DSM-IV Personality Disorders Research Articles

Psychological and Psychiatric Characteristics of People with Keratoconus

Background and Objectives: There are many reports in the literature on the co-occurrence of somatic diseases and psychiatric disorders. Relatively few have addressed the co-occurrence of corneal cone with anxiety, depression, or personality disorders. Materials and Methods: 99 patients with keratoconus (study group) and 92 patients without keratoconus (control group) participated in the entire study, which was conducted in 2015 and 2020–2023. The Hamilton Depression Rating Scale (HDRS) and Beck’s Depression Inventory (BDI) were used to assess depressive symptoms, the State-Trait Anxiety Inventory (STAI) to assess anxiety symptoms, and the DSM-IV Personality Disorder Inventory (IBZO-DSM-IV) to identify personality disorders. Results: In the study group, the severity of depressive and anxiety symptoms correlated with all types of personality disorders. In the control group, these symptoms did not correlate with antisocial and narcissistic personalities. In the comparative analysis, there were more patients with antisocial, schizotypal, obsessive compulsive, schizoid, paranoid, and dependent personality traits in the study group. Conclusions: Patients with keratoconus have increased expressions of antisocial personality traits, but no differences in anxiety and depression symptoms were evident. Further research is needed among patients diagnosed with keratoconus in the short term.

Effect of personality traits among teenagers for depression on the psychoanalytic therapy

Teenagers with Major Depressive Disorder (MDD) are much more inclined into have co-occurring Personality Disorder (PD). Teenagers with MDD benefit in short-term psychoanalytic psychotherapy (STPP). The FEST-IT research was an initial experimental study of transference among adolescents, which showed that STPP with MDD-affected adolescents was effective. Investigating potential moderators could improve the value of STPP. Following the diagnosis of 69 depressed teenagers (ages 16 to 18) using a systematic assessment for DSM-IV PDs; the teens were randomized to a 28-week STPP course, either with or without transference treatment. The operationalized model was a mixed linear model. Time, treatment group, and several PD criteria were used in a three-way exchange to assess the moderator impact. The findings for cluster B personality disorder indicate a small but significant moderating influence. When encouraged to examine their current patient-therapist contact, patients who started therapy with a higher percentage of group B PD symptoms fared better. Adolescents with signs of cluster B PD receiving psychoanalytic treatment for MDD appear to benefit more with relationship work than those without this disease.

Maladaptive personality traits are associated with burnout risk in Italian anesthesiologists and intensivists: a secondary analysis from a cross-sectional study

BackgroundBurnout is a maladaptive response to chronic stress, particularly prevalent among clinicians. Anesthesiologists are at risk of burnout, but the role of maladaptive traits in their vulnerability to burnout remains understudied.MethodsA secondary analysis was performed on data from the Italian Association of Hospital Anesthesiologists, Pain Medicine Specialists, Critical Care, and Emergency (AAROI-EMAC) physicians. The survey included demographic data, burnout assessment using the Maslach Burnout Inventory (MBI) and subscales (emotional exhaustion, MBI-EE; depersonalization, MBI-DP; personal accomplishment, MBI-PA), and evaluation of personality disorders (PDs) based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition) criteria using the assessment of DSM-IV PDs (ADP-IV). We investigated the aggregated scores of maladaptive personality traits as predictor variables of burnout. Subsequently, the components of personality traits were individually assessed.ResultsOut of 310 respondents, 300 (96.77%) provided complete information. The maladaptive personality traits global score was associated with the MBI-EE and MBI-DP components. There was a significant negative correlation with the MBI-PA component. Significant positive correlations were found between the MBI-EE subscale and the paranoid (r = 0.42), borderline (r = 0.39), and dependent (r = 0.39) maladaptive personality traits. MBI-DP was significantly associated with the passive-aggressive (r = 0.35), borderline (r = 0.33), and avoidant (r = 0.32) traits. Moreover, MBI-PA was negatively associated with dependent (r = − 0.26) and avoidant (r = − 0.25) maladaptive personality features.ConclusionsThere is a significant association between different maladaptive personality traits and the risk of experiencing burnout among anesthesiologists. This underscores the importance of understanding and addressing personality traits in healthcare professionals to promote their well-being and prevent this serious emotional, mental, and physical exhaustion state.

The relationship between mood disorders, personality disorder and suicidality in adolescence: does general personality disturbance play a significant role in predicting suicidal behavior?

IntroductionCurrent research points to the importance personality pathology and Major Depression e as relevant psycopathological risk factors for understanding suicidal risk in adolescence. Literature has mainly focused on the role of BPD, however current orientations in personality pathological functioning suggest that BPD may be the representative of a general personality disturbance, a factor of vulnerability underlying diverse psychopathological variants and aspects of maladaptive functioning. However, recent studies seem to have neglected the contributions that other specific personality disorders and personality pathology as a general factor of vulnerability for suicidality; and only marginally investigated the interaction of personality disorder (PD) as an overall diagnosis and individual PDs and major depression (MDD).In this paper, the independent and cumulative effects of MDD and DSM-IV PDs on suicidal risk are investigated in a sample of adolescents observed in a longitudinal window of observation ranging from three months preceding the assessment to a six-month follow up period of clinical monitoring.MethodsA sample of 118 adolescents (mean age = 15.48 ± 1.14) referred for assessment and treatment on account of suicidal ideation or behavior were administered the CSSRS, SCID II, Kiddie-SADS at admission at inpatient and outpatient Units. All subjects included in the study had reported suicidal ideation or suicide attempts at the C-SSRS; The CSSRS was applied again to all patients who reported further suicidal episodes during the six-months follow-up period of clinical monitoring. Dimensional diagnoses of PDs was obtained by summing the number of criteria met by each subject at SCID-%-PD 5, In order, to test the significance of the associations between the variables chosen as predictors (categorical and dimensional PDs and MD diagnosis), and the suicidal outcomes variables suicide attempts, number of suicide attempts and potential lethality of suicide attempt, non-parametric bivariate correlations, logistic regression models and mixed-effects Poisson regression were performed PD.ResultsThe categorical and dimensional diagnosis of PD showed to be a significant risk factors for suicide attempt and their recurrence, independently of BPD, that anyway was confirmed to be a specific significant risk factor for suicidal behaviors. Furthermore, PD assessed at a categorical and dimensional level and Major Depression exert an influence on suicidal behaviors and their lethality both as independent and cumulative risk factors.LimitationsBesides incorporating dimensional thinking into our approach to assessing psychopathology, our study still relied on traditionally defined assessment of PD. Future studies should include AMPD-defined personality pathology in adolescence to truly represent dimensional thinking.ConclusionThese results point to the importance of early identification of the level of severity of personality pathology at large and its co-occurrence with Major Depression for the management of suicidal risk in adolescence.

Exploring the predictive validity of personality disorder criteria.

We tested the predictive validity of personality disorder (PD) indicators at different levels of aggregation, ranging from general PD severity to PD syndrome scales to individual PD criteria. We compared the predictive validity of models on these levels based on interview data on all 78 DSM-IV PD criteria, by using 19 outcome scales in three different samples (N = 651, N = 552, and N = 1,277). We hypothesized that criteria of personality pathology yield a significant increase in predictive validity compared with scales that are aggregated at the syndrome- or general severity-level. We assessed out of sample performance of predictive models in a repeated cross-validation design using regularized linear regression and regression forest algorithms. We observed no significant difference in predictive performance between models trained at the item-level and models trained on scale-level data. We further tested the predictive performance of the trained linear models across samples on outcome measures shared between samples and inspected models for criteria-level information they relied on to make predictions. Our results suggest that little predictive variance is lost when interview items assessing DSM-IV PD criteria are aggregated to dimensional PD scales. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Neighbourhood characteristics and the treated incidence rate of borderline personality pathology among young people.

The impact of the wider social environment, such as neighbourhood characteristics, has not been examined in the development of borderline personality disorder. This study aimed to determine whether the treated incidence rate of full-threshold borderline personality disorder and sub-threshold borderline personality disorder, collectively termed borderline personality pathology, was associated with the specific neighbourhood characteristics of social deprivation and social fragmentation. This study included young people, aged 15-24 years, who attended Orygen's Helping Young People Early programme, a specialist early intervention service for young people with borderline personality pathology, from 1 August 2000-1 February 2008. Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Personality Disorders, and census data from 2006 were used to determine the at-risk population and to obtain measures of social deprivation and fragmentation. The study included 282 young people, of these 78.0% (n = 220) were female and the mean age was 18.3 years (SD = ±2.7). A total of 42.9% (n = 121) met criteria for full-threshold borderline personality disorder, and 57.1% (n = 161) had sub-threshold borderline personality disorder, defined as having three or four of the nine Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) borderline personality disorder criteria. There was more than a sixfold increase in the treated incidence rate of borderline personality pathology in the neighbourhoods of above average deprivation (Quartile 3) (incidence rate ratio = 6.45, 95% confidence interval: [4.62, 8.98], p < 0.001), and this was consistent in the borderline personality disorder sub-groups. This association was also present in the most socially deprived neighbourhood (Quartile 4) (incidence rate ratio = 1.63, 95% confidence interval: [1.10, 2.44]), however, only for those with sub-threshold borderline personality disorder. The treated incidence of borderline personality pathology increased incrementally with the level of social fragmentation (Quartile 3: incidence rate ratio = 1.93, 95% confidence interval: [1.37, 2.72], Quartile 4: incidence rate ratio = 2.38, 95% confidence interval: [1.77, 3.21]). Borderline personality pathology has a higher treated incidence in the more socially deprived and fragmented neighbourhoods. These findings have implications for funding and location of clinical services for young people with borderline personality pathology. Prospective, longitudinal studies should examine neighbourhood characteristics as potential aetiological factors for borderline personality pathology.

Emotional working memory training improves cognitive inhibitory abilities in individuals with borderline personality trait: A randomized parallel-group trial

BackgroundCognitive inhibition impairment is one of the causes of impulsive behaviors in individuals with borderline personality disorder (BPD). This study aimed to investigate the effect of emotional working memory training (EWMT) on cognitive inhibition in individuals with a clinically significant borderline personality trait. MethodsIn a randomized, parallel-group trial, 40 individuals with borderline personality trait, were selected out of 1000 screened individuals and were randomly assigned to the experimental (N = 20) and waiting-list control (N = 20) groups based on the score on the Borderline Personality Scale and the follow-up Structured Clinical Interview for DSM-IV Personality Disorders. The experimental group underwent 10 sessions of EWMT and the control group did not receive any intervention (waiting list). Participants completed the Stroop Color and Word Test (SCWT) and Go/No-Go task Before and after the intervention. ResultsEWMT significantly reduced reaction time of incongruent trials in the SCWT and commission errors in the Go/No-Go task after the intervention only in the experimental group. Furthermore, the interference score in SCWT and commission error rate at the post-intervention time were significantly lower for the experimental vs the waitlist group. LimitationsThe single-blind design and absence of follow-up measures. ConclusionsEWMT can improve cognitive inhibition in individuals with borderline personality trait and could be used for therapeutic purposes of impulsivity behavior in BPD.

Personality Disorders as a Possible Moderator of the Effects of Relational Interventions in Short-Term Psychoanalytic Psychotherapy with Depressed Adolescents.

A significant proportion of adolescents suffering from major depressive disorder (MDD) are likely to have a co-morbid personality disorder (PD). Short-term psychoanalytic psychotherapy (STPP) was found to be one treatment of choice for adolescents suffering from MDD. Background: The first experimental study of transference work-in teenagers (FEST-IT) demonstrated the efficaciousness of transference work in STPP with adolescents suffering from MDD. The usefulness of STPP may be enhanced by exploring possible moderators. Methods: Depressed adolescents (N = 69), aged 16–18 years, were diagnosed with the structured interview for DSM-IV PDs and randomized to 28 weeks of STPP with or without transference work. A mixed linear model was applied. The moderator effect was investigated by a three-way interaction including “time”, “treatment group” and “number of PD criteria”. Results: A small but significant moderator effect was found for cluster B personality pathology. Patients with a higher number of cluster B PD criteria at baseline did better up to one-year post-treatment where therapists encouraged patients to explore the patient–therapist relationship in the here and now. Conclusion: When treated with psychoanalytic psychotherapy for MDD, adolescents with cluster B PD symptoms seem to profit more from transference work than adolescents without such pathology.

Age-neutrality of the SCID-II: Differential Item Functioning in Younger Outpatients (Aged 20-45) and Older Outpatients (Aged 65+)

ABSTRACT Objectives Measurements are often developed for the assessment of personality disorders (PDs) in younger adults and seldom evaluated on the applicability in older adults. Remarkably, research has not yet been conducted into age-group appropriateness of the gold standard for the assessment of PDs, known as Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Therefore, the current study empirically investigated the age-neutrality of the PDs assessed by the SCID-II. Methods Age-neutrality was examined in 84 younger adults (aged 20–45 years) and 68 older adults (aged 65–85) by Differential Item Functioning (DIF). The impact of DIF on scale level was further examined using Differential Test Functioning analyzes to examine the impact of the amount of DIF variance in the items on scale level. Results Overall, the great majority, 95.8% of the categorically measured items and 87.5% of the dimensionally measured items, was endorsed in the same way by younger adults and older adults with equal scores on the PD scale. Subsequent analyzes revealed no large DTF for PD scales. Conclusions Overall the SCID-II in an outpatient population is age-neutral for both categorically and dimensionally scored PD scales. Clinical Implications The SCID-II can be used for the assessment of PDs in older adults.

Self- but not other-mentalizing moderates the association between BPD symptoms and somatic complaints in community-dwelling adolescents.

The aim of this study was to evaluate the potential moderator role of poor mentalization in the association between borderline personality disorder (BPD) traits and somatization, specifically focusing on the polarities of self- and other-mentalizing. This is a cross-sectional, general population study evaluating adolescents (n=162, 61.3% female; ages 12-18, M=14.63, SD=1.02). The relationship between BPD traits and somatization was evaluated with self-mentalization (attention to emotions and clarity of emotions) and other-mentalizing as moderator variables. One hundred sixty-two adolescents without serious mental health disorders were evaluated using self-report measures for borderline personality disorder traits (screening questionnaire for the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), somatic symptoms using the Somatic Symptoms Questionnaire (SSQ), self-mentalizing using the Trait Meta-Mood Scale-24 (TMMS) and other-mentalizing using the Adolescent Mentalizing Interview (AMI)). Linear regressions were conducted to test the moderation effects of self- and other-mentalizing in the relationship between BPD symptoms and somatic complaints, controlling for age and sex. Moderation analysis was conducted using PROCESS version 3.5. The association between BPD symptoms and somatic complaints was moderated by a self-mentalizing dimension (emotional clarity) (b=-0.019, 95% CI=-0.0379 to -0.0002, p=.0476), but not other-mentalizing (b=0.027, 95% CI=0.000 to 0.053, p=.051). The effect of BPD symptoms on somatization disappears when emotional clarity is high, regardless the level of attention to emotions. Self-mentalizing appears to be an adaptive skill as it attenuates the relationship between BPD traits and somatization. Specifically, emotional clarity rather than simple attention to emotions is the aspect of self-mentalizing attenuating this association. These results support that self-mentalization is an important function in the management of body-associated emotions even in non-clinical levels of BPD traits. Findings suggest that strengthening self-mentalizing skills across development might contribute to resilience and salutogenesis.

Trauma-focused EMDR for Personality disorders among Outpatients (TEMPO): study protocol for a multi-centre, single-blind, randomized controlled trial

BackgroundExisting recommended treatment options for personality disorders (PDs) are extensive and costly. There is emerging evidence indicating that trauma-focused treatment using eye movement desensitization and reprocessing (EMDR) therapy aimed at resolving memories of individuals’ adverse events can be beneficial for this target group within a relatively short time frame. The primary purpose of the present study is to determine the effectiveness of EMDR therapy versus waiting list in reducing PD symptom severity. Furthermore, the effects of EMDR therapy on trauma symptom severity, loss of diagnosis, personal functioning, quality of life, and mental health outcomes will be determined. In addition, the cost-effectiveness of EMDR therapy in the treatment of PDs is investigated. Moreover, predictors of treatment success, symptom deterioration and treatment discontinuation will be assessed. Lastly, experiences with EMDR therapy will be explored.MethodIn total, 159 patients with a PD will be included in a large multicentre single-blind randomized controlled trial. The Structured Clinical Interview for DSM-5 Personality Disorders will be used to determine the presence of a PD. Participants will be allocated to either a treatment condition with EMDR therapy (ten biweekly 90-min sessions) or a waiting list. Three months after potential treatment with EMDR therapy, patients can receive treatment as usual for their PD. All participants are subject to single-blinded baseline, post-intervention and 3-, 6- and 12-month follow-up assessments. The primary outcome measures are the Assessment of DSM-IV Personality Disorders and the Clinician-Administered PTSD Scale for DSM-5. For cost-effectiveness, the Treatment Inventory of Costs in Patients with psychiatric disorders, EuroQol-5D-3L, and the Mental Health Quality of Life Questionnaire will be administered. The PTSD Checklist for DSM-5, Brief State Paranoia Checklist and Difficulties in Emotion Regulation Scale will be used to further index trauma symptom severity. Type of trauma is identified at baseline with the Childhood Trauma Questionnaire-SF and Life Events Checklist for the DSM-5. Personal functioning and health outcome are assessed with the Level of Personality Functioning Scale-BF 2.0, Outcome Questionnaire-45 and Mental Health Quality of Life Questionnaire. Experiences with EMDR therapy of patients in the EMDR therapy condition are explored with a semi-structured interview at post-intervention.DiscussionIt is expected that the results of this study will contribute to knowledge about the effectiveness, and cost-effectiveness of trauma-focused treatment using EMDR therapy in individuals diagnosed with a PD. Follow-up data provide documentation of long-term effects of EMDR therapy on various outcome variables, most importantly the reduction of PD symptom severity and loss of diagnoses.Trial registrationNetherlands Trial Register NL9078. Registered on 31 November 2020

More is more: Evidence for the incremental value of the SCID-II/SCID-5-PD specific factors over and above a general personality disorder factor.

Currently, 3 competing conceptualizations of personality dysfunction can be distinguished: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorical model delineating 10 distinct types of personality disorders (PDs); the alternative model for PDs (DSM-5 Section III), which assesses personality functioning and traits separately; and the International Classification of Diseases, 11th Version conceptualization, which provides 1 single code for the presence of a PD (which is based on problems in functioning) as well as codes that specify the level of the disorder (mild/moderate/severe), and prominent trait domains or patterns (5 domains and 1 pattern). The current study aims to assess the incremental value of the DSM-5 PDs over and above a global personality dysfunction factor, using expert ratings obtained with the Structured Clinical Interview for DSM-IV PDs and the Structured Clinical Interview for DSM-5 PDs interview in a large sample of clinical patients (N = 3,851). All estimated bifactor models provided adequate fit to the data. We found a surprisingly low explained common variance for the g-factor (<40%), indicating that ignoring the specific PD factors would lead to a substantial loss of information. The strongest specific PDs in terms of explained common variance were the avoidant, schizotypal, and schizoid PD factors and the conduct disorder criteria set if included. Correlations between our factors and external variables were relatively low, except for the Severity Indices of Personality Problems, which aims to measure personality functioning. Our findings suggest that specific PDs still have an important role to play in the assessment of personality pathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Obsessive\u2013compulsive personality disorder in rapid eye movement sleep behavior disorder

Rapid eye movement sleep behavior disorder (RBD) is a common prodromic non-motor symptom of Parkinson’s disease (PD). Only few studies have evaluated the personality of RBD patients with conflicting results. Aim of the study was to evaluate the frequency of Personality Disorders (PeDs)in RBD. RBD patients, PD patients and healthy controls (HC) were enrolled. All the enrolled subjects underwent a full neurological examination. Motor symptoms were evaluated with the UPDRS-Motor Examination. PeDs were assessed with the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Twenty-nine RBD patients [14 men (48.3%); mean age 55.6 ± 11.1], 30 PD patients [17 men (56.7%); mean age 65.7 ± 10.7] and 30 HC [12 men (40%); mean age 65.7 ± 5.4] were enrolled in the study. PD patients had a disease duration of 4.5 ± 4.6 and presented a mean UPDRS-ME score of 26.7 ± 9.4. The most frequent PeDs was the Obsessive–Compulsive one (OCPeD); OCPeD was significantly more frequent in RBD (55.2%) patients than HC (13.3%; p-value < 0.001). No significant differences were found comparing the frequency of OCPeD in RBD patients to that in PD. In the present study, the prevalence of OCPeD in RBD patients was close to that reported in PD patients. Our data could suggest the existence of a common disease-specific RBD-PD personality profile.

Dimensional Model of Personality Disorder Incorporated Into ICD-11

Dimensional Model of Personality Disorder Incorporated Into ICD-11

Impact of Parental Impulsivity on Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder: Do Mothers' Attitudes Predict Symptom Severity in Children?

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder that occurs early in school-aged children, and it is highly comorbid with oppositional defiant disorder (ODD). Parents of children with ADHD frequently show mental problems related to impulsivity. The aim of this study was to examine the relationship between impulsivity of the mothers and the symptom patterns and severity of children. A total of 85 children between the ages of 6 and 12 and their mothers participated. Conners' Parent and Teacher Scales, Structured Clinical Interview for DSM-IV Personality Disorders, and ıowa gambling task were applied. We found a positive correlation between the impulsivity of the mothers and the total symptom severity of ADHD and ODD in children. During the treatment process of ADHD, the evaluation of impulsivity in mothers of children with ODD comorbidity and treatment of impulsivity in the mother would be beneficial. In future studies, examining the effects after treatment of impulsivity may contribute to the literature.

Personality Inventory for DSM-5 in China: Evaluation of DSM-5 and ICD-11 Trait Structure and Continuity With Personality Disorder Types.

The Personality Inventory for the DSM-5 (PID-5) is an established tool for assessing personality disorder (PD) traits that was developed based on section III of the DSM-5. It is composed of 220 items, organized into 25 facets, which are distributed among five domains. The psychometric properties of the Chinese version of the PID-5 remain to be demonstrated. Two samples were embodied in this study that included 3,550 undergraduates and 406 clinical patients. To probe the structure of the PID-5, parallel analyses were conducted to explore the unidimensionality of its 25 facets and a series of confirmatory factor analyses (CFAs) were carried out to confirm the 25 lower-order facets and their distribution among five higher-order domains. Then, the PID-5 was employed to measure the DSM-5 and ICD-11 trait models and to explore the relationship of DSM-IV categorical PDs with DSM-5 and ICD-11 personality traits. Correlation and regression analyses were conducted to probe how well DSM-IV categorical PDs correspond with maladaptive personality traits specified in the DSM-5 and five ICD-11 domains. The respective average internal reliability coefficients of the 25 facets obtained for undergraduate and clinical patient samples were 0.76 and 0.81, those obtained for the five DSM-5 domains were 0.89 and 0.91, and those obtained for the five ICD-11 domains were 0.87 and 0.89. Serial CFAs confirmed the rationality of the PID-5's lower-order 25-facet structure and higher-order five-domain structure in both samples. Correlation and regression analyses showed that DSM-5 specified traits explain the variance in PD presentation with a manifold stronger correlation (R2 = 0.24–0.44) than non-specified traits (R2 = 0.04–0.12). Overall, the PID-5 was shown to be a reliable, stable, and structurally valid assessment tool that captures pathological personality traits related to DSM-5 and ICD-11 PDs.

Psychiatric comorbidity and order of condition onset among patients seeking treatment for chronic pain and opioid use disorder

BackgroundThe study objective was to compare psychiatric comorbidity among patients seeking treatment for chronic pain and opioid use disorder (OUD) by order of condition onset (i.e., “Pain First,” “OUD First,” “Same Time”). MethodsData from 170 patients entering two clinical trials of treatments for current comorbid chronic pain and OUD conducted between March 2009 and July 2013 were compared by order of condition onset. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders (Axis II) were performed by doctoral-level providers using a standardized training protocol. Age of onset group differences on specific diagnostic variables were examined using multinomial logistic regression. ResultsFifty-two percent were in the “Pain First” group (n = 89), 35 % in the “OUD First” group (n = 59), and 13 % in the “Same Time” group (n = 22). Compared with the Pain First group, the Same Time group was less likely to report heroin (vs. prescription opioids) as the primary drug used (OR = 0.20, 95 % CI = 0.06−0.72) or meet criteria for an Axis II disorder (OR = 0.24, 95 % CI = 0.07−0.83). Compared with the Pain First group, the OUD First group was more likely to meet criteria for a current nonopioid substance use disorder (OR = 3.20, 95 % CI = 1.22−8.40). ConclusionsOur findings regarding differences in psychiatric comorbidity associated with order of condition onset indicate that varying pathways may exist for the emergence of chronic pain and OUD; further research should investigate potential treatment implications.

Discriminant validity of the alternative model of personality disorder.

The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 Section III alternative model of personality disorder (AMPD) was developed to rectify some of the failings of the DSM-IV personality disorders, including a lack of compelling discriminant validity. The primary purpose of the current study was to provide a direct comparison of DSM-IV with DSM-5 Section III AMPD with respect to discriminant validity in a sample of 302 community members from the United States who were currently receiving or had received mental health treatment. The AMPD Criterion A, level of personality functioning, was assessed by the Section III Criterion A impairment scales (Anderson & Sellbom, 2018). AMPD Criterion B, the five-domain pathological trait model, was assessed by the Personality Inventory for DSM-5 (Krueger, Derringer, Markon, Watson, & Skodol, 2012). Also included was the cross-cutting Level of Personality Functioning Scale-Self Report (Morey, 2017). DSM-IV personality disorders were assessed by the Personality Diagnostic Questionnaire-4 (Hyler, 1994) and the Multi-Source Assessment of Personality Pathology (Oltmanns & Turkheimer, 2006). Results demonstrate no substantive improvement in discriminant validity in the AMPD compared to the DSM-IV. Implications of these findings for the conceptualization and assessment of personality disorders are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Internalizing and externalizing subtypes in female patients with co-occurring post-traumatic stress disorder and substance use disorders

BackgroundResearch has described subtypes with more internalizing and more externalizing symptoms in samples of patients with post-traumatic stress disorder (PTSD) and samples of patients with substance use disorders (SUD). ObjectiveThis study sought to examine the respective subtypes in female PTSD-SUD patients and potential relationships with substance use characteristics. MethodsWe performed a latent class analysis (LCA) in 343 adult female participants of a multisite therapy trial on PTSD and SUD. We derived externalizing symptoms from the Assessment of DSM-IV Personality Disorders (ADP-IV) questionnaire. We assessed internalization using the Symptom Checklist-27 (SCL-27) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). We collected substance use–related information using the Addiction Severity Index-Lite (ASI-lite). ResultsLCA suggested four latent classes including an externalizing (10.8%), a moderately internalizing class (31.0%), and a highly internalizing class (22.0%), as well as a class with a low severity of psychological symptoms (36.3%). Externalizing participants used more substances than any other class, while the duration of substance use did not differ between groups. Regular use started at a significantly younger age among the members of the highly internalizing subgroup compared to the moderately internalizing and low severity participants, but at an older age compared to the externalizing group members. ConclusionsThe finding of two internalizing subgroups along with an externalizing and a low severity class emphasizes the heterogeneity and complexity of populations with PTSD and SUD. This heterogeneity bears implications for research among this group of patients, but also for their treatment, especially considering our results on differences in substance use.

Identity Impairment as a Central Dimension in Personality Pathology

Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an alternative model for diagnosing personality disorders (PDs). This model highlights identity impairment as a potential criterion of all PDs, which has stimulated researchers to characterize identity functioning across PD presentations. Accordingly, the present study examined associations between dimensions of identity functioning and PD symptomatology among 242 Flemish community adults (49.2% female; Mage = 42.76, SD = 14.42). Participants completed the Self-Concept and Identity Measure (Kaufman, Cundiff, & Crowell, 2015) to assess identity functioning and the Assessment of DSM-IV Personality Disorders (Schotte, De Doncker, Vankerckhoven, Vertommen, & Cosyns, 1998) to assess dimensionally measured PDs. A correlational analysis yielded negative associations between the consolidated identity subscale and all PDs, whereas scores on both disturbed identity and lack of identity scales were positively associated with PDs. A multivariate regression analysis indicated that the consolidated identity scale did not account for unique variance in PD dimensions. Disturbed identity and lack of identity scale scores positively predicted variance in all PDs, with the lack of identity scale being the stronger predictor of symptoms of paranoid, schizotypal, and borderline PDs. Study findings generally support identity impairment as a central dimension in PD symptomatology in a Flemish community sample.