Diagnostic Criteria For Personality Disorders Research Articles

Genome-wide association study of antisocial personality disorder diagnostic criteria provides evidence for shared risk factors across disorders.

While progress has been made in determining the genetic basis of antisocial behaviour, little progress has been made for antisocial personality disorder (ASPD), a condition that often co-occurs with other psychiatric conditions including substance use disorders, attention deficit hyperactivity disorder (ADHD), and anxiety disorders. This study aims to improve the understanding of the genetic risk for ASPD and its relationship with other disorders and traits. We conducted a genome-wide association study (GWAS) of the number of ASPD diagnostic criteria data from 3217 alcohol-dependent participants recruited in the UK (UCL, N = 644) and the USA (Yale-Penn, N = 2573). We identified rs9806493, a chromosome 15 variant, that showed a genome-wide significant association ( Z -score = -5.501, P = 3.77 × 10 -8 ) with ASPD criteria. rs9806493 is an eQTL for SLCO3A1 (Solute Carrier Organic Anion Transporter Family Member 3A1), a ubiquitously expressed gene with strong expression in brain regions that include the anterior cingulate and frontal cortices. Polygenic risk score analysis identified positive correlations between ASPD and smoking, ADHD, depression traits, and posttraumatic stress disorder. Negative correlations were observed between ASPD PRS and alcohol intake frequency, reproductive traits, and level of educational attainment. This study provides evidence for an association between ASPD risk and SLCO3A1 and provides insight into the genetic architecture and pleiotropic associations of ASPD.

Schizophrenia plus - comorbidity of schizophrenia and personality disorders. Clinician's reflections.

The diagnostic criteria for schizophrenia and the diagnostic criteria for personality disorders refer to the same dimensions of mental functioning, except for the presence of typical psychotic symptoms in schizophrenia (hallucinations, delusions and catatonic behaviours). Since schizophrenia is a psychosis with a predominantly chronic course, with exacerbations and steady course periods, a simultaneous diagnosis of personality disorders, which are also "permanent" in nature, and a significant part of which affect the same areas of mental functioning, in the same patient is at least controversial. Although therapeutic interventions in patients with schizophrenia are mainly based on pharmacotherapy, psychotherapy and work with the patient's family are also important. Since pharmacotherapy is virtually ineffective for personality disorders, psychotherapy is the main form of management. This however does not constitute a justification for a simultaneous use of these two diagnoses in the same patient.

A network analysis of DSM-5 avoidant personality disorder diagnostic criteria

Network analysis conceptualises psychopathology as systems of symptoms that interact and influence each other. It is hypothesised that network analysis can identify core symptoms relevant to the diagnosis and treatment of the disorder. We applied network analysis to avoidant personality disorder DSM-5 diagnostic criteria to identify such symptoms in a non-clinical and clinical sample (N = 718, N = 354). We estimated the networks as unregularised Ising models by fitting a log-linear model to each sample. Further on, we examined centrality indices, network stability, and normalised accuracy to determine which nodes are more central amongst avoidant personality disorder diagnostic criteria. “Fear of criticism and rejection” and “Certainty of being liked” emerged as the most central nodes in both networks. Symptom “Inferiority” had the lowest centrality levels. Results are discussed in terms of implications for the conceptualisation of avoidant personality disorder and similarities with other studies that focused on DSM-5 criteria.

How Does It Feel to Have a Disturbed Identity? The Phenomenology of Identity Diffusion in Patients With Borderline Personality Disorder: A Qualitative Study.

Identity diffusion is one of the defining characteristics of borderline personality disorder (BPD). Given its central importance in the formal diagnostic criteria for personality disorders, identity diffusion is remarkably under-researched. In particular, our knowledge of the phenomenology of identity diffusion needs to be improved. This study is based on semistructured interviews with 16 younger women SCID-5-diagnosed with BPD. All interviews were analyzed using the interpretative phenomenological analysis approach. On the basis of this analysis, the patients' descriptions of how identity diffusion manifests itself in their subjective experience are classified into nine categories: disintegrated self-image; using various façades to stabilize the self; painful feelings of the self as broken; feeling that the self does not fit in; inner emptiness; "I don't know what I want"; great need for attention from others to stabilize identity; feeling unable to handle interpersonal relationships; and using sex to distract the self and regulate painful self-states.

Further Validation of the MMPI-2-RF Personality Disorder Spectra Scales

The purpose of the current study was to extend research on the Personality Disorder (PD) Spectra scales developed for the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). We evaluated the scales against measures of both the DSM-5 Section II (traditional model) and Section III (Alternative Model of Personality Disorders; AMPD) PD diagnostic criteria. The participants were 474 undergraduate students from the University of Otago who were administered a range of measures for both DSM-5 PD models. The MMPI-2-RF PD Spectra scales showed significant moderate to large correlations with traditional PD measures, with the exception of Histrionic PD, as well as evidenced incremental validity over the MMPI-2-RF Personality Psychopathology-5 (PSY-5) – the only current formal measurement of personality pathology on the MMPI-2-RF- in accounting for scores on traditional PD measures. The MMPI-2-RF PD Spectra scales also showed moderate to high correlations with most hypothesized AMPD personality trait and impairment scales used to assess DSM-5 AMPD diagnostic criteria. The findings indicated that the scales align well with both paradigms for PD assessment, situating the MMPI-2-RF in a unique position as a bridging measure.

The eating disorders iceberg: Emotional deregulation and impulsivity lay below

IntroductionEating disorders (ED) and personality disorders (PD) are often interplayed in every-day clinical practice. Less is known on patient's emotional deregulation and impulsivity.AimsTo investigate whether clinical features of ED and PD correspond to a specific impulsivity and emotional background pattern.ObjectiveED, PD, impulsivity and emotional regulation.MethodsA group of outpatients with ED (n = 39) was compared to a group of healthy controls (n = 40) by means of semi-structured interviews and standardized questionnaires (BIS-11, DERS, Eat-26, SCID-II and STAI), in order to evaluate association between clinical features (ED and PD) and altered impulsivity or/and emotion regulation.ResultsSeventy-five percent of ED cases matched also diagnostic criteria for PD. Cluster B diagnoses occurred more frequently in Bulimia Nervosa (BN) and Binge eating disorders (BED) whereas Cluster C PD was strongly associated with restrictive anorexia (AN-R) (P < 0.001). BIS-11 scores were significantly higher in cluster B as compared to cluster C PD (P = 0.019). People with PD have a significantly higher DERS score compared to people without (P < 0.001). Mean DERS scores were similar in BN, BED and AN Binge purging (AN-BP) but lower in AN-R (P < 0.001).ConclusionsED is an iceberg top, of a three-step ladder. The intermediate step is built of personality traits and disorders forging the variety of ED clinical expressions. The hidden base of iceberg is represented by both the emotional (de)regulation and the level of impulsivity. Therapies focused on the base of this iceberg are needed for a clinical resolution of eating symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Borderline Personality Disorder Diagnostic Criteria as Risk Factors for Suicidal Behavior Through the Lens of the Interpersonal Theory of Suicide

Borderline personality disorder diagnostic criteria, particularly affective dysregulation and behavioral dysregulation, are avenues through which suicide risk is conferred, though pathways are not well understood. The interpersonal theory of suicide may help elucidate these associations. The current study examined indirect relationships between affective and behavioral dysregulation and suicidal ideation through perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. 169 outpatients completed measures prior to their intake assessment. Perceived burdensomeness accounted for the relationship between affective dysregulation and suicidal ideation. The acquired capability did not explain the association between behavioral dysregulation and suicide attempt history. Affective and behavioral dysregulation may be key targets in treatment for reducing suicide risk.

An Investigation of Adherence to Diagnostic Criteria, Revisited: Clinical Diagnosis of the DSM-IV/DSM-5 Section II Personality Disorders.

In an initial investigation by Morey and Ochoa (1989), adherence to DSM-III personality disorder diagnostic criteria was examined as an agreement rate between clinician (global) diagnoses and diagnoses algorithmically generated from DSM-III criteria rules. Morey and Ochoa (1989) findings suggested significant clinician-criterion diagnostic incongruity, a result that cross-validated in a DSM-III-R replication performed by Blashfield and Herkov (1996). The current study examined such adherence, utilizing DSM-IV decision rules, in a national sample of 337 clinicians and their target patients. The results of the current study are largely consistent with the earlier findings, with clinician-criterion agreement rates comparable to those commonly reported for interdiagnostician reliability. Ramifications for the future of personality disorder diagnostic classification are discussed.

Application of psychological diagnosis in the process of establishing criteria for psychodynamic therapy designed for patients with personality disorders.

Aim of the studyThe main purpose of this paper was to present a model of psychological diagnosis, aimed at establishing the fundamental criteria for qualifying patients with symptoms of various mental disorders (including neurotic and personality disorders) for outpatient psychodynamic therapy.Subject or material and methodsRorschach Inkblot Test, clinical interviewResultsThe research was conducted in the years 2010-2013 in the Neurosis Treatment Centre and in the Mental Health Outpatient Clinic A study population comprised 38 males and 42 females.DiscussionThe structure of personality characteristics and their impact on a patient’s eligibility to participate in a particular type of psychotherapy was assessed based on the major assumptions of psychodynamic approach, with special focus on the criteria put forward by Gabbard; the Big Five personality dimensions; as well as on the diagnostic criteria for personality disorders, developed by the American Psychiatric Association.ConclusionsAnalysis of the result of this research allowed to develop a model of fundamental criteria for selecting an appropriate form of psychotherapy designed for patients with various types of personality disorders. Eight criteria were found to be significant in the process of qualifying the aforementioned individuals for outpatient psychotherapy. They included two psychological dimensions: intrapsychic (describing psychological indicators of the self-structure and maturity level of the patient's identity) and interpersonal (describing indicators of the person’s capacity for establishing emotional relations with others). Diagnosis of the aforementioned indicators proves to contribute significantly to the process of selecting effective therapeutic methods for neurotic patients as well as individuals who exhibit symptoms of more severe destabilization of personality organization.

The prevalence of personality disorder in a general medical hospital population in Jamaica.

To determine the prevalence of personality disorders in patients admitted to the general medical wards of the University Hospital of the West Indies (UHWI). Patients (n = 100) sequentially admitted to the general medical wards of the UHWI were assessed for the diagnosis of personality disorder using the gold standard of a consultant assessment based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) diagnostic criteria for personality disorder, the International Personality Disorder Examination Screening questionnaire (IPDE-S) and the Jamaica Personality Disorder Inventory (JPDI). The three assessment instruments identified a prevalence of personality disorder in the cohort of patients of 21% consultant DSM IV-TR assessment, 28% JPDI and 70% IPDE-S. The prevalence rate identified by the IPDE-S was significantly higher than the local instruments used (p < 0.000). The prevalence of personality disorder assessed by the JPDI and the IPDE-S and the consultant DSM IV-TR instruments in Jamaica is significantly higher than the prevalence rate of studies in other countries.

The prevalence of personality disorder in a psychiatric and substance abuse population in Jamaica.

To determine the prevalence of personality disorders in patients admitted to the psychiatric wards of the University Hospital of the West Indies (UHWI). Patients (n = 100) sequentially admitted to the psychiatric wards of the UHWI were assessed for personality disorder using the gold standard of a consultant assessment using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM IV-TR) diagnostic criteria for personality disorder, the International Personality Disorder Examination Screening questionnaire (IPDE-S), and the Jamaica Personality Disorder Inventory (JPDI). The three assessment instruments identified a prevalence of personality disorder in the cohort of patients of 51% consultant DSM-IV-TR assessment, 57% JPDI and 86% IPDE-S. The prevalence rate identified by the IPDE-S was significantly higher that the local instruments used (p < 0.000). The prevalence of personality disorder assessed by the JPDI and the consultant DSM IV-TR instruments in Jamaica is comparable to the prevalence rate of studies in other countries in a similar population.

‘What’s needed as part of probation practice when working with personality disordered offenders? The importance of avoiding errors of logic’ – A practitioner response

This article is a response to Ramsden and Lowton’s article ‘What’s needed as part of probation practice when working with personality disordered offenders? The importance of avoiding errors of logic’. Ramsden and Lowton offer a useful model, and practical guidance, that can assist practitioners to work in a psychologically informed way. The potential benefits of such frameworks are discussed, before consideration is given to what else is needed to support probation’s work with service users who meet the diagnostic criteria for personality disorder.

An item response theory analysis of DSM-IV diagnostic criteria for personality disorders: findings from the national epidemiologic survey on alcohol and related conditions.

The purpose of this study was to evaluate the psychometric properties of DSM-IV symptom criteria for assessing personality disorders (PDs) in a national population and to compare variations in proposed symptom coding for social and/or occupational dysfunction. Data were obtained from a total sample of 34,653 respondents from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). For each personality disorder, confirmatory factor analysis (CFA) established a 1-factor latent factor structure for the respective symptom criteria. A 2-parameter item response theory (IRT) model was applied to the symptom criteria for each PD to assess the probabilities of symptom item endorsements across different values of the underlying trait (latent factor). Findings were compared with a separate IRT model using an alternative coding of symptom criteria that requires distress/impairment to be related to each criterion. The CFAs yielded a good fit for a single underlying latent dimension for each PD. Findings from the IRT indicated that DSM-IV PD symptom criteria are clustered in the moderate to severe range of the underlying latent dimension for each PD and are peaked, indicating high measurement precision only within a narrow range of the underlying trait and lower measurement precision at lower and higher levels of severity. Compared with the NESARC symptom coding, the IRT results for the alternative symptom coding are shifted toward the more severe range of the latent trait but generally have lower measurement precision for each PD. The IRT findings provide support for a reliable assessment of each PD for both NESARC and alternative coding for distress/impairment. The use of symptom dysfunction for each criterion, however, raises a number of issues and implications for the DSM-5 revision currently proposed for Axis II disorders (American Psychiatric Association, 2010).

Personality disorder–not otherwise specified evidence of validity and consideration for DSM-5

Personality disorder–not otherwise specified (PD-NOS) has received little study despite being a very prevalent diagnosis of personality disorder (PD). Although some studies suggest that PD-NOS is intermediate in severity between subjects with, and without, formal PD, studies examining a comprehensive set of measures and control subjects have not been reported. Nearly 800 subjects were studied with semi-structured diagnostic interviews and with a variety of measures of temperament, character, and specific dimensions of personality and behavior. The subjects were divided into healthy controls (n = 176), Axis I controls (n = 87), PD subjects (n = 344) and PD-NOS subjects (n = 177). Subjects who met General Diagnostic Criteria for Personality Disorder (GDCPD), but not criteria for any one, specific PD, were designated as PD-NOS. On nearly all measures, PD-NOS differed from Healthy and from Axis I Controls in the direction of more pathology. Although subjects meeting criteria for specific PDs appeared more pathological than PD-NOS, this was always due to severity of PD as reflected by the Structured Interview for the Diagnosis of DSM Personality 4 severity score. When compared with subjects with only one specific PD diagnosis, subjects with PD-NOS did not differ in any way. When diagnosed by GDCPD, subjects with PD-NOS are similar to subjects with specific personality disorders and differ, as expected, from Healthy and Axis I Controls on measures of psychosocial function and on various dimensions of personality and related behavior. Accordingly, PD-NOS by GDCPD is as valid a PD as any other specific PD by DSM criteria.

Personality Structures and Chronic Childhood Relational Trauma: Psychodynamic and Attachment based Perspectives that Challenge the Restricted Diagnosis of Personality Disorder

With the imminent publication of DSM V growing ever closer, the author suggests that headline diagnostic categories, such as narcissistic personality, histrionic personality or the ubiquitous borderline personality may actually be unhelpful to the clinician, who wishes to reach a deeper understanding of the factors shaping character pathology. The proposed revision of diagnostic criteria for personality disorder, in the forthcoming DSM V, to further emphasise traits within nosographical personality categories, appears to remain limited in conceptual scope. The psychoanalytic concept of personality structure is considered more malleable, from a conceptual perspective, in that it may enable the clinician to both describe and situate current psychological conflicts more appropriately, within a developmental context. It is suggested, in this paper, that such a conceptual progression is necessary in order to accommodate the rich seam of object relations, and attachment based approaches that have further shaped our understanding of personality development and personality difficulties, over the last two decades.

Capturing the Psychopathic Female: A Prototypicality Analysis of the Comprehensive Assessment of Psychopathic Personality (CAPP) Across Gender

Psychopathy in women has been subject to little systematic investigation; no coherent conceptualization of the disorder in women exists. Previous research is constrained by the reliance both on a male conceptualization of psychopathy and on assessment instruments developed, and primarily validated, with men. This study utilized a newly developed, broad, personality-based, and gender-sensitive lexical model of psychopathy, the Comprehensive Assessment of Psychopathic Personality (CAPP). Prototypical analysis was used to explore gender differences in the construct and the content validity of the CAPP model across gender. Symptoms were rated by international mental health professionals (N = 132). The findings support the content validity of the CAPP across gender and suggest that - at symptom and domain levels - psychopathic men and women have key similarities, but also that important gender differences exists. This has implications for the assessment of psychopathy in women, and has relevance for the proposed revision of diagnostic criteria for personality disorders.

Personality Disorders in Later Life: Questions About the Measurement, Course, and Impact of Disorders

Lifespan perspectives have played a crucial role in shaping our understanding of many forms of psychopathology. Unfortunately, little attention has been given to personality disorders in middle adulthood and later life. Several issues are responsible for this deficiency, including difficulty applying the diagnostic criteria for personality disorders to older people and challenges in identifying appropriate samples of older participants. The goal of this review is to explore the benefits of considering older adults in the study of personality disorders. Later life offers a unique opportunity for investigators to consider links between personality pathology and consequential outcomes in people's lives. Many domains are relevant, including health, longevity, social adjustment, marital relationships, and the experience of major life events. We review each domain and consider ways in which the study of middle-aged and older adults challenges researchers to evaluate how personality disorders in general are defined and measured.

Challenges associated with a polythetic diagnostic system: Criteria combinations in the personality disorders.

Converging research on the diagnostic criteria for personality disorders (PDs) reveals that most criteria have different psychometric properties. This finding is inconsistent with the PD diagnostic system according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), which weights each criterion equally. The purpose of the current study was to examine the potential effects of using equal weights for differentially functioning criteria. Data from over 2,100 outpatients were used to analyze and score response patterns to the diagnostic criteria for 9 PDs within an item response theory framework. Results indicated that combinations that included the same number of endorsed criteria yielded differing estimates of PD traits, depending on which criteria were met. Moreover, trait estimates from subthreshold criteria combinations often overlapped with diagnostic (at-threshold or higher) combinations, indicating that there were subthreshold combinations of criteria that indicated as much or more PD than did some combinations at the diagnostic threshold. These results suggest that counting the number of criteria an individual meets provides only a coarse estimation of his or her PD trait level. Implications for the assessment of polythetically defined mental disorders and for the PD proposal for the 5th edition of the Diagnostic and Statistical Manual of Mental 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.

Revising the personality disorder diagnostic criteria for the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-V): Consider the later life context.

The categorical measurement approach implemented by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) personality disorder (PD) diagnostic system is theoretically and pragmatically limited. As a result, many prominent psychologists now advocate for a shift away from this approach in favor of more conceptually sound dimensional measurement. This shift is expected to improve the psychometric properties of the personality disorder (PD) diagnostic system and make it more useful for clinicians and researchers. The current article suggests that despite the probable benefits of such a change, several limitations will remain if the new diagnostic system does not closely consider the context of later life. A failure to address the unique challenges associated with the assessment of personality in older adults likely will result in the continued limited validity, reliability, and utility of the Diagnostic and Statistical Manual of Mental Disorders (DSM) system for this growing population. This article discusses these limitations and their possible implications.