits lead to subsequent changes in personality disorders. In addition to offering large consistency estimates for personality traits and personality disorders, the results demonstrate significant cross-lagged relationships betw...

The longitudinal relationship of personality traits and disorders.

Personality disorders are presumed to be stable because of underlying stable and maladaptive personality traits, but while previous research has demonstrated a link between personality traits and personality disorders cross-sectionally, personality disorders and personality traits have not been linked longitudinally. This study explores the extent to which relevant personality traits are stable in individuals diagnosed with 4 personality disorders (schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders) and examines the assumption that these personality disorders are stable by virtue of stable personality traits. This assumption was tested via the estimation of a series of latent longitudinal models that evaluated whether changes in relevant personality traits lead to subsequent changes in personality disorders. In addition to offering large consistency estimates for personality traits and personality disorders, the results demonstrate significant cross-lagged relationships between trait change and later disorder change for 3 of the 4 personality disorders studied.

Age-related change in personality disorder trait levels between early adolescence and adulthood: a community-based longitudinal investigation.

To investigate change in personality disorder (PD) traits between early adolescence and early adulthood among individuals in the community. PD traits were assessed in 1983 (mean age = 14), 1985-86 (mean age = 16) and 1992 (mean age = 22) in a representative community sample of 816 youths. Overall, PD traits declined 28% during both adolescence and early adulthood. PD traits were moderately stable during the first 2-year interval, and were as stable as they have been reported to be among adults over similar intervals. PD trait stability declined slightly as the inter-assessment interval increased. Adolescents with PDs tended to have elevated PD traits during early adulthood. PD traits tend to decline steadily in prevalence during adolescence and early adulthood. However, adolescents with PDs often have elevated PD traits as young adults, and the stability of PD traits appears to be similar during adolescence and early adulthood.

Changes in personality disorders following behavior therapy for obsessive-compulsive disorder

A study was conducted to determine the effect of behavior therapy on personality disorders when treatment focused on an Axis I diagnosis of obsessive-compulsive disorder (OCD). Twenty-one patients diagnosed with OCD participated. At pretest, the mean number of personality disorders was approximately four, whereas the posttest number was approximately three. Analyses suggest that this change, although apparently small, is clinically relevant, since changes in number of personality disorders was significantly related to treatment outcome. Treatment was successful in alleviating obsessivecompulsive symptoms as measured with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; t (20) = 7.02, p < .001). Reliable change indexes for each patient showed that 18 of 21 improved significantly. Future research should examine the extent to which posttreatment number of personality disorders relates to relapse rates.

Coping Styles Predict Change in Personality Disorders

The present follow-up study is the first to investigate whether dispositional coping styles prospectively influence change in the Millón Clinical Multiaxial Inventory (MCMI-II) personality disorders. The sample consisted of 155 psychiatric outpatients who were investigated twice, namely 6 and 7 years after their admission to the clinic. Coping styles prospectively predicted change in most of the MCMI-II personality disorders, whereas sex and age did not affect the outcome. The use of problem-focused coping and seeking social support improved the patients' levels on the MCMI-II personality disorder scores. Dysfunctional coping styles such as self-distraction, disengagement, use of alcohol or drugs, and venting of emotions, however, aggravated the patients' MCMI-II personality disorders. Furthermore, the effects of coping patterns tended to be specific for single personality disorders.

Assessing change in personality disorder

Assessing change in core personality disorder is hampered by the scarcity of baseline severity data and the use of indirect measures of personality disorder that are not conceptually linked to the treatment focus.A more rational, systematic and collaborative approach to assessing change is required if research in this field is to progress.