Disordered Personality Functioning Research Articles

Reliability and construct validity of the Personality Inventory for ICD-11 (PiCD) in Italian adult participants.

To assess the psychometric properties of the Personality Inventory for ICD-11 (PiCD, where ICD-11 is the International Classification of Diseases, 11th Revision), a sample of Italian community-dwelling adult participants (N = 1,122) was administered the PiCD, the Five-Factor Model Rating Form, the Big Five Inventory, the Personality Inventory for DSM-5 Short Form (where DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders, fifth edition), and the Measure of Disordered Personality Functioning. Our findings supported the unidimensionality hypothesis for the PiCD Negative Affectivity, Detachment, and Dissocial scale items, whereas adequate fit indices were observed for the bifactor model of the PiCD Disinhibition and Anankastic item joint polychoric correlation matrix. The PiCD scales showed adequate internal consistency, test-retest reliability (n = 262), and meaningful relationships with five-factor model domains and their maladaptive variants. A four-factor model of the joint correlation matrix of the PiCD, Personality Inventory for DSM-5 Short Form, and the five-factor model composite score was provided with adequate fit. All PiCD scales were significantly associated with the impairment in personality functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cultural Aspects in Symptomatology, Assessment, and Treatment of Personality Disorders.

This review discusses cultural trends, challenges, and approaches to assessment and treatment of personality traits and disorders. Specific focus include current developments in the Asian, Italian, Iranian, and Australian societies, as well as the process of acculturation, following moves between cultures with the impact on healthy and disordered personality function. Each culture with its specific history, dimensions, values, and practices influences and gears the individual and family or group in unique ways that affect personality functioning. Similarly, each culture provides means of protection and assimilation as well as norms for acceptance and denunciations of specific behaviors and personality traits. The diagnosis of personality disorders and their treatment need to take into consideration the individual in the context of the culture and society in which they live. Core personality problems, especially emotion dysregulation and interpersonal functioning are specifically influenced by cultural norms and context.

Assessing Dimensions of Pathological Narcissism: Psychometric Properties of the Short Form of the Five-Factor Narcissism Inventory in a Sample of Italian University Students

ABSTRACTTo evaluate the psychometric properties of the Italian translation of the Five-Factor Narcissism Inventory–Short Form (FFNI–SF), 1,063 Italian university students were administered the scale, along with the Pathological Narcissism Inventory (PNI) and the Measure of Disordered Personality Functioning (MDPF). In general, the FFNI–SF scales showed good internal consistency (median α = .76; median interitem r = .44) and structural analyses suggested a 3-component model of FFNI–SF scales that was similar to that reported by Sherman et al. (2015). FFNI–SF second-order scales yielded meaningful convergent and discriminant correlations with PNI second-order grandiose and vulnerable dimensions. Finally, FFNI–SF second-order scales correlated in expected ways with 2 dimensions of personality dysfunction.

The Personality Inventory for DSM-5 Brief Form: Evidence for Reliability and Construct Validity in a Sample of Community-Dwelling Italian Adolescents.

To assess the reliability and construct validity of the Personality Inventory for DSM-5 Brief Form (PID-5-BF) among adolescents, 877 Italian high school students were administered the PID-5-BF. Participants were administered also the Measure of Disordered Personality Functioning (MDPF) as a criterion measure. In the full sample, Cronbach's alpha values for the PID-5-BF scales ranged from .59 (Detachment) to .77 (Psychoticism); in addition, all PID-5-BF scales showed mean interitem correlation values in the .22 to .40 range. Cronbach's alpha values for the PID-5-BF total score was .83 (mean interitem r = .16). Although 2-month test-retest reliability could be assessed only in a small ( n = 42) subsample of participants, all PID-5-BF scale scores showed adequate temporal stability, as indexed by intraclass r values ranging from .78 (Negative Affectivity) to .97 (Detachment), all ps <.001. Exploratory structural equation modeling analyses provided at least moderate support for the a priori model of PID-5-BF items. Multiple regression analyses showed that PID-5-BF scales predicted a nonnegligible amount of variance in MDPF Non-Cooperativeness, adjusted R2 = .17, p < .001, and Non-Coping scales, adjusted R2 = .32, p < .001. Similarly, the PID-5-BF total score was a significant predictor of both MDPF Non-Coping, and Non-Cooperativeness scales.

Clinical characteristics and temperament influences on ‘happy’ euphoric and ‘snappy’ irritable bipolar hypo/manic mood states

BackgroundWhile mood elevation and euphoria are the most commonly described phenotypic descriptors of hypo/mania, irritability and anger may dominate. This study was designed to pursue possible determinants of such differing states. MethodsPatients with bipolar I or II disorder were assigned to an ‘irritable/snappy’ or ‘euphoric/happy’ sub-set on the basis of their dominant hypo/manic symptoms. Group differences were examined across clinical, personality, lifestyle and illness impact measures. ResultsThe two sub-sets did not differ on age of depression onset, family history of mood disorders, or depression severity and impairment. The snappy sub-set reported higher levels of irritability in depressed phases and were more likely to have a comorbid anxiety disorder. Their hypo/manic episodes were shorter and they were more likely to be hospitalized at such times. On a temperament measure they scored as more irritable and self-focussed and as less cooperative and effective – indicative of higher levels of disordered personality functioning. LimitationsSome comparison analyses were undertaken on a reduced sample size, giving rise to power issues. Our bipolar I and II diagnoses deviated to some extent from DSM-5 criteria in not imposing duration criteria for hypo/manic episodes. ConclusionsFindings support a spectrum model for the bipolar disorders linking temperament to bipolar symptomatic state and which may have treatment implications.

Selected Neurobiological Arousal Issues as Manifested in a Clinical Case Illustration

Attachment patterns and defense mechanisms are profoundly affected by arousal systems within the brain and body to express in-born emotional circuits. Disordered personality functioning and the use and abuse of substances may augment or substitute for a compromised arousal system, leading to meeting criteria for psychiatric diagnoses. These arousal management and regulation issues are illustrated by a case history and session notes, including many of the neurobiological functions described in the introductory article of this journal issue.

Book Review: Psychotherapy: Psychoanalytic Diagnostic Manual (PDM)

Psychotherapy Psychoanalytic Diagnostic Manual (PDM) PDM Task Force. Silver Spring (MD): The Alliance of Psychoanalytic Organizations; 2006. 857 p. CDN$40.00. Reviewer rating: Excellent The necessary brevity of this review makes it difficult to do justice to this important volume. PDM is a collaborative effort of the American Psychoanalytic Association, International Psychoanalytic Association, Division of Psychoanalysis (39) of American Psychological Association, American Academy of Psychoanalysis and Dynamic Psychiatry, and National Membership Committee on Psychoanalysis in Clinical Social Work. It attempts to characterize an individual's full range of functioning-the depth as well as the surface of emotional, cognitive and social patterns.p1 This diagnostic framework describes healthy and disordered personality functioning; profiles of mental functioning, including patterns of relating, comprehending, and expressing feelings, coping with stress and anxiety, observing one's own emotions and behaviours, and forming moral judgements; and symptom patterns, including differences in each individual's personal, subjective experience of symptoms. The authors assert that mental health comprises more than simply absence of symptoms'p2 involving one's overall functioning, including relationships; emotional depth, range and regulation; coping capacities; and self-observing capacities: the full range of cognitive, emotional, and behavioural capacities. They note an increasing tendency to define mental problems primarily on the basis of observable symptoms, behaviours, and traits, relegating overall personality functioning and levels of adaptation to a secondary position, and refer to mounting evidence of the complexity of mental functioning. PDM is divided into 3 parts. Part 1, Classification of Adult Mental Disorders, employs 3 dimensions. Personality Patterns and Disorders (P Axis) locates the person on a continuum from healthier to more disordered functioning, and describes the nature of characteristic ways he or she organizes mental functioning and engages the world. An introduction describes different levels of personality functioning. A list of contributing constitutional-maturational factors, central tension-preoccupation, central affects, characteristic pathogenic beliefs about self and others, and central ways of defending follows descriptions of each personality disorder. Personality disorders omitted from DSM-IV-TR are included. Mental Functioning (M Axis) offers a detailed description of emotional functioning, capacities that contribute to one's personality and overall level of health-pathology. Categories include capacity for regulation, attention and learning; capacity for relationships and intimacy; quality of internal experience; capacity for affective experience, expression, and communication; defensive patterns and capabilities; capacity to form internal representations; capacity for differentiation and integration; self-observing capacities; and sense of morality. Mental capacities are defined as optimal or reasonable for age and phase or with phase-specific conflicts or transient developmental challenges, or having mild, moderate, or major constrictions or alterations in mental functioning, or major defects in basic mental functions. Manifest Symptoms and Concerns (S Axis) presents symptom patterns in terms of the patient's personal experience of prevailing difficulties. The authors comment on psychodynamic understanding of each symptom pattern, including treatment implications. Symptom patterns are understood in the context of one's personality structure and mental functioning profile, not disorders in their own right but overt expressions of how patients characteristically cope with experience. Part 1 ends with 3 case descriptions illustrating how to apply the PDM profile. Part 2 concerns classification of child and adolescent mental health disorders. It is divided into 2 sections, one for children and adolescents and the other for infants and very young children. …

Self-Harming in Depressed Patients: Pattern Analysis

As deliberate self-harm (DSH) is a common concomitant of depressive disorders, we undertook a study examining the relevance of possible determinants and correlates of DSH. Three separate samples of depressed outpatients were studied to determine consistency of identified factors across samples, with principal analyses involving gender, age and diagnosis-matched DSH and non-DSH subjects. Across the samples, some 20% of subjects admitted to episodes of DSH. Women reported higher rates and there was a consistent trend for higher rates in bipolar patients. Univariate analyses examined the relevance of several sociodemographic variables, illicit drug and alcohol use, past deprivational and abusive experiences, past suicidal attempts and disordered personality functioning. Multivariate analyses consistently identified previous suicide attempts and high 'acting out' behaviours across the three samples, suggesting the relevance of an externalizing response to stress and poor impulse control. Results assist the identification and management of depressed patients who are at greater risk of DSH behaviours.

Measuring disordered personality functioning: to love and to work reprised.

Current limitations to diagnosing and measuring the personality disorders encouraged a set of studies seeking to provide an alternate approach to modeling and measuring disordered personality function. A large set of self-reported descriptors of disordered personality function were factor analyzed in a sample of patients with clinician-diagnosed personality dysfunction, generating 11 lower-order and two higher-order constructs. Subjects and non-clinical controls also completed a measure of personality styles underpinning formalized personality disorder groupings. Properties of the refined self-report (SR) measure were assessed in an independent sample of patients with a clinically diagnosed personality disorder. Limitations in 'cooperativeness' and 'coping' formed the higher-order constructs defining disordered personality function, with these constructs relevant to all personality styles. Analyses of SR, corroborative witness (CW) and clinician-rated data in an independent sample supported measuring disordered personality function by our derived 20-item SR measure, and exposed limitations to clinician-based assessment. Study findings build to a multi-axial strategy for measuring personality disorder, involving separate dimensional assessment of both disordered personality function and of personality style.

Studying personality characteristics in bipolar depressed subjects: how comparator group selection can dictate results

To examine the extent to which identification of any distinct personality characteristics in bipolar subjects are influenced by selection of the comparison diagnostic group. Scores were compared on several general measures of personality style and, additionally, the prevalence of disordered personality functioning was examined in a sample of 198 non-psychotic depressed subjects, 39 with bipolar depression and 159 with unipolar depression. When the bipolar subjects were separately compared with unipolar subjects, and to sub-sets of those with clinically and DSM-IV defined melancholic and non-melancholic depression, quite differing results were suggested. In essence, clinically-defined melancholic subjects had the least personality psychopathology in comparison with the non-melancholic and bipolar subjects. Whether subjects with bipolar disorder have any distinct personality characteristics or over-represented co-morbid personality disorders remains quite unclear when reference is made to the literature. We suggest that inconsistencies across studies may reflect choice and representation of depressive sub-types within the unipolar comparator group.

Defining disordered personality functioning.

Current definitions of the PDs commonly combine descriptors of personality style and disordered personality functioning. This leads to artefactual comorbidity of formally separate disorders and compromising of diagnostic precision. We suggest that measurement of disordered functioning alone might provide a more efficient and precise first-level measure of PD. We review candidate constructs for the definition of disordered functioning and consider how constructs might be refined in subsequent research and lead to applied measures.

Depression and smoking: examining correlates in a subset of depressed patients.

The objective of this study was to examine for associations between depression and cigarette smoking. A sample of 92 depressed smokers was compared with a control sample of depressed non-smokers, matched for age, gender and diagnostic variables. Comparisons were made across a range of demographic, depression, family history, developmental factors, anxiety and personality style variables, as well as use of alcohol and illicit drugs. We failed to find any difference between smokers and non-smokers in history or severity of depression. Cigarette smokers were distinguished principally by greater exposure to aversive experiences in childhood, disordered personality function, greater use of illicit drugs, anxiolytics and alcohol. Logistic regression identified dysfunctional personality 'domains', physical violence in childhood, long-term anxiolytic use and illicit drug use as the most significant predictor set. Results favour a model of cigarette smoking and depression as linked by shared early deprivational variables, rather than cigarette smoking causing depression or the converse.

Predictors of 1-year outcome in depression.

We compared several different methods for assessing depression 'recovery' over a 1-year review interval, to determine the utility of the contrasting approaches. Second, we assessed baseline predictors of 1-year outcome and recovery status. Third, we examined the extent to which predictors showed consistency across the variable definitions of outcome and recovery. Twelve-month outcome was assessed in a sample of 182 subjects who at baseline assessment met DSM criteria for a major depressive episode. The contrasting methods involved a defined percentage reduction in Beck Depression Inventory self-rating scores, formalised change point definitions, no longer meeting DSM-IV major depression criteria, and clinical global improvement (CGI) ratings. Sixty-one per cent reached formalised change point criteria for full remission or recovery when trajectories across the 12-month interval were examined. Other measures quantified recovery rates ranging from 43% to 70%. Those with a psychotic or melancholic depression were more likely to have achieved recovery status in some analyses. Non-recovery at 12 months was predicted most consistently by higher baseline levels of anxiety and depression; high trait anxiety and a lifetime anxiety disorder; disordered personality function; and having reported exposure to acute and enduring stressors at baseline assessment. While the CGI was the superior system in terms of number of significant discriminating predictors of outcome, the change point definitional approach provides much greater information across the follow-up interval, arguing for their complementary utility. As several currently identified baseline predictors of outcome (i.e. anxiety, disordered personality function) also predicted onset of depression, their relevance as both depression-inducing and depression-propagating variables is suggested.

‘Acting out’ and ‘acting in’ behavioural stress responses: the relevance of anxiety and personality style

Objective: To look for links between ‘acting out’ and ‘acting in’ behavioural stress responses with anxiety and disordered personality function. Method: Depressed patients completed a self-report measure of behavioural responses to stress 1 year after baseline assessment of anxiety levels, personality functioning and other study variables. Results: Patients were assigned to four factorial groups on the basis of variable ‘acting out’ and ‘acting in’ scale scores, and effects of individual scale scores also examined. ‘Acting in’ styles were indicative of high trait anxiety, disordered personality functioning and, in particular, a Cluster C personality disorder style. ‘Acting out’ was linked most clearly with a Cluster B personality disorder style. Conclusions: We demonstrate links between behavioural stress responses and anxiety levels and disordered personality functioning. Assessing behavioural stresses responses may shape the clinical expression of some depressive disorders and inform the clinician about the likely salience of anxiety and personality styles.

An exploration of links between early parenting experiences and personality disorder type and disordered personality functioning.

Reports of early parenting were assessed using two measures, the Parental Bonding Index (PBI) and the Measure of Parenting Style (MOPS), in a sample of 265 patients with DSM-defined major depressive disorder. Psychiatrists then rated the extent to which sample members evidenced the personality "styles" underpinning 15 separate personality disorders, returning personality vignette scores. The extent of disordered functioning was also assessed across "parameters" and "domains" by psychiatrists, referrers, and family members, using a range of measures. Those with higher scores on vignettes measuring borderline, anxious, depressive, and self-defeating personality style rated parents as uncaring, overcontrolling, and abusive. When vignettes were consolidated into scores akin to the DSM clusters, the most consistent links between perceived dysfunctional parenting were with the Cluster C (anxious), and Cluster B (dramatic) styles and were nonsignificant for Cluster A (eccentric) style. Meeting criteria for an increasing number of personality disorder clusters was associated with increasing levels of adverse parenting. Multiple regression analyses indicated that disordered functioning (as assessed by the three independent rater groups) was most distinctly associated with paternal indifference and maternal overcontrol.

Sub-grouping non-melancholic major depression using both clinical and aetiological features.

In previous papers we have considered the extent to which two contrasting analytic approaches, examining reported clinical symptom variables alone and aetiological variables alone, assist definition of subgroups of non-melancholic major depression. Here, we address the same objective but combine both sets of variables, and contrast the combined solution with each of the contributing ones. We study a sample of 185 subjects with a putative non-melancholic major depressive disorder, with analyses involving 13 aetiological and 38 symptom variables. A four-class subgrouping was derived by use of a cluster analytic technique, with 'neurotic depression', non-anxious 'depressed', 'situational' and 'residual' groups. The largest group comprised 'neurotic depression' subjects, with characteristics compatible with a spectrum disorder encompassing both clinical features as well as an underlying temperament and personality style marked by anxiety. Comparative advantages and properties of the three differing analytic approaches to defining 'meaningful' non-melancholic major depressive subgroupings are considered. As a 'neurotic depressive' class has been consistently identified across those three approaches, but with quite varying numbers of subjects circumscribed, it is clearly a 'fuzzy' entity which may benefit from a dimensional approach to its measurement. As many of the non-melancholic groupings appear secondary to a substantive predisposing factor such as anxiety or disordered personality functioning, the clinical importance and treatment utility in identifying and circumscribing such classes are clearly supported.

Characteristics of depressed patients who report childhood sexual abuse.

Depressed patients who had and had not been exposed to childhood sexual abuse were studied to determine differences in severity of depressed mood, lifetime histories of anxiety and depression, childhood environment, and disordered personality function. Data were obtained from 269 inpatients and outpatients with major depression (171 women and 98 men) by means of structured clinical interviews and self-report questionnaires. Forty-six of the 269 patients reported childhood sexual abuse; 40 of these were women. These 40 women were compared with the 131 who did not report childhood sexual abuse. The patients who experienced abuse did not differ from those who had not on psychiatrist-rated mood severity estimates, but they did have higher self-report depression scores. They also evidenced more self-destructive behavior, more personality dysfunction, and more overall adversity in their childhood environment. Childhood sexual abuse status was associated with more borderline personality characteristics independently of other negative aspects of the patients' earlier parenting. Childhood sexual abuse status was linked strongly to adult self-destructiveness, as was early exposure to maternal indifference. Multivariate analyses suggest that depression is unlikely to be a direct consequence of childhood sexual abuse. Childhood sexual abuse appears to be associated with a greater chance of having experienced a broadly dysfunctional childhood home environment, a greater chance of having a borderline personality style, and, in turn, a greater chance of experiencing depression in adulthood.

On modelling personality disorders: are personality style and disordered functioning independent or interdependent constructs?

Current descriptors of personality disorder (PD) are an amalgam of two constructs, personality style and/or disorder. We seek to determine whether their intrinsic personality style descriptors are proxy measures of, or independent of, disordered personality functioning. In a sample of depressed patients, psychiatrists rated 16 differing PD personality style vignettes and assessed eight differing manifestations of disordered functioning. When "personality" vignettes and identified personality clusters were intercorrelated with "disorder" variables, interdependence was generally evident, suggesting that the personality descriptors underpinning current definition of the PDs actually act as proxy criteria for assessing disorder because they are, in and of themselves, descriptors of pathological functioning. The obsessional personality vignette provided an exception, seeming to be independent of disordered function. Such results assist consideration of how best to model, define and measure the personality disorders.

Non-melancholic depression: the contribution of personality, anxiety and life events to subclassification.

We sought to develop a clinically useful subtyping system for the non-melancholic depressive disorders, and here we assess one weighted to central aetiological factors. We studied 185 patients meeting DSM-III-R and/or clinical criteria for non-melancholic depression. Data were obtained by self-report, interview of patients and from corroborative witnesses. We developed a set of variables for class definition, assessing: (i) 'P', disordered personality as a vulnerability factor; (ii) 'A', meeting criteria for a lifetime anxiety disorder or positive on probe questions about trait anxiety characteristics, so assessing anxiety as a vulnerability factor; and (iii) 'L', psychiatrist and consensually-rated life event stress prior to depression onset. A latent class analysis generated a four-class solution for the P-A-L variables. Life event stressors had similar item probabilities across all four classes, and did not influence the four-class 'P-A' solution when deleted from the analysis, suggesting that life event stress may act more as a general provoking agent, rather than constituting any distinct 'reactive' or 'situational' depression class. Three classes generated clinically meaningful groupings, reflecting varying contributions of anxiety and disordered personality functioning, and with evidence of differential outcome over the following 12 months. We suggest that a refined aetiologically-weighted model may assist definition of the non-melancholic depressive disorders, and provide the logic for exploring the comparative utility of differing treatments to identified vulnerability-based classes.

An aetiological model of non-melancholic depression: study design and validity of the measures.

The aim of this paper is to describe an approach to sub-typing non-melancholic depression and to determine which raters from a variety of backgrounds provided the most valid information on study variables. A sample of non-melancholic depressed patients is described. Multiple raters (i.e. patients, psychiatrists, referrers and corroborative witnesses) completed measures of the patient's trait anxiety levels, severity of recent life event stressors and personality functioning. The study and representative data are reported. Congruence between several measures employed indicated that psychiatrist rating of disordered personality was superior to corroborative witness report. Assessment of anxiety traits indicated reasonable agreement between referrers and corroborative witnesses but poor agreement between those ratings and interview-elicited ratings. There were also discrepancies in quantifying 'severity' of life event stress, with patients and their corroborative witnesses rating such events as more severe than either the interviewing psychiatrist or psychiatrists involved in consensus rating sessions. Importantly, the psychiatrists' capacity to quantify the relative contribution of disordered personality, anxiety and life-event stress to the particular depressive episode was supported. Results indicate some of the difficulties in operationalising determinants that may contribute to and sub-type the non-melancholic depressions, and demonstrate the advantages of using a range of rating strategies and raters. In this study, psychiatrist-generated judgements are clearly favoured, although the advantages of also assessing trait anxiety and life-event stress impact by self-report strategies are conceded. Some techniques for estimating the contribution of disordered personality function, anxiety and life-event stress are offered for both their research and their clinical utility.