Core Features Of Personality Disorder Research Articles

Personality disorder traits, maladaptive schemas, modes and coping styles in participants with complex dissociative disorders, borderline personality disorder and avoidant personality disorder.

The schema mode model offers a new conceptualisation of complex dissociative disorders (CDD) as it explains shifts between identities as shifts between schema modes. Furthermore, in this model CDD is conceived as personality pathology, incorporating core features of personality disorders. This study tested the assumptions of this schema mode model of CDD. Questionnaires measuring personality disorder traits, schemas, schema modes and coping styles were filled out by patients with CDD, borderline personality disorder and avoidant personality disorder (N = 210), and their scores on the various constructs were compared. Participants with CDD were characterised by specific schizoid, schizotypal, borderline and avoidant personality traits and early maladaptive schemas in the domains of disconnection and rejection and over-vigilance and inhibition. The most pronounced schema modes were the dysfunctional parent modes, avoidant coping modes and the vulnerable child mode. For coping styles, no differences were found between the diagnostic groups. On all outcome measures participants with CDD scored at the level of personality disorders and showed a unique pattern different from participants with borderline and avoidant personality disorder. This suggests that CDD shows features akin to a personality disorder. A clinical implication is that an adapted form of schema therapy might present a viable treatment option for CDD.

Key insights from studies on the stability of personality disorders in different age groups.

While for decades, temporal stability has been conceived as a defining feature of personality disorders (PDs), cumulative findings appear to question the stability of PDs and PD symptoms over time. However, stability itself is a complex notion and findings are highly heterogenous. Building upon a literature search from a systematic review and meta-analysis, this narrative review aims to capture key findings in order to provide critical implications, both for clinical practice and future research. Taken together, this narrative review revealed that unlike previous assumptions, stability estimates in adolescence are comparable to stability estimates in adulthood and PDs and PD symptoms are not that stable. The extent of stability itself depends yet on various conceptual, methodological, environmental, and genetic factors. While findings were thus highly heterogenous, they all seem to converge in a notable trend towards symptomatic remission, except for high-risk-samples. This challenges the current understanding of PDs in terms of disorders and symptoms and argues instead in favor of the AMPD and ICD-11 reintroducing the idea of self and interpersonal functioning as the core feature of PDs.

Clinical Associations Between Severity of Impulsivity, Psychiatric Morbidity, Dysfunctional Defences and Personality Disorder: A Comparative Study With Axis-I Disorders.

ObjectivePsychiatric morbidity, impulsive behaviour and use of dysfunctional and maladaptive defences are core features of personality disorder (PD). This study aims to evaluate the significance of the strength of the association between these three core dimensions and PD.MethodUsing a cross-sectional design, a sample of co-morbid Axis-I & -II disorders, and a sample of Axis-I disorders with no co-morbid PD were recruited at three general psychiatric mental health resource centres and then compared.PD as dependent variable was analysed both as a categorical and as a dimensional entity using the Structured Clinical Interview for DSM-IV. The Symptoms Checklist 90-R general severity index (GSI), the Barratt Impulsivity Scale (BIS) and the Defense Style Questionnaire (DSQ) were used to measure severity of psychiatric morbidity, impulsivity and defensive style, respectively.ResultsBIS was a highly significant predictor of categorical PD (β = .13, SE = .03, p < .001), but not GSI and DSQ. BIS and GSI significantly predicted PD as a dimensional construct (β = 0.32, SE = .08, t = 4.05, p < 0.001; and β = 5.04, SE = 1.54, t = 3.28, p = 0.002, respectively). The diagnostic efficiency statistics found that BIS had greater sensitivity (.82) and specificity (.79), and overall predictive power (.87) of correctly identifying true positive and true negative PD diagnosis compared to the other two measures.ConclusionsBIS may be used in routine clinical practice as a screening measure to identify the presence of PD in complex presentations.

Disrupted physiological coregulation during a conflict predicts short-term discord and long-term relationship dysfunction in couples with personality pathology.

Interpersonal dysfunction is a core feature of personality disorders, often affecting close relationships. Nevertheless, little is known about the moment-to-moment dynamic processes by which personality pathology contributes to dysfunctional relationships. Here, we investigated the role of physiological attunement during a conflict discussion in romantic couples oversampled for personality pathology. We hypothesized that physiological coregulation would be disrupted in individuals with personality pathology, subsequently predicting short-term discord and long-term relationship dissatisfaction. One hundred twenty-one couples completed a 10-min discussion about an area of disagreement while cardiovascular physiology and behavior were recorded. We quantified coregulation using a dynamical systems model of heart rate changes. We found that greater interpersonal problem severity was associated with more contrarian coregulation, exacerbating negative affect and interpersonal perceptions. Furthermore, the extent to which coregulation was associated with increased discord prospectively predicted relationship dissatisfaction 1 year later. Altogether, this work sheds light on a pathway by which personality pathology contributes to problems in romantic relationships. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impulsivity-related traits and their relation to DSM-5 section II and III personality disorders.

Difficulties with impulse control are considered a core feature of personality disorders (PDs) as assessed by the Diagnostic and Statistical Manual of Mental Disorders (5th edition [DSM-5]; American Psychiatric Association, 2013). Despite this, there has been relatively little examination of the manner in which DSM-5 PDs are characterized by multidimensional models of impulsivity that parse this broad umbrella construct into smaller, more unidimensional constructs. Using the UPPS model and measure of impulsivity (Whiteside & Lynam, 2001), the relations between 4 impulsivity-related traits and interview-rated scores on both DSM-5 Section II and III PDs and PD traits were examined in a community sample of individuals currently receiving psychological or psychiatric care (N = 106). As expected, the UPPS traits manifested correlations with the new Section III trait model that were generally consistent with the assertion that this new DSM-5 trait model reflects a pathological variant of the Five-Factor Model (FFM; e.g., UPPS traits associated with FFM conscientiousness were most strongly related to DSM-5 disinhibition traits). Overall, the UPPS traits accounted best for variance in DSM-5 Section II and III Cluster B PDs, consistent with these PDs being characterized, in part, by emotionally and cognitively based forms of impulsivity.

When is it time to move on? Rejoinder for “The ironic fate of the personality disorders in DSM-5”.

Presents a rejoinder to comments by Silk (see record 2013-45025-005) and Zimmerman (see record 2013-45025-006) on the original article by Skodol et al. (see record 2013-45025-004) regarding personality disorders in the DSM-5. Here, Skodol et al. comment that many of the early decisions made by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) PPDWG and within the Personality and Personality Disorders Work Group (PPDWG) noted in Silk's commentary should be viewed in light of the original goals of the DSM-5, which included a break from past practices of "tinkering" with categorical criteria. In the end, a compromise hybrid dimensional-categorical model-the favored option of most personality disorder (PD) experts-was developed and was published in DSM-5 Section III. The "alternative model" preserves continuity with current clinical practice while also addressing numerous shortcomings of the exclusively categorical approach to PDs. The personality functioning and pathological trait components of the revised general criteria and the criteria for the six specific disorders and PD-TS are based on extensive data on the core features of PDs and the trait representation of personality pathology. The final model's thresholds for diagnosis, its criteria composition, and its decision rules are based for the first time on empirical data, unlike the diagnostic thresholds and decision rules for DSM-IV (now also in DSM-5 Section II), which for the most part are unsubstantiated. Thus, Zimmerman's comments to the contrary, the Section III alternative model has a greater empirical basis than much of what is in Section II and holds more promise for the future.

The General Assessment of Personality Disorder (GAPD) as an Instrument for Assessing the Core Features of Personality Disorders

This study presents a psychometric evaluation of the General Assessment of Personality Disorder (GAPD), a self-report questionnaire for assessing the core components of personality dysfunction on the basis of Livesley's (2003) adaptive failure model. Analysis of samples from a general (n = 196) and a clinical population (n = 280) from Canada and the Netherlands, respectively, found a very similar two-component structure consistent with the two core components of personality dysfunction proposed by the model, namely, self-pathology and interpersonal dysfunction. Moreover, the GAPD discriminated between patients diagnosed with and without Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) personality disorder(s) and demonstrated discriminative power in detecting the severity of personality pathology. Correlations with a DSM-IV symptom measure and a pathological traits model suggest partial conceptual overlap. Although further testing is indicated, the present findings suggest the GAPD is suitable for assessing the core components of personality dysfunction. It may contribute to a two-step integrated assessment of personality pathology that assesses both personality dysfunction and personality traits. The core features of personality disorder can be defined as disorders in the self and in the capacity for interpersonal functioning. A clinically useful operationalization of disordered functioning of personality is needed to determine the maladaptivity of personality traits. An integrated assessment of personality (dys)functioning and personality traits provides a more comprehensive clinical picture of the patient, which may aid treatment planning.

Core Features of Personality Disorder: Differentiating General Personality Dysfunctioning from Personality Traits

Core Features of Personality Disorder: Differentiating General Personality Dysfunctioning from Personality Traits

Core Features of Personality Disorder: Differentiating General Personality Dysfunctioning from Personality Traits

The distinction between general personality dysfunctioning (GPD) and specific personality traits (SPT) is an important focus of attention in the proposed revisions of the DSM-5. The present study explores the distinction between GPD and SPT using the self-report questionnaires General Assessment of Personality Disorder (GAPD) and Severity Indices for Personality Problems (SIPP-118) to measure GPD, and the NEO-PI-R to measure SPT. The sample consisted of 424 psychiatric patients. Using principal component analysis, GPD and SPT appeared to be clearly distinct components of personality. Our GPD model consisted of three factors, i.e., Self-identity dysfunctioning, Relational dysfunctioning, and Prosocial functioning. This model remained by and large intact when combined with SFT factors. Our findings support the distinction between personality traits and personality dysfunction laid down in the recent proposal by the Personality and Personality Disorders Work Group of the DSM-5 Task Force.

The relationship between interpersonal problems and outcome in psychodynamic hospitalization-based treatment for personality disorders: A 12-month follow-up study

Disturbances in interpersonal relationships are a core feature of personality disorders. Psychodynamic formulations in particular consider interpersonal problems as a central characteristic of personality pathology. Yet, despite the centrality of interpersonal issues in both theoretical conceptualizations and psychodynamic treatment approaches, relatively few studies have investigated the role and nature of interpersonal problems in psychodynamic treatments for personality pathology. This study set out to investigate in a sample of 44 personality-disordered patients whether hospitalization-based psychodynamic treatment was associated with changes in interpersonal problems, as measured with the Inventory of Interpersonal Problems, at the end of treatment and at three- and 12-month follow-up. In addition, this study investigated whether specific types of interpersonal problems were associated with symptomatic outcome assessed during treatment, at the end of treatment, and at three- and 12-month follow-up, and whether changes in interpersonal problems from baseline to the end of treatment were related to outcome at follow-up. Results showed that psychodynamic treatment was associated with significant improvements in interpersonal problems during treatment, and continuing improvement in interpersonal functioning after treatment. Yet, problems in the cold-vindictive and domineering domain were negatively related to outcome during, but specifically after, treatment, and also tended to show little improvement during treatment. Finally, the extent to which these interpersonal features and interpersonal problems in the overly nurturant and non-assertiveness domains changed during treatment, was associated with symptomatic improvement, particularly at follow-up. The implications of these findings for the psychodynamic treatment of personality-disordered patients are discussed.

The relationship between social problem-solving and personality in mentally disordered offenders

Poor social problem-solving skills may account for some criminal behaviours in mentally disordered offenders, and social problem-solving may be mediated by personality traits. We examined the relationship between personality and social problem-solving in 52 mentally disordered offenders, (38 mentally ill and 14 personality disordered) detained in a regional secure unit. Since t-tests indicated no differences between the mentally ill and personality disordered groups, they were pooled into a single sample. Correlations indicated that high neuroticism (N) was related to poor social problem-solving, and high scores on the other five-factor traits were related to good social problem-solving. High N, which is a core feature of personality disorders as well as being a common feature of offenders, may signal emotional reactivity which militates against effective social problem-solving. N is, however, negatively correlated with extraversion (E), conscientiousness (C), and agreeableness (A), therefore partial correlations were conducted controlling for N. Once N is discounted, the main trait associated with problem-solving is openness (O), which is positively related to problem-solving, perhaps due to the relationship of O to intelligence and creativity. A positive correlation between E and a more positive problem orientation remains, perhaps because optimism is a defining feature of high E.

A practical way to diagnosis personality disorder: a proposal.

General criteria for the diagnosis of personality disorder are provided based on rating a few items describing four core features of personality disorder: (a) low Self-directedness, (b) low Cooperativeness, (c) low Affective Stability, and (d) low Self-transcendence. These core features correspond closely with the basic concept of personality disorder in DSM-IV and are based on specific items easy for clinicians to rate in a short time. Criteria are also provided for rating severity of personality disorganization and for subtyping based on a profile of three additional dimensions corresponding to core features of DSM-IV clusters A, B, and C. This approach should facilitate efficient screening in clinical practice, encourage an understanding of the development of comorbidity as a self-organizing process, and provide a theory-driven basis for therapeutic planning with drugs and psychotherapy.

Coping and MCMI-II Personality Disorders

Inflexible and dysfunctional coping strategies are considered to be among the core features of personality disorders. In the present study, the relationship between coping and the second edition of the Millón Clinical Multiaxial Inventory (MCMI-II) personality disorder (PD) scales was investigated in a sample of 240 psychiatric clinic outpatients at follow-up. Three groups of coping strategies were studied, namely problem-focused, emotion-focused, and potentially dysfunctional coping strategies. Correlation and regression analyses indicated a considerable association between coping and most of the personality disorders (MCMI-II), irrespective of sex and age. The general pattern of association was that of deficits in problem-focused coping, together with an excess of dysfunctional coping. Patients with MCMI-II personality disorders tended to make little use of active coping and social support; instead they were inclined to disengage from goals and to discharge negative emotions. The findings seem promising with respect to a better understanding of the adaptational problems of patients with personality disorders.