Personality Disorder Group Research Articles

Personality disorders in offenders with intellectual disability: a comparison of clinical, forensic and outcome variables and implications for service provision

To establish any differences between patients with and without a diagnosis of personality disorders, being treated in a secure inpatient service for offenders with intellectual disability (ID) in the UK. A cohort study involving a selected population of people with ID and offending behaviours. Results The study included a total of 138 patients, treated over a 6 year period - 77 with a dissocial or emotionally unstable personality disorder and 61 without. Women were more likely to be in the personality disorder group. Both groups had high prevalence of abuse with no significant differences. Depressive disorders and substance abuse were more common in the personality disorder group, while epilepsy and autistic spectrum disorders were more common in the non-personality disorder group. Rather than differences, what was more striking was the rate and range of these comorbidities across both groups. Although past histories of violence and institutional aggression were no different, compulsory detention under criminal sections and restriction orders were more common in the personality disorder group. There were no differences in treatment outcomes. Although about half of patients detained in secure units for offenders with ID have a personality disorder, there were more similarities than differences between this group and the rest. While good treatment outcomes supported the case for specialised secure treatment units for people with ID, the case for establishing a more specialised ID-personality disorder unit was less convincing. There is also a need to explore whether there are alternative diagnostic models that can delineate better the group with personality difficulties in this population.

Cluster 'A' in personality disorders category - development and perspective

Background With the development of psychiatric science the group of Personality Disorders becomes clearly defined and within the various existing classifications a well-defined group stands out, characterized mainly by the cold affect and by the lack of empathy. The historical overview of the Paranoid and the Schizoid Personality Disorders reveals extremely high historical (temporal) stability of their diagnostic criteria. This stability and endurance of the Cluster A raises the question of its’ potential freedom from historical and/or cultural contextual effects.

Complex personality disorder in bulimia nervosa

Objective Recent research has suggested a move toward a dimensional system for the classification of personality disorders (PDs). Tyrer's dimensional model using severity as a form of categorizing PDs was used to compare eating disorder outcome in women with bulimia nervosa (BN) over 3 years. Method One hundred thirty-four women with BN were divided into 4 groups based on PD severity: no PD (n = 32), personality difficulty (n = 27), simple PD (n = 29), and complex PD (n = 46). Eating disorder symptoms and attitudes, general psychosocial functioning, and depressive symptoms were examined at pretreatment and at 1-year and 3-year follow-up (posttreatment). Results The complex PD group had greater Axis I comorbidity and psychopathology than the remaining 3 groups at pretreatment. At 1-year and 3-year follow-up, there were no differences in eating disorder outcome, general psychosocial functioning, and depressive symptoms across the 4 groups. Conclusion These results suggest that having an increased number of PDs comorbid with BN does not influence eating disorder outcome up to 3 years after treatment.

The integrity of corpus callosum and cluster B personality disorders: A quantitative MRI study in juvenile myoclonic epilepsy

Evidence suggests increased prevalence of cluster B personality disorders (PD) among patients with juvenile myoclonic epilepsy (JME), which has been associated with worse seizure control and more psychosocial dysfunctions. A preliminary voxel-based morphometry study demonstrated corpus callosum (CC) volume reduction in patients with JME and cluster B PD, particularly in the posterior midbody and isthmus. In this study we aimed to follow up these results with region of interest analysis. Sixteen JME patients with cluster B PD, 38 JME patients without any psychiatric disorder, and 30 demographically matched healthy controls submitted to a psychiatric evaluation and a magnetic resonance imaging scan. The total and regional callosal areas were obtained from the midsagittal slice using a semi-automated program. Psychiatric evaluation was performed through SCID-I and -II. Significant reductions in the posterior region of the CC were observed in the JME with PD group relative to the other groups. These data support previous findings of callosal reductions in cluster B PD, as well as a possible involvement of CC in patients with JME and such personality characteristics.

Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

To determine the prevalence of concurrent personality disorders (PDs) among alcoholic men and women seeking outpatient treatment, and to examine their effect on the course of alcohol treatment. Patients with alcohol use disorders (n = 165) were assessed by clinical and semi-structured interviews, as well as self-report scales, to measure levels of psychological distress, impulsivity, social functioning, and addiction severity at treatment intake. PD diagnoses were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorder (SCID-II). Course in treatment was monitored prospectively for 12 weeks. Using the results of the SCID-II (n = 138), the sample was divided into 3 groups-that is, no PD 41% (n = 57), Cluster B PD 32% (n = 44), and other PD 27% (n = 37). The 3 groups did not differ in their alcohol use severity at intake. However, the Cluster B PD group achieved alcohol milestones at a younger age. Subjects with a PD had more severe psychological and social problems at intake. The Cluster B PD group showed significantly higher levels of impulsivity at intake, greater likelihood of early treatment dropout, and quicker times to first slip and to relapse. This study supports the high prevalence of concurrent PDs, particularly Cluster B PDs, among treatment-seeking alcoholics. The relation between observed high levels of impulsivity and worse course in early alcohol treatment among people with a Cluster B PD merits further investigation.

P02-144 - Subjective well-being under neuroleptics (SWN): a predictor of clinical and psychosocial outcome in acute patients. preliminary data

ObjectivesTo evaluate the subjective well-being of a group of patients who were hospitalized at the Institute of Psychiatry (Novara), compared to the severity of illness.MethodsPatients are evaluated at admission and discharge through self-administration of the SWN (Subjective Well-being under Neuroleptics) scale, which contains five subscales (emotional regulation; self-control; mental functioning; social integration and physical functioning) assessing patients’ psychophysical and emotional well-being, calculating a value for each subscale and a total score. The clinician fills in the CGI (Clinical Global Impression) for each patient, which provides a global judgement in three areas: severity of illness, global improvement and therapeutic effectiveness.ResultsFrom June 2009, 51 patients were evaluated at admission and discharge: 26 diagnosed with psychosis and 25 diagnosed with personality disorders. Preliminary data suggest a meaningful improvement of the physical functioning in the psychotic group, a tendency to improvement of the social integration area in the personality disorders group. Among the psychotic group, the schizophrenic patients (n°=14) have shown an improvement in the self-control subscale.ConclusionsLiterature suggests that a high SWN score is associated with a better compliance and an early improvement of subjective well-being is a major predictor of the chance of remission. This study will allow to compare the subjective well-being evaluated by SWN with the clinical judgment of the CGI and above all if this can represent a predictor index for the compliance and the chance of remission.

Indices of orbitofrontal and prefrontal function in Cluster B and Cluster C personality disorders

Neuropsychological studies implicate disruption of frontal systems in personality disorders. Few studies have examined the performance of Cluster B and Cluster C personality disorder patients on tests of orbitofrontal (OFC) and prefrontal (PFC) cortex function. Patients carrying diagnoses of either Cluster B ( n = 56) or Cluster C ( n = 19) personality disorders were compared with healthy control subjects ( n = 61) on the Iowa Gambling Task and University of Pennsylvania Smell Identification Test. They also completed the Wechsler Abbreviated Scale of Intelligence as a control for general intellectual ability. On the gambling task, Cluster B and Cluster C patients made more disadvantageous decisions during certain portions of the task but overall did not differ from healthy controls. Whereas no appreciable differences in olfactory identification performances were detected between patient and healthy control groups, IQ was higher for controls and was related to Cluster B patients' lower educational levels. Overall, there was limited evidence for neurocognitive inefficiency for personality disorder groups on tests sensitive to OFC and PFC function. The present study is among the first to report neurocognitive findings for the full range of Cluster B personality disorders and any Cluster C personality disorder.

Changes in personality in pre- and post-dialectical behaviour therapy borderline personality disorder groups: A question of self-control

Dialectical behaviour therapy (DBT) is an evidence-based therapy for people with borderline personality disorder (BPD). Past research has identified behavioural changes indicating improved functioning for people who undergo DBT. To date, however, there has been little research investigating the underlying mechanism of change. The present study utilised a between-subjects design and self-report questionnaires of Self-Control and the five factor model of personality and drew participants from a metropolitan DBT program. We found that pre-treatment participants were significantly lower on Self-Control, Agreeableness and Conscientiousness when compared to both the post-treatment assessment and the norms for each questionnaire. Neuroticism was significantly higher both before and after treatment when compared to the norms. These findings suggest that Self-Control may play a role in both the presentation of this disorder and the effect of DBT. High levels of Neuroticism lend weight to the Linehan biosocial model of BPD development.

The stability of personality traits in individuals with borderline personality disorder.

Although stability and pervasive inflexibility are general criteria for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994) personality disorders (PDs), borderline PD (BPD) is characterized by instability in several domains, including interpersonal behavior, affect, and identity. The authors hypothesized that such inconsistencies notable in BPD may relate to instability at the level of the basic personality traits that are associated with this disorder. Five types of personality trait stability across 4 assessments over 6 years were compared for BPD patients (N = 130 at first interval) and patients with other PDs (N = 302). Structural stability did not differ across groups. Differential stability tended to be lower for 5-factor model (FFM) traits in the BPD group, with the strongest and most consistent effects observed for Neuroticism and Conscientiousness. Growth curve models suggested that these 2 traits also showed greater mean-level change, with Neuroticism declining faster and Conscientiousness increasing faster, in the BPD group. The BPD group was further characterized by greater individual-level instability for Neuroticism and Conscientiousness in these models. Finally, the BPD group was less stable in terms of the ipsative configuration of FFM facet-level profiles than was the other PD group over time. Results point to the importance of personality trait instability in characterizing BPD.

Co morbilidad de trastornos de personalidad en personas sin hogar

En este estudio se lleva a cabo una investigación sobre co morbilidad en los trastornos de personalidad en personas sin hogar. El objetivo del estudio era analizar si existe co morbilidad entre trastornos. Para ello, se lleva a abo un estudio ex post facto, de carácter transversal, con una muestra de 91 pacientes, que cumplimentaron una entrevista semiestructurada y el MCMI II, en el transcurso de su tratamiento. Los resultados muestran como en un 40,66% de la muestra, coexisten 2 o más trastornos de personalidad a un tiempo, con una media de 2,06 TP por persona. Además, los trastornos de personalidad del grupo B; antisocial, límite, histriónico y narcisista, son los que unmayor índice de co morbilidad presentan. Por el contrario, trastornos de personalidad del grupo C: obsesivo-compulsivo, por evitación o por dependencia, a pesar de tener mayor presencia, apenas presentan co morbilidad con otros. Por último, se comenta la implicación que tiene este estudio en la práctica clínica y líneas futuras de investigación.

A comparison of the family and childhood backgrounds of hospitalised offenders with schizophrenia or personality disorder

Previous studies have demonstrated high levels of childhood adversity and familial criminality in offender patients with schizophrenia and/or personality disorder, but few have directly compared these groups. To compare the parenting histories of offender patients with schizophrenia with those with personality disorder. We hypothesised that rates of family criminality and experiences of disrupted parenting would be higher in the personality disorder group than the schizophrenia group. A retrospective case-control methodology compared the family background and childhood experiences of patients with either schizophrenia or personality disorder (n = 3088) admitted to any of the English high-security hospitals. Compared with those with schizophrenia, patients with personality disorder had experienced higher rates of family criminality, parental separation, and multiple changes of caregiver and institutional care. There was no significant difference in the prevalence of family psychiatric history between the groups. Although our hypotheses were sustained, we were impressed that rates of disruption to parenting were high in the schizophrenia group as well as in the personality disorder group. Less than a third of the personality disorder group had survived childhood without a change in parenting, but this was true for about half of the schizophrenia group, too. Family work tailored for people with schizophrenia is needed, even though within personality disorder services, a greater demand for disorder-sensitive family work is likely to be encountered.

Are personality traits of juvenile myoclonic epilepsy related to frontal lobe dysfunctions? A proton MRS study

Personality traits characterized by emotional instability and immaturity, unsteadiness, lack of discipline, hedonism, frequent and rapid mood changes, and indifference toward one's disease have been associated with patients who have juvenile myoclonic epilepsy (JME). Literature data demonstrate worse seizure control and more psychosocial dysfunctions among patients with JME who have those traits. In this controlled study we performed a correlation analysis of psychiatric scores with magnetic resonance spectroscopy (MRS) values across JME patients, aiming to verify the existence of a possible relation between frontal lobe dysfunction and the prevalence of personality disorders (PDs) in JME. Sixteen JME patients with cluster B PDs, 41 JME patients without any psychiatric disorder, and 30 healthy controls were submitted to a psychiatric evaluation and to a quantitative multivoxel MRS of thalamus; insula; cingulate gyrus; striatum; and frontal, parietal, and occipital lobes. Groups were homogeneous according to age, gender, and manual dominance. Psychiatric evaluation was performed through the Scheduled Clinical Interview for DSM-IV, Axis I and II (SCID I and II, respectively). A significant reduction of N-acetyl-aspartate over creatinine (NAA/Cr) ratio was observed mainly in the left frontal lobe in the JME and PD group. In addition, a significant increase in the glutamate-glutamine over creatinine GLX/Cr ratio was also observed in this referred region in the same group. These data support the hypothesis that PDs in JME could represent neuronal dysfunction and possibly a more severe form of this epileptic syndrome.

Validity of the Prodromal Risk Syndrome for First Psychosis: Findings From the North American Prodrome Longitudinal Study

Treatment and prevention studies over the past decade have enrolled patients believed to be at risk for future psychosis. These patients were considered at risk for psychosis by virtue of meeting research criteria derived from retrospective accounts of the psychosis prodrome. This study evaluated the diagnostic validity of the prospective "prodromal risk syndrome" construct. Patients assessed by the Structured Interview for Prodromal Syndromes as meeting criteria of prodromal syndromes (n = 377) from the North American Prodrome Longitudinal Study were compared with normal comparison (NC, n = 196), help-seeking comparison (HSC, n = 198), familial high-risk (FHR, n = 40), and schizotypal personality disorder (SPD, n = 49) groups. Comparisons were made on variables from cross-sectional demographic, symptom, functional, comorbid diagnostic, and family history domains of assessment as well as on follow-up outcome. Prodromal risk syndrome patients as a group were robustly distinguished from NC subjects across all domains and distinguished from HSC subjects and from FHR subjects on most measures in many of these domains. Adolescent and young adult SPD patients, while distinct from prodromal patients on definitional grounds, were similar to prodromals on multiple measures, consistent with SPD in young patients possibly being an independent risk syndrome for psychosis. The strong evidence of diagnostic validity for the prodromal risk syndrome for first psychosis raises the question of its evaluation for inclusion in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).

Learning Disabilities and Serious Crime – Sex Offences

This review paper follows on from two previous reviews of the literature with regard to, firstly, learning disability and murder and, secondly, learning disability and arson. This paper, in turn, examines the relationship, if any, between learning disability and sexual offence. The approach taken in all these papers involves the concept of Disruptive Behaviour Disorder as being the group of behaviour and personality disorders most involved in the aetiology of these criminal and anti-social behaviours. Disruptive behaviour disorders (Read 2007) comprise: Oppositional Defiant Disorder Conduct Disorder Anti-social Personality Disorder Intermittent Explosive Disorder (DSM IVR 2001) The common characteristics of these disorders comprise aggression, irritability, over-activity, high arousal, and repetitive behaviour.

P03-173 Study of pathological personality as a modulating factor of schizotypy

Aims:From a dimensional point of view, the schizotypal features would be continuously distributed in normal population and individuals with schizophrenia spectrum disorders. in the latter, differences have been found in personality traits between the diagnostic categories of the dimension, and also different schizotypy scores between them. in this study our main objective was to specify the domains and traits of pathological personality that can be considered risk factors for schizotypy.Method:SPQ and DAPP-BQ were administered to a sample of 91 subjects that were divided in four groups: psychotic patients with schizophrenia spectrum disorders, siblings of patients from this spectrum, patients with personality disorders, and healthy controls.Results:Patients with personality disorders presented the highest scores of schizotypy measured with SPQ, followed by psychotic patients, siblings, and finally the healthy controls. both groups of patients obtained higher pathological personality scores compared to siblings and controls. in the psychotic patients and their siblings emotional dysregulation, dissocial behavior and inhibition domains correlated with the SPQ factors, while in the personality disorder patients SPQ correlated only with inhibition. the trait social avoidance appears to be a predictive variable of psychometric schizotypy.Conclusions:Pathological personality underlying the schizotypy of psychotic patients of schizophrenia spectrum and their siblings is different from that of the personality disorder group. Social avoidance is a risk factor for schizotypy measured with SPQ.

A Graphical Analysis of Handwriting of Prisoners Diagnosed with Antisocial Personality

Some researchers have claimed that important aspects of personality can be assessed using a person's handwriting. The aim of this research is to pull together systematically and extend data on the relationships between handwriting and antisocial personality. Specifically examined was whether there are specific identifiable characteristics of writing and, if so, are these useful in handwriting analysis to diagnose a personality disorder. The graphic handwriting characteristics of 50 inmates with a diagnosis of Antisocial Personality Disorder was analyzed and compared with that of 40 inmates without such diagnosis and 50 nonprisoner controls, also without Antisocial Personality Disorder. Forensic experts examined the documents, concentrating on those aspects of handwriting which previous researchers had reported associated with Antisocial Personality Disorder, such as a sinusoidal line, heavy pressure, and an open-shaped "a". Analyses of variance comparing the frequencies of 13 handwriting parameters indicated no significant differences for characteristics in any of the groups on any parameter. The diagnosis of Antisocial Personality Disorder was not significantly associated with any of the graphical measures; however, 5 of the 13 parameters were different between the Antisocial Personality Disorder and the non-Antisocial Personality Disorder groups in a direction opposite of expectations.

Learning Disability and Serious Crime - Arson

This review paper follows on from a previous review of the literature with regard to learning disability and murder (Read, S. 2008). This paper, in turn, examines the relationship, if any, between learning disability and fire setting. The approach taken in both these papers involves the concept of Disruptive Behaviour Disorder as being the group of behaviour and personality disorders most involved in the aetiology of these criminal and anti-social behaviours. Disruptive behaviour disorders (Read, 2007) comprise: Oppositional Defiant Disorder Conduct Disorder Anti-social Personality Disorder Intermittent Explosive Disorder (DSM IVR, 2001, APA) The common characteristics of these disorders comprise aggression, irritability, over-activity, high arousal, and repetitive behaviour. In this context, perhaps we can see there is a continuum of offences. As we will show in the third paper (on Learning Disability and Sexual Offence), the sexual offences most often carried out by individuals with an intellectual disability are those of a less serious nature (for example, exhibitionism or indecent assault), than compared to the more serious sexual offence of aggravated rape. If serious crime involving individuals with a learning disability can then be graded as to gravity along a continuum from sexual offence to arson, through to murder as the most serious, then the involvement of learning disabled people becomes less as the offence becomes more serious then the involvement of learning disabled people becomes less as the offence becomes more serious. Consequently, a conclusion of the paper concerning murder was that learning disabled people are not disproportionately involved. This is not true of arson, where learning disabled people are over-represented (however, this over-representation should be treated with some caution as there may be methodological problems within studies that support this finding). This paper, as with the paper concerned with murder (Read, 2008), shows that the predominant diagnoses of arsonists are those in the group of Disruptive Behaviour Disorders. Mental illness is a minority diagnosis amongst those firesetters who suffer from learning disability. This accords well with the Review findings of Whitaker and Read (2007), who evidenced that there is little to support the notion that learning disabled people suffer disproportionately high levels of mental illness. However, behaviour and personality disorders are over-represented. The aetiology of these conduct and personality disorders is not so clear and these review papers regarding murder and arson relate the common occurrence of environmental factors in the developmental years as being of direct relevance to the offending behaviour as well as the association with learning disability which dates from birth or very early years. Such observations are seen to have import with regard to treatment which is likely to be as much supervisory, educational and psychological as it is pharmacological. Medical treatment cannot be ignored as it represents the first step in psychiatric rehabilitation, involving as it does the drug treatment of conduct and personality disorders. However other treatment modalities, importantly individually tailored, are liable to be of great importance with regard to reducing risk of repeated offending.

Scientific Geniuses' Psychopathology as a Moderator in the Relation Between Creative Contribution Types and Eminence

The present study investigated whether scientific geniuses' psychopathology might exert significant influences on their scientific eminence by its interaction with their creative contribution types (paradigm-preserving contributions or paradigm-rejecting contributions). A systematic review of literature on psychopathology of geniuses was conducted using PsycINFO (1967–2005). Seventy-six scientific geniuses were chosen and divided into 4 groups: No Psychopathology Group (n = 22), Personality Disorders Group (n = 27), Mood Disorders Group (n = 13), and Schizophrenia Group (n = 14). The results suggested that psychopathology of geniuses might play the role of a moderator in the relation between creative contribution types and scientific eminence. Implications regarding the mad-genius debate were discussed.

Age-Related Differences in Individual DSM Criteria for Borderline Personality Disorder

This study examined age-related effects of individual DSM criteria for borderline personality disorder (BPD) and symptoms of depression and anxiety in three groups: patients diagnosed with BPD, another personality disorder, or no personality disorder. The goal was to determine if distinctive age effects emerged within the BPD group. This mixed clinical and community sample (N = 380) ranged from 20-50 years old. Each participant was assessed for symptoms of axis I and II psychopathology. We found significant interactions for personality disorder group x age for the suicidal behavior and impulsivity criteria that reflected distinctive changes in the BPD group. The BPD group reported significantly more anxious and depressive symptoms. However, no main effect for age or personality disorder x age interaction emerged with symptoms. These results demonstrate that older individuals with BPD report less impulsivity and fewer suicidal behaviors, although symptoms of distress persist.

A study on the comparability of SCID-II and PDQ-4

Objective To study the comparability of two personality diagnostic instruments(SCID-Ⅱ and PDQ-4)in psychiatric patients. Methods One hundred and twelve mental disorder patients were investigated with the SCID-Ⅱ and PDQ-4. Results 1)Significant differences were found between groups(dividing by total scores on PDQ-4)by means of SCID-Ⅱ interviews(P＜0. 0 1). 2)Categorical personality disorder(PD)groups by means of SCID-Ⅱ interviews had hisher scores on PDQ-4 than their related non-PD groups. 3)For agreement on categorical diagnoses between SCID-Ⅱ and PDQ-4, the correlation coefficients varied from 0. 17 to 0. 57. Except for antisocial PD(r=0. 57), the others had poor-fair coefficients, as r＜0. 50. Conclusions In general, there is some correlation between SCID-Ⅱ and PDQ-4. Low agreement between PDQ-4 and SCID-Ⅱ is observed for categorical PD evaluations. Thus, PDQ-4 can't be a substitute tool for SCID-Ⅱ. Key words: Mental health; Personality disorder; SCID-Ⅱ 2.0; PDQ-4