Personality Disorder Clusters Research Articles

P-1253 - Schizophrenia or personality disorder cluster I - a diagnostic dilemma

Differentiation of the psychiatric diagnosis in the clinical praxis sometimes could be difficult; particulary in cases of kindred/similar diagnoses like schizophrenia, schizoaffective disorder or personality disorder cluster A (or cluster I) - paranoid, schizoid and schizotipal. Relationship between schizophrenia and personality disorder cluster I is not quite clear; according some authors, descendants of schizophrenic patients could suffer from personality disorder cluster I; which suggest on possible genetic correlation between those diagnoses. As a case report we going to present a female single patient, 32 years of age, no kids, living with her mother, disapointed in herself after unsucessfull second year on faculty of low which she left. After that, she closed up, she also had problems with nutrition, showing signs of anorexic and bulimic behavior. After 10–12 years of living in social retraction, not working, without social contacts, she „decided to start from the beginning” after being on intensive vitamine therapy, and asked for the psychiatric therapy for the first time in her life, with motivation for working. In conclusion, in this study we are going to present a critical view of both diagnosis traying to understand similarity and differences, as well as identify common points between them and make guidelines for practical approach to the question.

Role of childhood traumatic experience in personality disorders in China

BackgroundThere has been no large-scale examination of the association between types of childhood abuse and personality disorders (PDs) in China using standardized assessment tools and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Hence, this study aimed to explore the relationship between retrospective reports of various types of childhood maltreatments and current DSM-IV PDs in a clinical population in China, Shanghai. MethodOne thousand four hundred two subjects were randomly sampled from the Shanghai Psychological Counselling Centre. PDs were assessed using the Personality Diagnostic Questionnaire, Fourth Edition Plus. Participants were also interviewed using the Structured Clinical Interview for DSM-IV axis II. The Child Trauma Questionnaire (CTQ) was used to assess childhood maltreatment in 5 domains (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect). ResultsAccording to Pearson correlations, childhood maltreatment had a strong association with most PDs. Subsequently, using partial correlations, significant relationships were also demonstrated between cluster B PDs and all the traumatic factors except physical neglect. A strongest positive correlation was found between cluster B PD and CTQ total scores (r = .312, P < .01). Using the Kruskal-Wallis rank sum test, significant differences in 4 groups of subjects (clusters A, B, and C PD and non-PD) in terms of emotional abuse (χ2 = 34.864, P < .01), physical abuse (χ2 = 14.996, P < .05), sex abuse (χ2 = 9.211, P < .05), and emotional neglect (χ2 = 17.987, P < .01) were found. Stepwise regression analysis indicated that emotional abuse and emotional neglect were predictive for clusters A and B PD, and sexual abuse was highly predictive for cluster B PD; only emotional neglect was predictive for cluster C PD. ConclusionEarly traumatic experiences are strongly related to the development of PDs. The effects of childhood maltreatment in the 3 clusters of PDs are different. Childhood trauma has the most significant impact on cluster B PD.

Comorbid personality traits in schizophrenia: Prevalence and clinical characteristics

Accumulating evidence suggests high rates of personality disorder (PD) in schizophrenia (Sz), and as such, the implications of PD in this context are beginning to be studied more thoroughly. We examined clinical, cognitive and experiential (i.e., reported childhood adversity) correlates of aberrant personality traits in schizophrenia and healthy controls (HC) as measured by the International Personality Disorder Examination Questionnaire (IPDEQ). Participants were 549 individuals with schizophrenia or schizoaffective disorder, and 572 healthy adults recruited to the Australian Schizophrenia Research Bank (ASRB). Schizophrenia participants were significantly more likely than healthy controls to screen positive for personality disorder across all ICD-10 subtypes, and there was substantial overlap between clusters, with ∼33% of Sz participants screening positive for all 3 personality disorder clusters. Among both Sz and HC groups, cluster B personality characteristics were significantly associated with increased suicidal behaviours, lower cognitive performance, and the experience of childhood adversity. In addition, Cluster C personality features were associated with higher overall ratings of affective blunting in schizophrenia, and Cluster A personality features were associated with childhood ‘loss’ in HC participants only. The cumulative effects of screening positive for more than one personality disorder in Sz was associated with higher likelihood of suicidal behaviour, earlier age of onset of Sz, and poorer cognitive functioning. The results suggest that abnormal co-occurrence of personality traits across DSM-IV clusters is evident in a significant proportion of individuals with schizophrenia, and that these personality features impact significantly on clinical and cognitive characteristics of Sz.

Recurrence of MDD: A prospective study of personality pathology and cognitive distortions.

Major depressive disorder (MDD) is characterized by a high risk of recurrence, especially among individuals whose initial episode occurs during adolescence. Identifying predictors of recurrence of MDD among young samples is therefore of paramount clinical importance. Survival analytic models were used to evaluate the effects of dysfunctional cognitions and Axis II personality pathology on MDD recurrence in a sample of 130 previously, but not currently, depressed young adults. Participants were initially assessed for depression, dysfunctional attitudes, and personality pathology during their first semester in college and then reevaluated via the Longitudinal Interval Follow-up Evaluation interview every 6 months for 18 months. Baseline level of depressive symptoms significantly (HR-1.07, p = .002) predicted recurrence of MDD. In the survival analyses with baseline level of depression serving as a current mood state covariate, overall personality pathology (HR-1.04, p < .05), but not cognitive distortions, uniquely predicted MDD recurrence. In similar analyses, none of the specific DSM-IV personality disorder cluster scores uniquely predicted recurrence. We discussed the theoretical, empirical, and clinical implications of these findings, and we noted the limitations of the study.

Childhood adversity and personality disorders: Results from a nationally representative population-based study

BackgroundAlthough, a large population-based literature exists on the relationship between childhood adversity and Axis I mental disorders, research on the link between childhood adversity and Axis II personality disorders (PDs) relies mainly on clinical samples. The purpose of the current study was to examine the relationship between a range of childhood adversities and PDs in a nationally representative sample while adjusting for Axis I mental disorders. MethodsData were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n=34,653; data collection 2004–2005); a nationally representative sample of the United States population aged 20 years and older. ResultsThe results indicated that many types of childhood adversity were highly prevalent among individuals with PDs in the general population and childhood adversity was most consistently associated with schizotypal, antisocial, borderline, and narcissistic PDs. The most robust childhood adversity findings were for child abuse and neglect with cluster A and cluster B PDs after adjusting for all other types of childhood adversity, mood disorders, anxiety disorders, substance use disorders, other PD clusters, and sociodemographic variables (Odd Ratios ranging from 1.22 to 1.63). In these models, mood disorders, anxiety disorders, and substance use disorders also remained significantly associated with PD clusters (Odds Ratios ranging from 1.26 to 2.38). ConclusionsFurther research is necessary to understand whether such exposure has a causal role in the association with PDs. In addition to preventing child maltreatment, it is important to determine ways to prevent impairment among those exposed to adversity, as this may reduce the development of PDs.

PCL-R Psychopathy and its Relation to DSM Axis I and II Disoders in a Sample of Male Forensic Patients in a Belgian Security Hospital

The purpose of this study was to examine the relationship between the psychopathy, assessed using the PCL-R, and DSM Axis I and II disorders in a Belgian adult male forensic patients (N= 84). Regarding Axis I disorders, diagnoses of psychopathy were associated only with diagnoses of substance abuse/dependence. Regarding Axis II disorder, psychopathy diagnoses were associated with antisocial personality disorder. This relationship was asymmetrical, as psychopathy was highly predictive of antisocial personality disorder but not vice versa. Furthermore, there was a significant positive association between antisocial personality disorder and PCL-R total scores, Factor 1 and 2 scores, and Facet 1, 3, and 4 scores. There was also a significant positive correlation between narcissistic personality disorder and PCL-R Factor 1 and Facet 1 scores. These findings are congruent with the international research literature and have potential therapeutic relevance, as Cluster B disorders including antisocial personality disorders are associated with low treatment motivation and compliance (Widiger & Corbitt, 1997; Robins, Tipp, & Przybeck, 1991). Overall, diagnoses of psychopathy were rather specific and unrelated to most major mental disorders (psychoses, mood or anxiety disorders) and personality disorders (Clusters A and C).

P.6.d.021 Cannabinoid CB2 receptor antagonist prevents cannabidiol-induced decrease in body weight gains in rats

The influence of psychopathology on suicide method has revealed different distributions among different psychiatric disorders. However, evidence is still scarce. We hypothesized that having a diagnosis of personality disorder (PD) affect the suicide method, and that different PD clusters would influence the suicide method in different ways. In addition, we hypothesized that the presence of psychiatric and somatic co-morbidity also affects the suicide method.We examined 25,217 individuals aged 15–64 who had been hospitalized in Sweden with a main diagnosis of PD the years 1987–2013 (N = 25,217). The patients were followed from the date of first discharge until death or until the end of the follow-up period, i.e. December 31, 2013, for a total of 323,508.8 person-years, with a mean follow up time of 11.7 years. The SMR, i.e. the ratio between the observed number of suicides and the expected number of suicides, was used as a measure of risk.Overall PD, different PD-clusters, and comorbidity influenced the suicide method. Hanging evidenced highest SMR in female PD patients (SMR 34.2 (95% CI: 29.3–39.8)), as compared to non-PD patients and jumping among male PD patients (SMR 24.8 (95% CI: 18.3–33.6)), as compared to non PD-patients. Furthermore, the elevated suicide risk was related to both psychiatric and somatic comorbidity.The increased suicide risk was unevenly distributed with respect to suicide method and type of PD. However, these differences were only moderate and greatly overshadowed by the overall excess suicide risk in having PD. Any attempt from society to decrease the suicide rate in persons with PD must take these characteristics into account.

Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

Clinical experience suggests that individuals with borderline personality disorder commonly report being in psychotherapy and taking standing psychotropic medications over substantial periods of time. Clinical experience also suggests that patients with borderline personality disorder are frequently rehospitalized. However, only two longitudinal studies have prospectively examined the long-term course of the psychiatric treatment received by these patients. In the first of these studies [1], treatment utilization of patients with borderline personality disorder and axis II comparison participants was studied over six years of prospective follow-up in the McLean Study of Adult Development (MSAD). It was found that prevalence rates of individual therapy, standing medications, and psychiatric hospitalizations declined significantly for those in both study groups but remained significantly higher among patients with borderline personality disorder than axis II comparison participants. Perhaps most striking was the finding that 70% of patients with borderline personality disorder participated in individual therapy and 70% took standing medications in all three follow-up periods. In the second longitudinal study (the Collaborative Longitudinal Personality Disorders Study or CLPS), the treatment use of patients with borderline personality disorder was compared to that of patients with major depressive disorder and no personality disorder over the course of three years [2]. It was found that patients with borderline personality disorder were significantly more likely to be in individual therapy, have had a medication consultation, and been hospitalized for psychiatric reasons than those with major depressive disorder. The current study, which is an extension of the MSAD study mentioned above, has two purposes. The first is to describe the prevalence of three key treatment modalities reported by a large and well-defined sample of patients with borderline personality disorder and axis II comparison participants over 10 years of prospective follow-up. The second purpose is to detail time-to-cessation and time-to-resumption of these three forms of treatment by patients with borderline personality disorder.

Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

The study determined the prevalence of use of three treatment modalities (individual therapy, medication, and hospitalization) reported over a ten-year period by patients with borderline personality disorder and by those in a comparison group with other axis II disorders. Time to cessation and time to resumption for each modality among patients with borderline personality disorder were also determined. Treatment history of inpatients with a reliable diagnosis of borderline personality disorder (N=290) and of other axis II disorders (N=72) was assessed with an interview of proven reliability during the index admission. Treatment history was reassessed at two-year intervals for ten years. For all three treatment modalities, prevalence of use declined significantly among patients with borderline personality disorder and among those in the comparison group. Among patients with borderline personality disorder, 52% reported having stopped individual therapy and 44% reported having stopped medication at one or more of the follow-up interviews over ten years. However, 85% of those who had stopped psychotherapy and 67% of those who stopped taking medication resumed these treatments during a subsequent two-year period. In contrast, 88% had experienced at least one two-year period without a psychiatric hospitalization by the time of the ten-year follow-up; however, almost half of these patients were subsequently rehospitalized. The results suggest that patients with borderline personality disorder tend to use outpatient treatments without interruption over prolonged periods. They also suggest that inpatient treatment is used far more intermittently by patients with borderline personality disorder.

The correlation and difference of childhood traumatic experiences in personality disorders

Objective To explore the relationship between childhood traumatic experiences and personali-ty disorders. Methods 1511 clients were sampled randomly from Shanghai Psychological Counseling Center. Per-sonality Diagnostic Questionnaire (PDQ+4) was administered to 1402 clients to screen personality disorders. Childhood Trauma Questionnaire(CTQ) and Blind semi-structure interviews using Structured Clinical Interview for DSM-Ⅳ Axis Ⅱ (SCID-Ⅱ) were conducted to screened subjects whose PDQ + 4 test was defined as positive. Re-suits Correlation analysis revealed that the total score of CTQ had a strong association with all the of personality disorders. Using partial correlations,the significant relationships between Cluster-B personality disorders and all the CTQ factors except physical neglect were demonstrated. Emotional abuse positively correlate with Ciuster-A per-sonality disorders(r=0.139, P<0.001 ), Cluster-C could be related to none of the early life experiences. Using Kruskal Wallis test,all the groups of subjects had significantly difference in emotional abuse,physical abuse,sexual abuse,physical neglect(P<0.01). Stepwise regression analysis showed that emotional abuse,emotional neglect en-tered the regression equation of Cluster-A and Cluster-B of personality disorders,standardized regression coefficient was 0.135 and 0.119(Cluster-A) ,0. 200 and 0. 084(Cluster-B) ,emotional neglect entered the regression equa-tion of Cluster-C of personality disorders, standardized regression coefficient was 0.077 and 0.141 (Cluster-C). Conclusion Childhood traumatic experiences might contribute to individuals susceptibility to personality disor-ders. The effect of the Cluster-B personality disorders are the most obviously. Childhood traumatic experiences in 3 clusters of personality disorders are different. Key words: Personality disorders; Childhood traumatic experiences; Client; Abuse; Neglect

Personality Disorders and Older Adults

As an academic geriatric psychiatrist and a former training director of a geriatric psychiatry fellowship program, I am always on the lookout for books that can give a comprehensive review of topics in geriatric psychiatry for trainees to read. Over the years, I have reviewed multiple books and articles on personality disorders in the elderly, but was never impressed by what I saw or read. It was fortunate that I got a chance to review this wonderful book by Drs. Segal, Coolidge, and Rosowsky. In my opinion, Personality Disorders and Older Adults: Diagnosis, Assessment, and Treatment is a must-read for anyone who is caring for elderly patients. It is also a must-have for any medical library, as the contents of this book will be useful to any clinician interested in dealing with difficult elderly patients. The charm of the book lies in the fact that it is beautifully written in a simple style that catches one's attention immediately. It has enough material to not only provide basic information to satisfy the curiosity of a lay person but to also cater to the needs of a senior professional dealing with the care of the elderly. This book is very easy to read because it is well organized into different chapters starting with an introduction to personality disorder and aging (chapter 1) and ending with the chapter on the “Goodness of Fit” model and its implication for treatment (chapter 11). The book provides a comprehensive review of each cluster of personality disorders and addresses the issues of comorbidity, epidemiology, diagnosis, and treatment of the elderly with personality disorder. Case vignettes highlighting each of the clusters of personality disorders make the narrative more interesting. The authors have also done an excellent job of providing a comprehensive framework for conceptualizing personality disorders combining the psychodynamic, cognitive, and biological realms. It is a tribute to the authority of Drs. Segal, Coolidge, and Rosowsky on the concept of personality disorders in older adults that they have been able to provide such a comprehensive narrative on this difficult to understand and treat condition. Elegantly designed in hardcover and priced appropriately at $60.00, Personality Disorders and Older Adults: Diagnosis, Assessment, and Treatment is a wonderful addition to the growing world of literature on psychiatric issues in the elderly. Rajesh R. Tampi, M.D., M.S. Yale University School of Medicine, New Haven, Connecticut

Childhood maltreatment and adult personality disorder symptoms: Influence of maltreatment type

The present study examines the effects of different types of childhood maltreatment on personality disorder symptoms in a sample of adults with no Axis I psychopathology. Participants reporting a history of moderate to severe maltreatment on the Childhood Trauma Questionnaire ( n = 70) were grouped by type of abuse and compared with a non-abused group ( n = 35) with regard to the number of personality disorder symptoms endorsed. Physical/sexual abuse and emotional abuse/neglect each were associated with elevated symptoms of all three personality disorder clusters. Elevated symptoms of several specific personality disorders were also seen, including paranoid, borderline, avoidant, dependent, obsessive–compulsive, and depressive personality disorder. There were no significant differences between the maltreatment groups. These findings indicate that emotional abuse/neglect and physical/sexual abuse are risk factors for a broad array of personality outcomes in a non-clinical sample.

A comparison of personality disorder characteristics of patients with nonepileptic psychogenic pseudoseizures with those of patients with epilepsy

We sought to determine the type of personality disorder cluster associated with patients with nonepileptic psychogenic seizures (NES) compared with that of patients with epileptic seizures (ES). Consecutive adult patients admitted for video/EEG monitoring found to have NES were compared with a simultaneously admitted patient with confirmed epilepsy. Personality was assessed using the Structured Clinical Interview for DSM-IV-TR Axis II Personality Disorders. Personality disorders were then divided into personality clusters described in the DSM-IV-TR: A = paranoid, schizotypal, schizoid; B = borderline, histrionic, antisocial, narcissistic; or C = avoidant, dependent, obsessive-compulsive. Thirteen of 16 patients with NES and 12 of 16 patients with ES met criteria for personality disorders. Patients with NES were more likely to meet criteria for a personality disorder in Cluster A or B, compared with patients with ES, who were more likely to have Cluster C personality disorders (chi(2) test, P=0.007). We propose that the personality traits of patients with NES contribute to the development of nonepileptic psychogenic seizures. However, the large proportion of patients with ES with Cluster C personality disorders was unexpected, and further, for the patients with epilepsy, the direction of the association of their personality traits with the development of epilepsy is unknown.

A functional dopamine-β-hydroxylase gene promoter polymorphism is associated with impulsive personality styles, but not with affective disorders

Dopamine-beta-hydroxylase (DbetaH) catalyzes the conversion of dopamine to norepinephrine in central noradrenergic and adrenergic neurons and thus is critically involved in the biosynthesis of catecholamines. There are equivocal findings concerning the question whether or not DssH activity levels are altered in affective disorders or in subtypes of affective disorders. Moreover, information about the role of dopamine beta-hydroxylase (DBH) genotype, which explains a large part of the variance of enzymatic activity, in affective disorders and personality dimensions is limited. To resolve these inconsistencies, association tests were performed using four independent samples, healthy volunteers (N = 387), patients with affective disorders (N = 182), adult attention deficit hyperactivity disorder (ADHD) patients (N = 407), and patients with personality disorders (N = 637). In the latter two samples, the revised NEO personality inventory (NEO-PI-R) was administered. All participants were genotyped for a putatively functional single nucleotide polymorphism (C-1021T, rs1611115). No differences in DBH C-1021T genotype distribution were observed between patients with affective disorders and healthy control subjects. Also when the patient sample was divided into uni- and bipolar patients versus controls, no significant differences emerged. Furthermore, no clear-cut association was detected between the TT genotype and personality disorder clusters while there was a significant association with adult ADHD. However, personality disorder patients carrying the DBH TT genotype exhibited higher neuroticism and novelty seeking scores as compared to individuals with the CC or CT genotype. Analyses on the level of the neuroticism and novelty seeking subscales revealed that the DBH TT genotype was primarily associated with personality features related to impulsiveness and aggressive hostility. Also adult ADHD patients carrying the homozygous TT genotypes displayed by significantly increased neuroticism scores; when both personality disorder and adult ADHD patient were analyzed together, TT carriers also displayed by significantly lower conscientiousness levels. Our results thus do not implicate the DBH C-1021T polymorphism in the pathophysiology of depressive disorders or personality disorders, yet homozygosity at this locus appears to increase the risk towards personality traits related to impulsiveness, aggression and related disease states, namely adult ADHD. These data argue for a dimensional rather than categorical effect of genetic variance in DBH activity; accordingly, the inconsistency of previous findings concerning DbetaH levels in affective disorders might be caused by the underlying association of the TT genotype at DBH-1021 with impulsive personality traits.

DSM-IV Personality Disorders and Their Axis I Correlates in the South African Population

Background: The prevalence of personality disorders (PD) in the South African population is largely unknown. Thus, we undertook to estimate prevalence, demographic correlates, co-morbidity and treatment rates of DSM-IV PD among South Africans. Sampling and Methods: A three-stage probability sample design was used. Of the 4,433 interviews obtained, based on quality control criteria, 4,315 interviews were retained for analysis. All participants were screened for PD and axis I disorders with the World Health Organisation Composite International Diagnostic Interview. The multiple imputation method was then used to estimate prevalence. Results: The multiple imputation prevalence estimate in the total sample was 6.8%. All three PD clusters were significantly co-morbid with each other and with other axis I disorders. Male gender was the only significant predictor of PD. Of note was the finding that less than one fifth of participants with a possible PD diagnosis had received treatment for a mental health or substance abuse problem in the previous 12 months. Conclusion: The high co-morbidity of PD with axis I disorders in South Africa is consistent with previous reports elsewhere. However, more research is indicated to determine the reasons for the higher prevalence of cluster A disorders than of cluster B and C disorders in this population.

DSM-IV personality disorders in Mexico: results from a general population survey

OBJECTIVE: This paper reports the first population estimates of prevalence and correlates of personality disorders in the Mexican population. METHOD: Personality disorders screening questions from the International Personality Disorder Examination were administered to a representative sample of the Mexican urban adult population (n = 2,362) as part of the Mexican National Comorbidity Survey, validated with clinical evaluations conducted in the United States. A multiple imputation method was then implemented to estimate prevalence and correlates of personality disorder in the Mexican sample. RESULTS: Multiple imputation method prevalence estimates were 4.6% Cluster A, 1.6% Cluster B, 2.4% Cluster C, and 6.1% any personality disorder. All personality disorders clusters were significantly comorbid with DSM-IV Axis I disorders. One in every five persons with an Axis I disorder in Mexico is likely to have a comorbid personality disorder, and almost half of those with a personality disorder are likely to have an Axis I disorder. CONCLUSIONS: Modest associations of personality disorders with impairment and strong associations with treatment utilization were largely accounted for by Axis I comorbidity suggesting that the public health significance of personality disorders lies in their comorbidity with, and perhaps effects upon, Axis I disorders rather than their direct effects on functioning and help seeking.

Social Functioning of Patients With Personality Disorder in Secondary Care

Social Functioning of Patients With Personality Disorder in Secondary Care

Personality disorders and perceived stress in major depressive disorder

The investigation of comorbidity between major depressive disorder (MDD) and personality disorders (PDs) has attracted considerable interest. Whereas some studies found that the presence of PDs has adverse effects on the course and treatment of MDD, others have failed to demonstrate this link. These inconsistent findings suggest that specific PD comorbidity might affect the course of MDD by modulating factors that increase the overall risk of depression, including an elevated tendency to perceive stress. To investigate whether the presence of a specific PD cluster was associated with elevated levels of stress appraisal, we administered the Perceived Stress Scale (PSS) before and after treatment to 227 MDD outpatients enrolled in an 8-week open-label treatment with fluoxetine. Following treatment, multiple linear regression analyses revealed that the presence of Cluster A, but not Cluster B or C, was associated with higher levels of perceived stress, even after adjusting for baseline depression severity and PSS scores, as well as various sociodemographic variables. The presence of Cluster A PD comorbidity was uniquely associated with elevated stress appraisal after antidepressant treatment, raising the possibility that stress exacerbation might be an important factor linked to poor treatment outcome in MDD subjects with Cluster A pathology.

Trait Correlates of Relational Aggression in a Nonclinical Sample: DSM-IV Personality Disorders and Psychopathy

The implications of adult relational aggression in adults for personality pathology are poorly understood. We investigated the association between relational aggression and features of DSM-IV personality disorders and psychopathy in a sample of undergraduates (N = 220). In contrast to the childhood literature, we found no significant difference in relational aggression between men and women. Unlike overt aggression, which correlated about equally highly with features of all three personality disorder clusters, relational aggression correlated significantly more highly with features of Cluster B than Clusters A or C. In addition, even after controlling for overt aggression, relational aggression correlated significantly with features of psychopathy, although only with Factor 2 traits. With the exception of sadistic personality disorder features, gender did not moderate the relationship between relational aggression and personality pathology. Further research on the psycho-pathological implications of relational aggression in more severely affected samples is warranted.

A pilot personality disorder outreach service: development, findings and lessons learnt

Aims and MethodWe describe the development of a pilot personality disorder outreach service. A case series of 13 patients was studied. Data were collected using pro forma, semi-structured interviews and a structured assessment of personality disorder.ResultsAll personality disorder clusters were represented among the 13 patients. Treatment recommendations usually supported the existing approach – the ‘added value’ of the outreach service was that difficult interpersonal dynamics could be considered and thought through with an objective observer. Opinions differed on whether the service was more useful for the assessment and brief treatment or continuing care teams.Clinical ImplicationsPersonality disorder services need to develop expertise in all clusters. There is a need to moderate the harsh self-critical attitudes of the care coordinators. The national framework for personality disorder is useful for service development, but the services need to be tailored to the individual needs of specific teams.