Personality Disturbance Research Articles

Etiological Factors of Mental Disorders among Members of the Polish Military Forces

This project attempts to establish possible links between psychosocial factors and mental disorders among Polish professional soldiers. The examined group consisted of 1,785 professional soldiers hospitalized in the psychiatric department of the 107th Military Hospital in Walcz in the years 1982 to 1984, 1986 to 1989, and 1993 to 1996. The study was based on analysis of accessible medical files. Special attention was paid to diagnosis, age, year of service, garrison size, position, and motivation to remain in military service. The International Classification of Diseases, Tenth Revision, diagnostic scheme was used. Neurotic disorders were the most often diagnosed psychic disturbances in all groups of professional soldiers. More than half of the soldiers hospitalized from 1986 to 1989 became unfit for further military duty because of their mental disturbances. This study confirmed statistical links between dismissals of professional soldiers and motivation, age, or job seniority. Also, we found a link between military positions and increased psychiatric morbidity among soldiers. Personality disturbances, maladaptive syndromes, and substance-related disorders dominated at command positions in all years investigated. The results showed the necessity of further elaborations of preventive and new treatment rules, leading to a diminution of mental disturbances among professional soldiers in Poland.

A two-factor model of disordered eating

General psychopathology (i.e., personality disturbance, mood/affect dysregulation) has been identified as common and perhaps etiologically important in eating disorder (ED) patients. In this context, we examined a two-factor model of disordered eating which implicated the independent and interactive contribution of (a) general psychopathology (personality) and (b) eating-related psychopathology (body esteem) in explaining deviant eating patterns. A sample of 266 female college/university students ( M age=22.1) and 76 women with a clinically diagnosed ED ( M age=28.09) completed paper and pencil questionnaires of deviant eating patterns, body esteem, and personality pathology. First, a K-means cluster procedure revealed a compelling three-cluster solution among the nonclinical women based on deviant eating variables: «deviant eaters»( n=61), «restrainers» ( n=92), and «nondeviant eaters» ( n=103). The ED women were classified as Cluster 4; «clinical» ( n=76). Second, to evaluate our two-factor model, multinomial logistic regression (MLR) was used with cluster membership as the outcome variable and the following variables as predictors: body esteem, personality pathology, and all two-way interactions. In addition to several significant main effects, three interaction terms were marginally significant: Body esteem appearance×Narcissism ( P=.047), Body esteem weight×Narcissism ( P=.044), and Body esteem attribution×Stimulus seeking( P=.051). The overall extent of correct cluster classification was 63%. These results indicate that the presence of both low body esteem and maladaptive personality, and the interactive operation of these two factors, seems to contribute to the likelihood of having an eating disorder, beyond the independent contribution of either factor alone. Results are considered in the context of etiological models in which general psychopathology presents a vulnerability factor in ED development.

Neuropsychological differentiation of late onset schizophrenia and frontotemporal dementia

Frontaltemporal dementia (FTD) and schizophrenia are characterised by disturbances in cognition, personality, behaviour, and social functioning often leading to a decline in activities in daily living. Deterioration of comportment and disturbances in attention are typical in both disorders and manifest behaviourally in terms of withdrawal, isolation, lack of volition, emotional unresponsiveness, and poverty of speech. Accordingly, the considerable overlap in behavioural expression between patients with schizophrenia and FTD makes a differential diagnosis difficult. This different diagnosis is especially difficult when the age of onset of schizophrenia is late (i.e., 45 +). The purpose of this study was to identify which neuropsychological tests best differentiate patients with late onset schizophrenia from patients with FTD. Hence, neurocognitive test results from a total of 12 patients with FTD and 32 patients with schizophrenia were analysed using test sensitivity statistics (i.e., Cohen's U2% overlap). The results support a test battery composed of the WAIS-R Vocabulary, Information, Digit Span, and Comprehension subtests, and the Hooper Visual Organisation test as being the most sensitive measures to diagnostic differentiation between patients with FTD and those with late onset schizophrenia.

The clinical course of childhood and adolescent adrenoleukodystrophy before and after Lorenzo's oil

The clinical course of Japanese patients with childhood and adolescent adrenoleukodystrophy (ALD) who were treated with Lorenzo's oil after the progression of early symptoms was investigated by Kaplan-Meier analyses. Many of the early symptoms, including visual, personality, hearing, mental and speech disturbances, had already appeared when the oil therapy was started. These early symptoms appeared significantly faster than bed-ridden state or dysphagia (P<0.01). Gait disturbance appeared faster than bed-ridden state and dysphagia (P<0.05), and tended to appear later than the early symptoms. These results would reflect the early natural course of childhood and adolescent ALD before treatment, and provide a basis for the evaluation of therapeutic trials for ALD.

The personality structure questionnaire (PSQ): a measure of the multiple self states model of identity disturbance in cognitive analytic therapy

AbstractThe Multiple Self‐States Model (MSSM) of Cognitive Analytic Therapy (CAT) conceptualizes identity disturbances in personality, particularly borderline personality disorder. The Personality Structure Questionnaire (PSQ) has been devised to measure deficits in personality integrity and represent an assessment measure of the MSSM. A spectrum of multiplicity in the self and dissociation is implied within the MSSM with gradation from borderline personality to dissociative identity disorder. The construction, psychometric properties, reliability, validity and clinical utility of the PSQ as a measure of the MSSM are described based on data from the present study and that of Broadbent, Clarke and Ryle (The Personality Structure Questionnaire: a brief self‐report measure of personality integration. Unpublished manuscript) and its relationship to psychological constructs of identity integrity is investigated. A series of non‐clinical and clinical groups of participants were administered the PSQ and other standardized measures. The PSQ was shown to be a reliable self‐report measure and factor analysis revealed it to be unidimensional and to correlate convergently with multiplicity, dissociation and constructs related to identity disturbance. Regression analysis indicated the PSQ to be predicted by greater multiplicity. The PSQ, in combination with other constructs, also discriminated between diagnosed clinical groups (psychotherapy patients, borderline personality disorder and dissociative identity disorder). The PSQ is shown to be a brief, psychometrically sound self‐report measure of identity disturbance as conceptualized by the MSSM in CAT. The applicability of the PSQ and its relevance to the concepts of multiplicity and dissociation within the MSSM of CAT are discussed. Copyright © 2001 John Wiley &amp; Sons, Ltd.

Psicoterapia Cognitiva del Paziente Grave: Metacognizione e Relazione Terapeutica

Psicoterapia Cognitiva del Paziente Grave: Metacognizione e Relazione Terapeutica Antonio Semerari (Ed.). Milano, Rome: Raffaello Cortina Editore (www.raffaellocortina.it). 1999, 366 pp., 26, 86 Euro (softcover). Over the course of time, some of the world's finest literature has gone unappreciated due to being penned in languages foreign to the reader. Unfortunately, not all great literature is completely translatable from its original tongue and hence, despite conceited efforts and skill, much may be lost in the process of translation. Even though there are many similarities between the romance languages (i.e., Italian, Spanish, French and Portuguese), there is still much in the prose that would leave this work incomprehensible to the majority of cognitive-behavioral therapists outside of Italy. Consequently, only a minimal number of readers may benefit from the content which is a pity, since it is so very nicely prepared. The book, edited by Antonio Semerari, is titled Cognitive Therapy With Serious Patients. The editor recruited a number of seasoned and well-trained psychiatrists and psychologists who emanate from the renowned Center for Cognitive Therapy in Rome. This Center in Rome has earned both European and American recognition for its research and training programs. The editor and his contributors embark on the arduous task of applying cognitive therapy to patients with some of the more serious types of illnesses, which include personality disorders, psychotic states, and anxiety disorders. Using state of the art techniques in an overall metacognitive approach, the editor and contributors outline their dimensional approach for treating serious cases. The text addresses the topic from a metacognitive approach and is delineated in three sections. The initial section covers the theoretical references in which the concept of metacognition is boldly introduced and discussed. One area that is clearly highlighted is metacognition and the theory of the mind. In this section, the authors contend that metacognitions evolve from early cognitive development and are later shaped by the individual's perception of his/her life experiences. There is also a chapter that traces the synthesis of cognitive therapy with severely disturbed patients and focuses on treatment aspects that are elaborated in the second part of the text. The contributors also review some of the history of the constructive approach and how it dovetails with Aaron Beck's work on personality disturbance. …

Social phobia: Research and clinical practice

Social phobia is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity, occurring in about 18% of the clinical population. Despite good results with cognitive-behavioural treatment, social phobia seems to be a chronic disorder with several complications. The author describes an analysis of a divorced woman who was exposed to an early premature sexual seduction by her father, abruptly terminated because of an accident. The loss of the father was repaired by a delusional system as defence against the re-emergence of a catastrophic situation. Her compulsion to repeat the traumatic situation was seen in symbolic attempts to reproduce the lost experience of forbidden pleasure with other men, ending in hopeless affairs. According to DSM-IV the patient hadbesides social phobiaseveral personality disturbances, clinically manifested by weak ego boundaries, an unclear identity, and low self-esteem. Cognitive-behavioural therapy and psychopharmaca were without any effect. The childhood experiences were repeated in the context of the analysis and worked through, especially the pre-oedipal and oedipal conflicts. Important repeating themes were "crime", guilt, and punishment. After 3 years of analysis it was possible for the patient to expose herself to anxiety-producing situations with less symptoms. It was possible for her to withdraw the projections and take more responsibility for the unconscious sexual and aggressive impulses. At the 5-year follow-up her satisfactions had become more realistic and she became involved in a positive relationship.

Adult Somatic Preoccupation and Its Relationship to Childhood Trauma

Somatic preoccupation has been associated with a variety of comorbid psychiatric conditions including childhood trauma, personality disorder, and depression. The current study was undertaken to simultaneously explore the inter-relationship of these psychiatric variables as conceptualized in a path model. Participants (N = 120), both men and women, seen for nonemergent health care in a resident-staffed internal medicine clinic, were given questionnaires exploring the presence of childhood trauma, borderline personality symptomatology, current depression, worry, and somatic preoccupation. With one exception, all simple correlation coefficients among study variables were relatively substantial. By sequencing variables into an a priori model and using a path analytic approach, several indirect and direct relationships among variables were evident. Most important, childhood trauma exhibited a direct effect on somatic preoccupation as well as indirect effects through borderline personality disturbance and current depression. These data suggest that childhood trauma may be a precursor for somatic preoccupation during adulthood.

Acquired Personality Disturbances Associated With Bilateral Damage to the Ventromedial Prefrontal Region

Personality changes in 7 participants with bilateral ventromedial prefrontal lesions (PF-BVM), 14 participants with prefrontal lesions but not bilateral ventromedial involvement (PF-NBVM), and 36 with nonprefrontal lesions (NPF) were investigated with the Iowa Rating Scales of Personality Change. Informants rated 30 specific characteristics for degree of disturbance and change from premorbid personality. PF-BVM participants showed a higher rate of acquired disturbances than NPF participants in blunted emotional experience, apathy, low emotional expressiveness, inappropriate affect, poor frustration tolerance, irritability, lability, indecisiveness, poor judgment, social inappropriateness, lack of planning, lack of initiation and persistence, and lack of insight. Differences between the PF-BVM and PF-NBVM groups were significant for several of these characteristics. All 7 PF-BVM participants developed a syndrome, including general dampening of emotional experience; poorly modulated emotional reactions; defective decision making, especially in the social realm; impaired goal-directed behavior; and striking lack of insight. Similarities between this syndrome of "acquired sociopathy" and developmental psychopathy in characteristic personality disturbances and psychophysiological abnormalities suggest that diminished emotionality, impaired decision making, and psychosocial dysfunction may be related to ventromedial prefrontal dysfunction in both groups.

Trauma in the family: groupwork on family awareness for men in high security hospital

AbstractIntroductionIt is typically considered important in clinical practice to generate an understanding of the relationships and consequences of interaction patterns within the families of patients with serious interpersonal difficulties and histories of violent offending.MethodEight men on a dedicated treatment unit for patients with personality disturbance within a maximum security hospital participated in structured groupwork which focused on family awareness.ResultsTwo measures of outcome were employed: their recollections of family life were assessed before and after the intervention, and their general progress in rehabilitation was followed up 12 months later. Summary scores of the participants' recall of feelings associated with familial figures indicate that the group reported changes in their feelings over the eight‐month period. For the duration of the group, and during the subsequent year, the group members remained on the same ward; two had been transferred to medium security at follow‐up.DiscussionThe inherent bias and the small numbers in the group prevent generalization. However, it seems that patients who participated in group work are likely to remain on the ward studied or be moved to lower security. The recollection and sharing experiences of family life may have reduced the patients' sense of isolation. Copyright © 2000 Whurr Publishers Ltd.

P03.392 Mental disturbances in persons exposed to radiation after chernobyl NPP accident

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Ecstasy (MDMA): a review of its possible persistent psychological effects.

Recreational use of "ecstasy" (3,4-methylenedioxymethamphetamine; MDMA) has become increasingly widespread. Until recently, however, little was known about the possible persistent psychological effects of extensive use of this drug. The aim of the present review is to evaluate recent empirical evidence concerning the persistent psychological sequelae of recreational ecstasy use. The methodologies of open trial studies of recreational ecstasy users are evaluated and reports of the presence or absence of persistent psychological problems are related to the extent of past exposure to ecstasy. There is growing evidence that chronic, heavy, recreational use of ecstasy is associated with sleep disorders, depressed mood, persistent elevation of anxiety, impulsiveness and hostility, and selective impairment of episodic memory, working memory and attention. There is tentative evidence that these cognitive deficits persist for at least 6 months after abstinence, whereas anxiety and hostility remit after a year of abstinence. The possibility that some of these psychological problems are caused by ecstasy-induced neurotoxicity is supported by preclinical evidence of MDMA-induced neurotoxicity and behavioural deficits, evidence of depleted serotonin in heavy ecstasy users, and by dose-response relationships between the extent of exposure to ecstasy and the severity of cognitive impairments. An increasing number of young, heavy ecstasy users are at significant risk of persistent cognitive impairments and disturbances of affect and personality. Some of these problems may remit after abstinence, but residual neurotoxicity and decline of serotonergic function with age may result in recurrent psychopathology and premature cognitive decline.

The SCL-90-R as a screening instrument for severe personality disturbance among outpatients with mood and anxiety disorders.

Our objective was to examine whether the SCL-90-R, a widely used self-report measure of distress and psychopathology, could screen for personality disorders in general and for severe personality disturbance (SPD) in particular, at the time when patients seek treatment for a state (mood or anxiety) disorder. The SCL-90-R was administered to 112 consecutive outpatients with various mood and anxiety disorders. The personality severity index (PSI) score, defined as the mean value of the scores on the SCL-90-R subscales of interpersonal sensitivity, hostility, and paranoid ideation, was compared with the current symptom index (CSI) score, defined as the mean value of the scores on the remaining six SCL-90-R subscales. A positive screen was considered if PSI > CSI. SPD was defined as the presence of any DSM-III-R Cluster A and/or Cluster B personality disorder. The accuracy of the screen was verified by means of the Structured Clinical Interview for DSM-III-R Personality Disorders. The sensitivity of the PSI > CSI criterion to screen for SPD was 89.4%, while its sensitivity to screen for any DSM-III-R personality disorder was 72.9%. The SCL-90-R subscales that contributed the most to the screening discriminability of this SCL-90-R-derived screening measure were hostility, paranoid ideation, somatization, and obsessive-compulsive behavior. The SCL-90-R may be used to screen for SPD in routine work with outpatients with mood and anxiety disorders, but the results of the screening need to be verified because of the possibility of false negatives and false positives, although that possibility is apparently low. These findings may have important prognostic and treatment implications.

Stapes surgery and psychiatric complications

Changes in auditory perception can cause disturbances in development and personality. This phenomenon has been studied in particular in children hearing loss or in progressive or sudden hearing loss in the adult. We present the case of a patient with psychobehavioural alterations after restoration of hearing following a small fenestra stapedectomy for bilateral otosclerosis with moderate–severe hearing impairment. The diagnosis, physiopathology and medicolegal implications are discussed.

Recent developments in borderline personality disorder

Patients with borderline personality disorder (BPD; known in ICD–10 (World Health Organization, 1992) as emotionally unstable personality disorder) pose some of the most difficult management problems facing the clinical psychiatrist. They frequently present in crisis, but are often difficult to engage in any form of treatment. Their behaviour causes considerable anxiety but their ambivalence about treatment often leaves professionals feeling frustrated and resentful. These feelings can all too easily be transformed into therapeutic nihilism. As well as being a significant problem in its own right, comorbid personality disturbance complicates the management of other psychiatric disorders and has a negative effect on their prognosis (Reich &amp; Vasile, 1993).

Side effect profiles of atypical antipsychotics, typical antipsychotics, or no psychotropic medications in persons with mental retardation

Antipsychotic medications have been used to treat a variety of behavioral and psychiatric disturbances in persons with mental retardation. Given the well-documented side effects of traditional antipsychotics, newer “atypical” antipsychotics have been well received in this population due to initial reports of a more favorable side effect profile. We compared the side effect profiles of both the typical and atypical antipsychotics using a comprehensive instrument, the Matson Evaluation of Drug Side Effects (MEDS) scale. Participants taking atypical antipsychotics did not differ in overall side effects from a matched control group taking no psychotropic medication, and both groups showed significantly fewer overall side effects than participants taking typical antipsychotics. Subscales designed to measure involuntary movements (e.g., akathisia, tardive dyskinesia) detected differences between participants taking either atypical or typical antipsychotics with respect to akathisia only. Implications of these findings and directions for future research are discussed.

Pharmacological treatment of mood disturbances, aggression, and self-injury in persons with pervasive developmental disorders.

Aggression, self-injury, and mood disturbances in persons with autistic disorders, while not uncommon, do not constitute core features of autism. Moreover, these problems can occur for a variety of reasons, which need to be assessed in order to plan appropriate and frequently combined (behavioral-pharmacological) treatments. Drugs acting primarily in the dopaminergic, serotonergic, adrenergic, opioidergic, and glutamatergic systems all have been explored in the treatment of aggression and self-injury. While no single drug or class of medication has yet emerged as consistently effective, a number of drugs appear promising. Advances in the assessment of aggressive behaviors, the identification of predictors of drug response, and additional controlled clinical drug trials specifically aimed at these target behaviors are essential in improving the approach to these problematic behaviors in the context of autistic disorder.

Predictors of comorbid personality disorders in patients with panic disorder with agoraphobia

The aim of this study was to ascertain predictors of comorbid personality disorders in patients with panic disorder with agoraphobia (PDAG). Sixty consecutive outpatients with PDAG were administered the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) for the purpose of diagnosing personality disorders. Logistic regressions were used to identify predictors of any comorbid personality disorder, any DSM-IV cluster A, cluster B, and cluster C personality disorder. Independent variables in these regressions were gender, age, duration of panic disorder (PD), severity of PDAG, and scores on self-report instruments that assess the patient's perception of their parents, childhood separation anxiety, and traumatic experiences. High levels of parental protection on the Parental Bonding Instrument (PBI), indicating a perception of the parents as overprotective and controlling, emerged as the only statistically significant predictor of any comorbid personality disorder. This finding was attributed to the association between parental overprotection and cluster B personality disorders, particularly borderline personality disorder. The duration of PD was a significant predictor of any cluster B and any cluster C personality disorder, suggesting that some of the cluster B and cluster C personality disorders may be a consequence of the long-lasting PDAG. Any cluster B personality disorder was also associated with younger age. In conclusion, despite a generally nonspecific nature of the relationship between parental overprotection in childhood and adult psychopathology, the findings of this study suggest some specificity for the association between parental overprotection in childhood and personality disturbance in PDAG patients, particularly cluster B personality disorders.

Female Analogies to Perversion

Unlike the intrapsychic mechanism for self-esteem regulation in males as a basic component of perversion-extrapsychically (compensationally) culminating in an output of sexual impulsesa functional stabilization of the female self-concept seems more likely if conflict drives were to be focused on reproductional aspects and not on sexuality. It therefore seems more suitable to use a new expression in linguistic analogy to perversion: ''reproversion. The case history gives an example of a clinical manifestation of ''reproverse symptom formation. The general survey describes the main points of view inregard to clinically oriented differentiation, i.e., intensity, ego-proximity in the personality structure, and one's own self-acceptance within ''reproverse symptom formation. Underlying personality disturbances are also discussed. The significance of reproversion is relevant to many different specialized medical fields. This is explained in conclusion, using the examples of denied pregnancy and infanticide at birth based on initial empirical results.

Rating well-being and distress

There is insufficient research on rating psychological well-being and distress in clinical populations. The aim of this study was to evaluate the differential characteristics of instruments assessing well-being and distress in 20 remitted patients with affective (mood and anxiety) disorders and 20 healthy control subjects matched for sociodemographic variables. Remitted patients displayed significantly higher levels of psychological distress—as measured by Paykel's Clinical Interview for Depression (CID), Van Praag's Scale for Personality Disturbances and Kellner's Symptom Questionnaire (SQ)—and significantly less well-being—as measured by Ryff's Scales of Psychological Well-Being (PWB) and the SQ—than control subjects. The correlations between scales of psychological distress and well-being were found to be complex in both patients and controls. Psychotherapeutic treatment of residual symptomatology in patients disclosed a differential sensitivity of the scales to changes. The results thus suggest that well-being cannot be equated to lack of distress (as implicitly endorsed by current psychiatric paradigms), and the need for a multidimensional assessment in stress medicine. Copyright © 2000 John Wiley & Sons, Ltd.