Course Of Personality Disorder Research Articles

Award for Distinguished Scientific Early Career Contributions to Psychology: Aidan G. C. Wright.

The Early Career Awards, given for the first time in 1974, recognize the large number of excellent early career psychologists. Recipients of this award may not have held a doctoral degree for more than nine years. For outstanding early career research in personality and psychopathology, Aidan G. C. Wright's trailblazing studies on the structure and dynamics of individual differences have changed the way the field thinks about psychopathology. By applying sophisticated and often longitudinal data analysis to multisource personality and psychopathology data, he has made specific advances in understanding the course of personality disorders, connections between personality traits and mental health symptoms, and within-person processes in psychopathology. His cutting-edge studies marrying established structures of individual differences with person-specific models of psychological functioning have opened up entirely new approaches to public health. Overall, Dr. Wright's research provides a strong methodological and conceptual foundation for more data-driven and individualized approaches to the assessment, understanding, and ultimately prevention and treatment of mental health problems. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Longitudinal Course of Borderline Personality Disorder: What Every Clinician Needs to Know

Longitudinal research describing the course of borderline personality disorder (BPD) has radically revised psychiatry’s stigmatizing assumptions of its immutability and poor prognosis. This review outlines major findings from four of the largest, most methodologically rigorous prospective studies of BPD in childhood and adulthood to provide a scientifically informed understanding of its precursors, structure, trajectory, interaction with other psychiatric illnesses, and impact on treatment utilization and functional outcomes. BPD’s fluctuating symptoms and underlying diathesis interact over time to increase psychiatric vulnerability and divergence in developmental trajectory from peers throughout early life, resulting in higher levels of disability and adversity in adulthood. High rates of remission, low rates of relapse, and moderate but unstable recovery provide good news for its prognosis, while risk for persistence of psychiatric comorbidities, multiple suicide attempts, poor health outcomes, intensive treatment utilization, and severe functional impairment underscore its status as a serious mental illness. Longitudinal research on BPD has validated BPD as a distinct, serious, and disabling disorder, and defined clinically relevant predictors of outcome which can guide practitioners in their diagnostic disclosure, psychoeducation, and collaborative treatment planning as early as childhood. This research has also influenced more refined conceptualizations of personality disorders, which account for stable dimensions of personality traits more generally and the fluctuating course of personality disorder symptoms intermittently, pointing to alternative models of diagnosis in development.

A Developmental Psychopathology Perspective on Personality Disorder: Introduction to the Special Issue

A Developmental Psychopathology Perspective on Personality Disorder: Introduction to the Special IssueJennifer L. Tackett and Carla SharpJennifer L. TackettAddress correspondence to Jennifer L. Tackett, Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204; E-mail: [email protected]Search for more papers by this author and Carla SharpUniversity of Houston.Search for more papers by this authorPublished Online:December 2013https://doi.org/10.1521/pedi.2014.28.1.1PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Next article FiguresReferencesRelatedDetails Cited byCited by1. Using the Personality Assessment Inventory-Adolescent in Legal SettingsOnline publication date: 1 February 2022. Go to citation Crossref Google Scholar2. Public Health Considerations in PsychopathyOnline publication date: 13 March 2022. Go to citation Crossref Google Scholar3. Open Peer Commentary and Author'S ResponseOnline publication date: 1 September 2018. Go to citation Crossref Google Scholar4. Integrating developmental aspects in current thinking about personality pathologyOnline publication date: Go to citation Crossref Google Scholar5. Das Schizoidie-Konzept in der PsychiatrieOnline publication date: 11 July 2017. Go to citation Crossref Google Scholar6. Up-regulation of neural indicators of empathic concern in an offender populationOnline publication date: 30 June 2016. Go to citation Crossref Google Scholar7. Online publication date: Go to citation Crossref 8. The Influence of Maternal Personality and Risk Factors for Impaired Mother-Infant Bonding on Breastfeeding DurationOnline publication date: Go to citation Crossref Google ScholarVera Ramos, Guilherme Canta, Filipa de Castro and Isabel Leal9. The relation between attachment, personality, internalizing, and externalizing dimensions in adolescents with borderline personality disorderOnline publication date: 1 September 2016. Go to citation Crossref 10. Parenting stress and postpartum depression/anxiety in mothers with personality disorders: indications for differential intervention prioritiesOnline publication date: 23 September 2015. Go to citation Crossref Google Scholar11. Preface to Developmental Psychopathology, Third EditionOnline publication date: 10 February 2016. Go to citation Crossref Google Scholar12. Toward a Unifying Perspective on Personality Pathology Across the Life SpanOnline publication date: 10 February 2016. Go to citation Crossref Google Scholar13. ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practiceOnline publication date: 14 August 2015. Go to citation Crossref Google ScholarPeter Fonagy, Patrick Luyten and Elizabeth Allison14. Epistemic Petrification and the Restoration of Epistemic Trust: A New Conceptualization of Borderline Personality Disorder and Its Psychosocial TreatmentOnline publication date: 22 September 2015. Go to citation Crossref 15. Paranoid, schizoid, selbstunsicher, dependent und zwanghaftOnline publication date: 5 August 2015. Go to citation Crossref Google Scholar16. L’enfant borderline en devenir II : validation préliminaire de l’Échelle de traits de personnalité limite pour enfantsOnline publication date: 29 January 2016. Go to citation Crossref Google Scholar17. Personality Disorders in Adolescence: Introduction to the Special IssueOnline publication date: 30 November 2014. Go to citation Crossref Google Scholar Volume 28Issue 1Feb 2014 Information© 2014 The Guilford PressPDF download

Personality Disorders and Mood Disorders: Perspectives on Diagnosis and Classification from Studies of Longitudinal Course and Familial Associations

The results of three rigorous studies of the naturalistic course of personality disorders indicate the following: (1) personality psychopathology improves over time at unexpectedly significant rates; (2) particular maladaptive personality traits are more stable than personality disorder diagnoses; (3) although personality psychopathology improves, residual effects are usually seen in the form of persistent functional impairment and ongoing Axis I psychopathology; and (4) improvement in personality psychopathology may eventually be associated with reduction in ongoing personal and social burden. A comparison of the longitudinal stability of personality disorders and mood disorders does not support a clear distinction between them based on differential stability of either psychopathology (at least based on remission rates) or functional impairment. Differences may yet emerge with respect to relapse rates over the longer term. Both types of disorders may share some common underlying vulnerabilities best conceptualized in term of personality traits. A group of promising, though methodologically flawed, family studies suggest familiality of at least BPD among the personality disorders and the coaggregation of BPD and depressive disorders (but not bipolar disorders) that may contribute to their frequent co-occurrence. Again, underlying personality traits may prove to be more heritable than either type of disorder.

Childhood personality pathology: Dimensional stability and change

Studies on the developmental course of personality disorders have suggested that adult personality disorders enclose both features with a natural plasticity over time, as well as stable components represented by underlying trait dimensions. The current study broadens this dimensional stability perspective toward an earlier developmental stage, and describes with different indices of stability the longitudinal behavior of basic childhood maladaptive trait dimensions in a community sample of 477 Flemish children. The results underscore structural, rank-order, and within-person stability for the disagreeableness, emotional instability, introversion, and compulsivity dimensions and suggest a similar maturation principle as has been proposed for adults. Individual growth curve analyses indicate that children's maladaptive trait scores generally decrease as they grow older, with a smaller decline for high-scoring individuals. Childhood maladaptive traits and general psychopathology dimensions show similar longitudinal patterns in terms of shape and change over time, supporting a spectrum conceptualization of Axis I related pathology and personality disorder precursors at young age. The implications of these findings for a developmental perspective on dimensional conceptualizations of personality disorders are discussed.

The development of personality disorders: Perspectives from normal personality development in childhood and adolescence

The developmental pathways leading to personality disorders are poorly understood, but clues to these pathways come from recent research on personality disorders and normal personality development in childhood and adolescence. The first section of this paper reviews recent work on personality disorders in childhood and adolescence, and concludes that personality disorders in adolescence are already prevalent, moderately stable, and impairing. The second section draws on McAdams and Pals' personality model to offer a taxonomy of personality differences that can account for the known patterns of emerging personality pathology. This taxonomy includes youths' temperament and personality traits, mental representations (including attachment), coping strategies, and narrative identities. Individual differences in all of these domains may play critical roles in the development, manifestation, and course of personality disorders. Existing knowledge of normal and abnormal personality development can inform future research on the developmental pathways leading to personality pathology, the diagnostic criteria for personality disorders, and the development of validated treatments for personality disorders in the first two decades of life.

Socioeconomic background and the developmental course of schizotypal and borderline personality disorder symptoms

Low socioeconomic status (SES) background has been identified as a risk for several mental disorders. However evidence regarding SES and the developmental course of personality disorder (PD) has not been addressed. Nor is it clear whether an SES relationship to PD symptom course may be attributable to known associated risks. Further, specificity of such relationships to a particular PD diagnostic pattern independent of comorbidity with other PD or with depression has not been investigated. Data are from a general population studied longitudinally between ages 10 and 36 in four assessment waves. Effects of SES-associated risks on the level of symptoms of schizotypal and borderline disorders are estimated and compared to effects on depressive symptoms. Low family SES had robust modest independent effects on both PDs over the entire age span despite substantial cumulative effects of trauma history, stressful recent life events, IQ, poor parenting, and comorbid symptoms. SES effects on depressive symptoms were generally absent, but a small "protective" effect of low SES appeared when comorbidity with PD symptoms was taken into account. Cumulatively, these risks account for developmental failures of substantial magnitude and consequence, marking the importance of understanding the remaining mechanisms of SES effects and programmatic implications for minimizing associated risk.

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 relevance of a geriatric sub‐classification of personality disorders in the DSM‐V

Little is known about the course of personality disorders across the life span. A major problem is that the current DSM nosology for personality disorders does not account for age-associated changes in behaviour and interpersonal functioning. This editorial will discuss the main diagnostic bottlenecks when applying the current DSM-IV-TR Axis II criteria to older adults. Subsequently, suggestions will be given for future research and the development of a geriatric sub-classification.

The Children in the Community Study of Developmental Course of Personality Disorder

The Children in the Community (CIC) Study is an ongoing investigation of the course of psychiatric disorders including personality disorders (PDs) in an epidemiological sample of about 800 youths. In addition to tracking developmental trajectories over 20 years from adolescence into adulthood, the CIC Study has used prospective data to investigate early risks for Axis II disorders and symptoms (including both environmental factors and early characteristics), implications of comorbidity with Axis I disorders, and associated negative prognostic risk of adolescent PDs into adulthood. The substantial independent impact of PD on subsequent Axis I disorders, suicide attempts, violent and criminal behavior, interpersonal conflict, and other problematic adult outcomes confirms the importance of attention to these problems when they manifest in early adolescence. The implications of study findings for potential changes in the DSM are discussed.

Progress and Innovation: Personality Disorders and the Vanguard of Psychopathology Research

Important progress in our understanding of the natural course of personality disorders (PDs) is documented in the articles for this special section. This progress could set the stage for ideas developed in the study of PDs to play a central role in research on psychopathology more broadly conceived. The Collaborative Longitudinal Personality Disorders Study (Skodol et al., this issue), the Children in the Community Study (Cohen, Crawford, Johnson, & Kasen, this issue), and the McLean Study of Adult Development (Zanarini, Frankenburg, Hennen, Reich, & Silk, this issue) reveal the importance of personality in understanding psychopathology, and point toward a dimensional approach to conceptualizing psychopathology that could also frame categorical clinical decision making processes.

Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder

Since the 2001 publication of APA’s Practice Guideline for the Treatment of Patients With Borderline Personality Disorder (1), more studies have been published on borderline personality disorder (BPD) than on any other personality disorder (2, 3). New analyses of the validity of the DSMIV-TR criteria–defined construct of BPD have been published, new data on the prevalence of BPD are available, risk factors for and biological characteristics of BPD are being elucidated, and new studies on the treatment of BPD have been carried out. This guideline watch highlights the most important of these developments.

Associations in the course of personality disorders and Axis I disorders over time.

In this study, the authors examined time-varying associations between schizotypal (STPD), borderline (BPD), avoidant (AVPD), or obsessive-compulsive (OCPD) personality disorders and co-occurring Axis I disorders in 544 adult participants from the Collaborative Longitudinal Personality Disorders Study. The authors tested predictions of specific longitudinal associations derived from a model of crosscutting psychobiological dimensions (L. J. Siever & K. L. Davis, 1991) with participants with the relevant Axis I disorders. The authors assessed participants at baseline and at 6-, 12-, and 24-month follow-up evaluations. BPD showed significant longitudinal associations with major depressive disorder and posttraumatic stress disorder. AVPD was significantly associated with anxiety disorders (specifically social phobia and obsessive-compulsive disorder). Two of the four personality disorders under examination (STPD and OCPD) showed little or no association with Axis I disorders.

The natural course of bulimia nervosa and eating disorder not otherwise specified is not influenced by personality disorders.

To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) and to test the effects of personality disorder (PD) comorbidity on the outcomes. Ninety-two female patients with current BN (N=23) or EDNOS (N=69) were evaluated at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS). Eating disorders (EDs) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders. Personality disorders (PDs) were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV). The course of BN and EDNOS was assessed with the Longitudinal Interval Follow-up Evaluation and the course of PDs was evaluated with the Follow-Along version of the DIPD-IV at 6, 12, and 24 months. Probability of remission at 24 months was 40% for BN and 59% for EDNOS. To test the effects of PD comorbidity on course, ED patients were divided into groups with no, one, and two or more PDs. Cox proportional regression analyses revealed that BN had a longer time to remission than EDNOS (p<.05). The number of PDs was not a significant predictor of time to remission, nor was the presence of Axis I psychiatric comorbidity or Global Assessment of Functioning scores. Analyses using proportional hazards regression with time-varying covariates revealed that PD instability was unrelated to changes in ED. BN has a worse 24-month course (longer time to remission) than EDNOS. The natural course of BN and EDNOS is not influenced significantly by the presence, severity, or time-varying changes of co-occurring PDs, co-occurring Axis I disorders, or by global functioning.

Personality disorders prevalence study among inpatients with mood disorders, psychoactive use disorders and anxiety disorders

The aim of this study was to asses type and prevalence of Personality Disorders (PDs) and their patterns of comorbidity with Axis I disorders in a sample of psychiatric inpatients. The sample consisted of 300 subjects admitted to a psychiatric unit on a voluntary bases for an index episode. The study was conducted over a period of 12 months, from 1.11.1997 to 31.10.1998. The Italian version of SCID-II-PQ (Structured Clinical Interview for DSM-III-R personality disorders, with Personality Questionnaire--PQ--a self report questionnaire). More than half the patients had at least one personality disorder. The mean of disorders per patient was 2.83 +/- 1.93 (+/- SD). The most prevalent Axis II disorders were Borderline PD (30.7%), Obsessive-compulsive PD (30.7%) and Avoidant PD (25.3%). Women were significantly more likely than men to meet criteria for Dependent PD and Avoidant PD. Man showed significantly more frequently than women Antisocial PD. Significant associations (p < 0.05) were found for comorbidity of Mood Disorders and Avoidant PD, and for Psicoactive Use Disorders and Antisocial PD. Our study confirms the high prevalence of PDs in psychiatric inpatients and showe some interesting associations between Axis I and Axis II disorders. These results can't be generalized to outpatients because our clinical sample involved mainly severely ill inpatients, but they raise questions about the exact nature of PDs and of the relationship with Axis I disorders. Further research involving outpatients and general population is needed to examine factors that could affect development and course of Personality Disorders.

Stability and course of personality disorders: the need to consider comorbidities and continuities between axis I psychiatric disorders and axis II personality disorders.

The literature pertaining to the stability and course of personality disorders is briefly reviewed. Available data suggest that PD diagnoses demonstrate only moderate stability and that--although generally associated with a plethora of negative outcomes--they can show improvement over time. This paper highlights the pervasiveness of diagnostic co-occurrence and its implications for continued investigation of the question of PD stability. In addition to examining the stability (and outcome) of PDs, longitudinal studies need to consider continuities between diagnoses. The Collaborative Longitudinal Personality Disorder Study (CLPS) is described briefly vis-a-vis some of these major issues.

Stability and course of personality disorders

The literature pertaining to the stability and course of personality disorders is reviewed, with a focus on reports published during the period 1997-1998. Available data suggest that personality disorders demonstrate only moderate stability and that, although personality disorders are generally associated with negative outcomes, they can improve over time and can benefit from specific treatments. Implications for future research are suggested and methodologic issues that must be considered are noted.

The Assessment and Treatment of Bulimia Nervosa

This is the fourth and final article in a special series on personality disorders (PDs). The focus of this article is the course and stability of PDs. Studies that have addressed the naturalistic history and course of PDs are reviewed. Selected findings from treatment outcome studies that have implications for understanding the course of PDs are briefly presented. Based on available evidence, we conclude that 1) PDs demonstrate only moderate stability; 2) although generally associated with a plethora of negative outcomes, PDs can show improvement over time; and 3) psychosocial and pharmacologic interventions can have a positive impact on the course of PDs. This review highlights more questions than answers. We suggest implications for future research and note methodologic issues that must be considered in order to determine whether PDs are, in fact, enduring and stable patterns. An improved understanding of the course and stability of PDs is needed in order to inform our diagnostic system(s).