Collaborative Longitudinal Personality Disorders Study Research Articles

The impact of demoralization on the stability of personality traits in a clinical sample.

This study examined whether reductions in the severity of personality disorders (PD) mainly reflect changes in personality traits or rather an alleviation of a demoralized state involving nonspecific unpleasant affect. We used 4 years of longitudinal data from the Collaborative Longitudinal Personality Disorders Study, in which patients (N = 419) completed the Neuroticism-Extraversion-Openness Personality Inventory-Revised (NEO-PI-R) three times over 4 years (at baseline and at 6-month and 4-year follow-up assessments). We compared the NEO Demoralization scale with NEO-PI-R domain scales adjusted for demoralization-related items to determine whether changes in demoralization are more pronounced than changes in adjusted personality traits. Results showed that adjusted Neuroticism and Demoralization changed at similar rates and both changed more than other traits. These changes were most pronounced in the first 6 months and tapered thereafter. Rank-order correlations were somewhat lower for Demoralization than adjusted traits. Our findings suggest that decreases in PD symptoms over time have to do with reductions in negative affect and that Demoralization as assessed via a subset of NEO-PI-R items is limited in its ability to distinguish negative affect from trait Neuroticism. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Borderline personality disorder symptom networks across adolescent and adult clinical samples: examining symptom centrality and replicability.

Numerous theories posit different core features to borderline personality disorder (BPD). Recent advances in network analysis provide a method of examining the relative centrality of BPD symptoms, as well as examine the replicability of findings across samples. Additionally, despite the increase in research supporting the validity of BPD in adolescents, clinicians are reluctant to diagnose BPD in adolescents. Establishing the replicability of the syndrome across adolescents and adults informs clinical practice and research. This study examined the stability of BPD symptom networks and centrality of symptoms across samples varying in age and clinical characteristics. Cross-sectional analyses of BPD symptoms from semi-structured diagnostic interviews from the Collaborative Longitudinal Study of Personality Disorders (CLPS), the Methods to Improve Diagnostic Assessment and Service (MIDAS) study, and an adolescent clinical sample. Network attributes, including edge (partial association) strength and node (symptom) expected influence, were compared. The three networks were largely similar and strongly correlated. Affective instability and identity disturbance emerged as relatively central symptoms across the three samples, and relationship difficulties across adult networks. Differences in network attributes were more evident between networks varying both in age and in BPD symptom severity level. Findings highlight the relative importance of affective, identity, and relationship symptoms, consistent with several leading theories of BPD. The network structure of BPD symptoms appears generally replicable across multiple large samples including adolescents and adults, providing further support for the validity of the diagnosis across these developmental phases.

A Comparison of Two Five-Factor Model Operationalizations of the Triarchic Model of Psychopathy in a Clinical Sample.

Structural models of personality traits, particularly the five-factor model (FFM), continue to inform ongoing debates regarding what personality attributes and trait domains are central to psychopathy. A growing body of literature has linked the constructs of the triarchic model of psychopathy (boldness, meanness, disinhibition) to the FFM. Recently, researchers developed both item and regression-based measures of the triarchic model of psychopathy using the NEO Personality Inventory-Revised-a popular measure of the FFM. The current study examines the correlates of these two FFM-derived operationalizations of the triarchic model using data from the Collaborative Longitudinal Personality Disorders Study. The two approaches had strong convergent validity coefficients and similar patterns of criterion-related validity coefficients. Meanness related to greater personality pathology characterized by exploitation of others and poor attachment, whereas disinhibition related to indicators of greater negative affect and poor behavioral constraint. Boldness related to reduced negative affect and greater narcissistic personality traits. Although the item and regression-based approaches showed similar patterns of associations with criterion-variables, the item-based approach has some practical and psychometric advantages over the regression-based approach given strong correlations between the meanness and disinhibition scores from the regression approach.

Association of Borderline Personality Disorder Criteria With Suicide Attempts

Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions. To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria. The CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York, New York, Boston, Massachusetts, New Haven, Connecticut, and Providence, Rhode Island. A total of 733 participants were recruited at baseline, with 701 completing at least 1 follow-up assessment. The cohorts were recruited from September 1996 through April 1998 and September 2001 through August 2002. Data for this study using this follow-up sample (N = 701) were analyzed between March 2019 and August 2020. Participants were assessed annually using semistructured diagnostic interviews and a variety of self-report measures for up to 10 years. Multiple logistic regression analyses were used to examine baseline demographic and clinical risk factors, including BPD and individual BPD criteria, of suicide attempt assessed over 10 years of prospective follow-up. Of the 701 participants, 447 (64%) identified as female, 488 (70%) as White, 527 (75%) as single, 433 (62%) were unemployed, and 512 (73%) reported at least some college education. Of all disorders, BPD emerged as the most robust factor associated with prospectively observed suicide attempt(s) (odds ratio [OR], 4.18; 95% CI, 2.68-6.52), even after controlling for significant demographic (sex, employment, and education) and clinical (childhood sexual abuse, alcohol use disorder, substance use disorder, and posttraumatic stress disorder) factors. Among BPD criteria, identity disturbance (OR, 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR, 1.63; 95% CI, 1.03-2.57), and frantic efforts to avoid abandonment (OR, 1.93; 95% CI, 1.17-3.16) emerged as significant independent factors associated with suicide attempt(s) over follow-up, when covarying for other significant factors and BPD criteria. In the multisite, longitudinal study of adults with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts. Identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment may be clinically overlooked features of BPD in context of suicide risk assessment. In light of the high rates of BPD diagnostic remission, our findings suggest that these criteria should be independently assessed and targeted for further study as suicide risk factors.

Borderline personality disorder is equally trait-like and state-like over ten years in adult psychiatric patients.

Borderline personality disorder (PD) has historically been cast as an unabating condition. Longitudinal data, however, support a more variable time course marked by remission and relapse. In the present study, we tested the possibility that borderline PD has both stable (i.e., consistently present across time and situation, as modern diagnostic systems stipulate) and dynamic (i.e., episodic and situational) elements. Participants were 668 patients from the Collaborative Longitudinal Personality Disorders Study who were administered semistructured diagnostic interviews 5 times over a decade. Trait-state-occasion modeling dissected borderline pathology into time-invariant (i.e., trait) and time-varying (i.e., state) components. Contradicting traditional views of PD intransigence, less than half of borderline PD variability (approximately 45%) was time-invariant (i.e., perfectly stable) over the study timeframe. Furthermore, we found that the time-invariant component of borderline pathology, which we termed borderline proneness, was very closely related (r = .81) to a previously validated Five Factor Model trait composite of borderline features. Moreover, the trait versus state components showed a clear pattern of discriminant validity in relation to several putative causal agents for borderline PD (i.e., environmental pathogens, temperament dimensions). We conclude that borderline pathology contains a stable core and sizable situational components, and that both elements relate systematically to normative personality dimensions and known risk factors. These findings have key implications for etiological research, prognosis, and treatment for borderline PD. (PsycINFO Database Record

Personality disorder risk factors for suicide attempts over 10 years of follow-up.

Identifying personality disorder (PD) risk factors for suicide attempts is an important consideration for research and clinical care alike. However, most prior research has focused on single PDs or categorical PD diagnoses without considering unique influences of different PDs or of severity (sum) of PD criteria on the risk for suicide-related outcomes. This has usually been done with cross-sectional or retrospective assessment methods. Rarely are dimensional models of PDs examined in longitudinal, naturalistic prospective designs. In addition, it is important to consider divergent risk factors in predicting the risk of ever making a suicide attempt versus the risk of making an increasing number of attempts within the same model. This study examined 431 participants who were followed for 10 years in the Collaborative Longitudinal Personality Disorders Study. Baseline assessments of personality disorder criteria were summed as dimensional counts of personality pathology and examined as predictors of suicide attempts reported at annual interviews throughout the 10-year follow-up period. We used univariate and multivariate zero-inflated Poisson regression models to simultaneously evaluate PD risk factors for ever attempting suicide and for increasing numbers of attempts among attempters. Consistent with prior research, borderline PD was uniquely associated with ever attempting. However, only narcissistic PD was uniquely associated with an increasing number of attempts. These findings highlight the relevance of both borderline and narcissistic personality pathology as unique contributors to suicide-related outcomes.

Handbook of Good Psychiatric Management for Borderline Personality Disorder

Handbook of Good Psychiatric Management for Borderline Personality Disorder

Interactions of borderline personality disorder and mood disorders over 10 years.

To examine the relationship of borderline personality disorder (BPD) to mood disorders by using data from the Collaborative Longitudinal Personality Disorders Study on the reciprocal interactions of BPD with both depressive and bipolar disorders over the course of 10 years. The study included 223 BPD patients with DSM-IV-defined co-occurring major depressive disorder (MDD) (n = 161), bipolar I disorder (n = 34), and bipolar II disorder (n = 28) who were reliably and prospectively assessed over a period of 10 years between 1997 and 2009. Proportional hazards regression analyses were used to assess the effects of improvement or worsening of BPD and mood disorders on each disorder's time to remission and time to relapse. Borderline personality disorder and MDD had strong and statistically significant reciprocal effects, delaying each disorder's time to remission (BPD's effect on MDD, P = .0004; MDD's effect on BPD, P = .0002) and accelerating time to relapse (BPD's effect on MDD, P = .0410; MDD's effect on BPD, P = .0011), whereas BPD and the bipolar disorders were largely independent disorders except that bipolar II lengthened BPD's time to remission (P = .0085). Borderline personality disorder and MDD interactions suggest overlap in their psychopathologies and argue for prioritizing the treatment of BPD. Borderline personality disorder and bipolar disorders appear to be independent disorders, underscoring the need to provide appropriate treatment for each.

Convergent and incremental predictive validity of clinician, self-report, and structured interview diagnoses for personality disorders over 5 years.

Research has demonstrated poor agreement between clinician-assigned personality disorder (PD) diagnoses and those generated by self-report questionnaires and semistructured diagnostic interviews. No research has compared prospectively the predictive validity of these methods. We investigated the convergence of these 3 diagnostic methods and tested their relative and incremental validity in predicting independent, multimethod assessments of psychosocial functioning performed prospectively over 5 years. Participants were 320 patients in the Collaborative Longitudinal Personality Disorders Study diagnosed with PDs by therapist, self-report, and semistructured interview at baseline. We examined the relative incremental validity of therapists' naturalistic ratings relative to these other diagnostic methods for predicting psychosocial functioning at 5-year follow-up. Hierarchical linear regression analyses revealed that both the self-report questionnaire and semistructured interview PD diagnoses had significant incremental predictive validity over the PD diagnoses assigned by a treating clinician. Although, in some cases, the clinicians' ratings for individual PDs did have validity for predicting subsequent functioning, they did not generally provide incremental prediction beyond the other methods. These findings remained robust in a series of analyses restricted to a subsample of therapist ratings based on clinical contact of 1 year or greater. These results from a large clinical sample echo previous research documenting limited agreement between clinicians' naturalistic PD diagnoses and those from self-report and semistructured interview methods. They extend prior work by providing the first evidence about the relative predictive validity of these different methods. Our findings challenge the validity of naturalistic PD diagnoses and suggest the use of structured diagnostic instruments.

Facts, Artifacts, Mythofacts, Invisible Colleges, Illusory Colleges: The Perils of Publication Segmentation, Citation Preference, and Megamultiple Authorship: A Commentary on Blashfield and Reynolds

When the editors of the Journal of Personality Disorders asked me to pen a commentary on the Blashfield and Reynolds (2012) piece on their “invisible college” analysis of the reference list associated with the DSM-5 work group’s proposal, I was not particularly inclined to do so. However, with some reflection I came to see the paper as affording any number of interesting points for discussion. In reading (and rereading) the Blashfield and Reynolds paper, I found myself thinking: What did they find? Why did they find what they found? Most importantly, what do their findings mean? At the end of the day, I believe Blashfield and Reynolds have offered us evidence not of an “invisible college” of insiders connected with one of the longitudinal studies of personality disorders at work crafting the DSM-5. Rather, consideration of their findings, the data upon which they are based, and their interpretation point to the existence of an “illusory college” reflective of fascinating publication artifacts. The intellectual danger afoot in Blashfield and Reynolds’s paper is that their invisible college interpretation could take on the status of what my former colleague Brendan A. Maher (1992) called a “mythofact,” or a fact-like statement that, while not actually true, is demanded by the flow of the narrative. In short, my impression of the results obtained by Blashfield and Reynolds in their citation analysis reflects a perfect storm resulting from (a) publication segmentation, (b) citation preference/style, and (c) megamultiple authorship propensities on the Collaborative Longitudinal Personality Disorders Study (CLPS). The results of the Blashfield and Reynolds analysis do not provide compelling support for their claim of the CLPS staff driving the hybrid dimensional/categorical model proposed for the DSM-5.

An Invisible College View of theDSM-5Personality Disorder Classification

The DSM-5 Personality and Personality Disorders Work Group released the final proposed changes for the upcoming manual in May 2012. The proposal, located at www.dsm5.org , included a hybrid dimensional/categorical method of diagnosing personality disorders. This brief article examines the reference section of the DSM-5 personality disorder proposal rationale (American Psychiatric Association, 2012). The authors counted the number of authors and the coauthorships; coauthorship patterns were then examined and diagramed. The data suggested that a group of researchers involved with the Collaborative Longitudinal Personality Disorders Study (CLPS) were central to the hybrid classification created by the DSM-5 work group.

Socioeconomic-Status and Mental Health in a Personality Disorder Sample: The Importance of Neighborhood Factors

This cross-sectional study examined the associations between neighborhood-level socioeconomic-status (NSES), and psychosocial functioning and personality pathology among 335 adults drawn from the Collaborative Longitudinal Personality Disorders Study. Participants belonged to four personality disorder (PD) diagnostic groups: Avoidant, Borderline, Schizotypal, and Obsessive Compulsive. Global functioning, social adjustment, and PD symptoms were assessed following a minimum two-year period of residential stability. Residence in higherrisk neighborhoods was associated with more PD symptoms and lower levels of functioning and social adjustment. These relationships were consistent after controlling for individual-level socioeconomic-status and ethnicity; however, the positive association between neighborhood-level socio-economic risk and PD symptoms was evident only at higher levels of individual-level socio-economic risk. Our findings identify NSES as a candidate for explaining some of the variability in symptoms and functioning among PD individuals.

It Takes a Borderline Village

It Takes a Borderline Village

"Psychometric characteristics and clinical correlates of NEO-PI-R fearless dominance and impulsive antisociality in the Collaborative Longitudinal Personality Disorders Study": Correction to Witt et al. (2010).

"Psychometric characteristics and clinical correlates of NEO-PI-R fearless dominance and impulsive antisociality in the Collaborative Longitudinal Personality Disorders Study": Correction to Witt et al. (2010).

Impaired Social Functioning Lingers After BPD Symptoms Remit

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessImpaired Social Functioning Lingers After BPD Symptoms RemitMark MoranMark MoranSearch for more papers by this authorPublished Online:7 Oct 2011https://doi.org/10.1176/pn.46.19.psychnews_46_19_19_1AbstractSymptoms of borderline personality disorder (BPD) often remit over a 10-year period, but patients continue to experience severe and persistent impairment in social functioning. That was the finding from a follow-up of patients with BPD in the Collaborative Longitudinal Personality Disorders Study, a report of which appears in the August Archives of General Psychiatry. The analysis found that the 10-year course of BPD is characterized by high rates of remission, low rates of relapse, but severe impairment in social functioning (see Key Findings From BPD Study). The report extends and confirms previous reports about the long-term course of BPD, which have suggested that therapies for the disorder tend to work well for the most acute symptoms—such as self-harm and emotional dysregulation—but do little to address impairments in social functioning. "What this shows is that over time, patients are more quietly dysfunctional than they were likely to have been when originally treated," lead author John Gunderson, M.D., told Psychiatric News. "A minority of patients go on to a reasonably good functional level with a job and a family life, and then another minority remain both functionally and symptomatically ill. But the largest group of patients are not symptomatic but don't have friends or stable relationships." Gunderson is a professor of psychiatry at Harvard Medical School and director of psychosocial and personality research at McLean Hospital in Belmont, Mass. In the study, 75 patients with BPD, 312 with cluster C personality disorder, and 95 with major depressive disorder (MDD) but no personality disorder were followed for a decade. Subjects were drawn from 19 clinical settings (hospital and outpatient) in four northeastern U.S. cities. The Diagnostic Interview for DSM-IV Personality Disorders and its follow-along version were used to diagnose personality disorders and assess changes in the symptoms over time. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Longitudinal Interval Follow-Up Evaluation were used to diagnose MDD and assess changes in MDD and in social function. Eighty-five percent of patients with BPD remitted, but remission was slower than for patients with MDD and minimally slower than for those with other personality disorders. The other notable finding from the study is that once they are in remission, patients rarely relapse: 12 percent of patients with BPD relapsed, a rate less frequent than that for patients with MDD and with other personality disorders. However, social-functioning scores showed severe impairment with only modest (although statistically significant) improvement; patients with BPD remained persistently more dysfunctional than those in the other two groups. Gunderson said that the "most obvious reason" for the discrepancy between symptomatic and functional improvement is that treatments for BPD, as for many psychiatric and other medical disorders, are best for addressing acute symptoms, but do not typically address long-term functional and social deficits. "Another fundamental answer is that even when the symptoms remit, the underlying basis of the disorder—whether it is psychological or genetic—remains," he said. Those with the disorder aren't well "just because they aren't shouting and cutting themselves and being admitted into the hospital. There are fundamental handicaps that these patients have in terms of genetic predispositions." And there is a social learning aspect to the long-term course of BPD. "By the time a patient has BPD, he or she may never have gone through a job interview," he said. "We don't know how much of their dysfunction is genetic and how much is impaired social learning, but they are both important." Gunderson added that at McLean Hospital, social rehabilitation has been made a focus of BPD treatment. "Most of our patients eventually go to school or work, and we expect them to," he said. He added that office-based psychiatrists who work with BPD patients over the long term know "that we in the psychiatric community can and should expect more and give more to our patients in terms of social rehabilitation." "Ten-Year Course of Borderline Personality Disorder: Psychopathology and Function From the Collaborative Longitudinal Personality Disorders Study" is posted at <http://archpsyc.ama-assn.org/cgi/content/abstract/68/8/827>. ISSUES NewArchived

Prospective investigation of a PTSD personality typology among individuals with personality disorders

This study investigated the replicability of a previously proposed personality typology of posttraumatic stress disorder (PTSD, and explored stability of cluster membership over a 6-month period. Participants with current PTSD (n = 156) were drawn from the Collaborative Longitudinal Personality Disorders Study (CLPS). The CLPS project tracked a large sample of individuals who met criteria for 1 of 4 target diagnoses (borderline, schizotypal, avoidant, and obsessive-compulsive) and a contrast group of individuals who met criteria for depression but no personality disorder. A cluster analysis using scales from the Schedule of Nonadaptive and Adaptive Personality yielded 3 clusters: “internalizing,” “externalizing,” and “low pathology.” Using K-means cluster analysis, the results did not replicate previous work. Using Ward's method, the hypothesized 3-cluster structure was confirmed at baseline but did not demonstrate temporal stability at 6 months.

Interaction of personality disorders with other co‐occurring psychiatric disorders

T. Widiger presents a thoughtful and balanced overview of the bidirectional ways that personality and psychopathology can influence each other. He focuses first on the differential effects that various personality types might have on the development of specific psychiatric disorders, suggesting some phenotypic similarities between personality traits (referring to the five-factor model, FFM) and features of specific disorders, such as selected eating disorders. In the clinical context of the growing interest in prevention and early intervention, it is valuable to consider whether or not certain personality types might be thought of as predictive patterns, to bring early attention to those with heritable risk for specific illnesses that might emerge during adverse environmental circumstances. Widiger does not differentiate here between personality types characterized by the FFM and personality disorders as defined by DSM-IV-TR, but similar arguments have been made about the influence of Axis II disorders on the course of Axis I disorders. In particular, a recent paper by Skodol et al 1 reported that, in a large nationally representative sample of adults with major depressive disorder (MDD), borderline personality disorder (BPD) strongly predicted persistence of MDD over time and was more strongly predictive of persistent depression than the co-occurring presence of Axis I disorders. Widiger then reviews the influence of psychopathology on personality. He contends that personality assessment will be inaccurate if carried out when a patient is experiencing an acute symptomatic episode of illness. There is some controversy about this assertion, however. Morey et al 2, for example, recently reported that personality disorders can be validly diagnosed during depressive episodes. Regarding the interactive dynamics over time, Widiger cites a report from the Collaborative Longitudinal Personality Disorders Study (CLPS), published in 2003, in which Gunderson et al 3 suggest that remission of BPD may often follow resolution of an Axis I disorder. However, the CLPS group subsequently reported that, over 3 years, the rate of remission of BPD was not affected by whether or not patients had co-morbid MDD, whereas time to remission of MDD was significantly prolonged in patients with co-occurring BPD 4. Similar findings were described in a 10-year follow-up study from the same research group 5. Widiger’s summary of studies indicating that personality disorders can be understood as extreme variants of the FFM is a helpful conceptual model, one that is familiar in the medical world and similar to medical conditions such as hypertension. However, the argument that many DSM-defined personality disorders exist on a spectrum linking them to major Axis I categories is more controversial. Here, the evidence is most persuasive that patients with schizotypal personality disorder share some biomarkers and some degree of genetic risk with those at risk to develop schizophrenia. The evidence is more controversial regarding the link of other personality disorders to Axis I categories. The recognition that psychopathology, particularly if severe and persistent, can alter or shape personality is certainly persuasive in many clinical situations. How, or whether even to try, to diagnose the presence of a personality disorder in certain patients, such as patients with early onset severe and persistent schizophrenia, is certainly a legitimate question. However, even in these cases, there almost always is a “person” who has been there all along, prior to the development of the Axis I condition, and it will help us to sustain hope and a recovery framework to remember that. Sometimes the interconnectivity of conditions can be quite thorny. I recall one patient to whom I administered the Personality Disorder Examination, a semi-structured clinical diagnostic interview for DSM-defined personality disorders. I began with the usual introductory instructions that I was interested in what she was like most of her adult life, not just during a period of illness such as depression or substance abuse. She said “stop”, which I did, and she informed me that she was 35 years old, that this was her first hospitalization for severe alcoholism, and that the last time she remembered being sober was when she was 12. In a case like this, we could only learn “who she is” over time, and then only if she achieved and maintained sobriety. These and many other issues are nicely assembled in this welcome paper by Widiger, which points us in important directions for further study.

Self-Harm Subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP)

We examined the predictive power of the self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP) to identify suicide attempters in the Collaborative Longitudinal Study of Personality Disorders (CLPS). The SNAP, a self-report personality inventory, was administered to 733 CLPS participants at baseline, of whom 701 (96%) had at least 6 months of follow-up data. Cox proportional hazards regression analyses were performed to examine the SNAP-self-harm subscale (SNAP-SH) in predicting the 129 suicide attempters over 8 years of follow-up. Possible moderators of prediction were examined, including borderline personality disorder, major depressive disorder (MDD), and substance use disorder. We also compared baseline administration of the SNAP-SH to subsequent administrations more proximal to the suicide attempt, and to a higher-order SNAP-negative temperament (SNAP-NT) subscale. Receiver operating characteristic analyses were conducted using suicide attempts (n = 58) over the first year of follow-up to provide reference points for sensitivity and specificity. The SNAP-SH demonstrated good predictive power for suicide attempts (hazard ratio = 1.28, P < .001) and appeared relatively consistent across borderline personality disorder, MDD, and substance use disorder diagnoses. Using more proximal scores did not increase predictive power. The SNAP-SH compared favorably to the predictive power of the higher-order SNAP-NT. Receiver operating characteristic analyses indicate several cutoff scores on the SNAP-SH that yield moderate to high sensitivity and specificity for predicting suicide attempts over the first year of follow-up. The SNAP-SH may be a useful screening instrument for risk of suicide attempts in nonpsychotic psychiatric patients.

The association of personality disorders with the prospective 7-year course of anxiety disorders

This study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs. Participants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia. Estimated remission rates for anxiety disorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxiety disorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxiety disorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxiety disorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia. Findings suggest that specific PD diagnoses have negative prognostic significance for the course of anxiety disorders underscoring the importance of assessing and considering PD diagnoses in patients with anxiety disorders.

Psychometric characteristics and clinical correlates of NEO-PI-R fearless dominance and impulsive antisociality in the Collaborative Longitudinal Personality Disorders Study.

This study evaluates the validity of derived measures of the psychopathic personality traits of Fearless Dominance and Impulsive Antisociality from the NEO Personality Inventory-Revised (NEO-PI-R; Costa & McCrae, 1992) using data from the Collaborative Longitudinal Personality Disorders Study (baseline N = 733). These 3 issues were examined: (a) the stability of the measures over a 10-year interval, (b) their criterion-related validity, and (c) their incremental validity relative to an alternative NEO-PI-R profile-rating approach for assessing psychopathy. NEO-PI-R Fearless Dominance and Impulsive Antisociality scales were relatively stable across 10 years and demonstrated differential associations with measures of personality pathology and psychopathology generally consistent with past research and theoretical considerations. Moreover, these measures demonstrated an appreciable degree of incremental validity over the NEO-PI-R profile-rating approach.