Personality Disorder In People Research Articles

Personality disorders in people with epilepsy: a review.

Epileptologists and psychiatrists have long observed a correlation between epilepsy and personality disorders (PDs) in their clinical practice. We conducted a comprehensive PubMed search looking for evidence on PDs in people with epilepsy (PwE). Out of over 600 results obtained without applying any time restriction, we selected only relevant studies (both analytical and descriptive) limited to English, Italian, French and Spanish languages, with a specific focus on PDs, rather than traits or symptoms, thus narrowing our search down to 23 eligible studies. PDs have been investigated in focal epilepsy (predominantly temporal lobe epilepsy - TLE), juvenile myoclonic epilepsy (JME) and psychogenic non-epileptic seizures (PNES), with heterogeneous methodology. Prevalence rates of PDs in focal epilepsy ranged from 18 to 42% in surgical candidates or post-surgical individuals, with Cluster C personality disorders or related traits and symptoms being most common. In JME, prevalence rates ranged from 8 to 23%, with no strong correlation with any specific PDs subtype. In PNES, prevalence rates ranged from 30 to 60%, with a notable association with Cluster B personality disorders, particularly borderline personality disorder. The presence of a PD in PwE, irrespective of subtype, complicates treatment management. However, substantial gaps of knowledge exist concerning the neurobiological substrate, effects of antiseizure medications and epilepsy surgery on concomitant PDs, all of which are indeed potential paths for future research.

Development and Preliminary Evaluation of a Rapid Screening Tool for Detecting Borderline Personality Disorder in People Aged over 60 Years

ABSTRACT Objectives Screening and diagnostic instruments for Borderline Personality Disorder (BPD) are not validated in people aged over 60. We report a pilot study examining the sensitivity and specificity of a de-novo screening instrument in older adults. Methods The BPD-OA screening tool incorporates DSM 5 and literature describing the expression of BPD in older adults. This study was conducted using a case control design. The Diagnostic Interview for Borderlines–Revised (DIB-R) and the McLean Screening Instrument for BPD (MSI-BPD) were used as comparators. Comprehensive assessment by psychiatric teams determined participants to be (i) BPD-positive (n = 22) or (ii) BPD-negative (gender matched; n = 21). Results The BPD-OA was the most sensitive instrument for discriminating older adult BPD from non-BPD participants (sensitivity = 0.82). No significant relationship was found between the BPD-OA score and age in BPD-diagnosed participants (r = −0.181, n = 21, p = .432). Participant age explained 3.2% of the variance in BPD-OA scores. Of the 21 BPD-negative participants, eight false positives experienced prominent mood disorders (specificity = 0.62). Conclusions The BPD-OA screening tool is clearly superior to instruments validated for use in younger people. Further refinement and evaluation will enhance its sensitivity and specificity. Clinical Implications Detection of BPD in older adult care settings will improve outcomes for patients, families, and staff through better understanding and appropriate management and treatment strategies.

Demographic Characteristics and Personality Disorders in People With Gender Dysphoria in East Azerbaijan Province, Iran

Background: Gender identity is an important part of human identity. It is a personal conception of oneself as male or female. One of the major goals of treatment for individuals with Gender Dysphoria (GD) is to treat comorbid psychological and psychiatric disorders such as personality disorders. The present study aims to investigate demographic characteristics and personality disorders in people with GD seeking gender reassignment therapy in East Azerbaijan Province, Iran. Methods: In this descriptive cross-sectional study, study population consists of all patients with GD referred to the forensic medicine centers in East Azerbaijan province during 2016-2020, of whom 61 (21 males and 40 females) were selected using a convenience sampling method. Their age, gender, educational level, and marital status were recorded and their personality profile was assessed by the Millon Clinical Multiaxial Inventory–III. Results: The frequency (percentage) of Cluster A, B and C personality disorders in males were 0(0%), 9(50%) and 2(11.10%), while in females they were 1(5.56%), 4(22.40%), and 2(11.10%), respectively. The frequency (percentage) of antisocial, obsessive, borderline, avoidant, narcissistic, histrionic, and paranoid personality disorders in males were 4(22.2%), 2(11.10%), 3(16.67%), 0(0%), 0(0%), 2(11.10%), and 0(0%), while in females they were 4(22.20%), 1(5.56%), 3(16.67%), 1(5.56%), 1(5.56%), 2(11.10%), and 1(5.56%), respectively. The prevalence of different clusters (P=0.34) and types (P=0.18) of personality disorders was not significantly different between males and females. Conclusion: Personality disorders are comorbid with GD. They exist in one-third of patients with GD in East Azerbaijan Province. Personality disorders are significantly more prevalent in male patients with GD than in females.

Personality Disorders among Individuals Seeking Cosmetic Botulinum Toxin Type A (BoNTA) Injection, a Cross-Sectional Study

Body dysmorphic disorder, narcissistic personality disorder, and histrionic personality disorders are the most frequent personality disorders in patients seeking cosmetic interventions. Botulinum toxin type A (BoNTA) injection for cosmetic purpose is the most popular among non-surgical cosmetic procedures and is also the second common aesthetic treatment in Iran. The current study aimed to assess personality disorders in people who were referred for BoNTA injection in Ardabil, Iran. To the best of our knowledge, this is the first study on personality disorders in applicants for cosmetic BoNTA injection in Iran. In a descriptive cross-sectional study, 200 eligible applicants for cosmetic BoNTA injection were selected by non-probability sampling. Firstly, the participants' demographic data were recorded in data gathering forms. Then their personality characteristics were evaluated via the Milton Clinical Multiaxial Inventory 3rd edition, which is a standardized self-report questionnaire for the assessment of personality disorders and clinical syndromes. Narcissistic personality trait was the most common (34.5%) followed by histrionic personality trait (27%), and obsessive personality trait was the least common personality trait (4%) in patients seeking BoNTA injection. Anxiety disorder had the highest frequency of clinical syndromes (46%) among the participants in this study, somatization had 25.5%, and dysthymia had the lowest frequency (11%). The current study concluded that narcissistic and histrionic personality traits and anxiety and somatization symptoms are higher in applicants for cosmetic BoNTA injection.

Problem-gambling severity, suicidality and DSM-IV Axis II personality disorders

BackgroundDespite the strong associations between personality disorders and problem/pathological gambling, few studies have investigated the relationships between personality disorders, problem-gambling severity and suicidal thoughts/behaviors. ObjectivesWe examined the relationships between problem-gambling severity and personality disorders among individuals with differing levels of suicidality (none, thoughts alone, attempts). MethodsWe analyzed data from 13,543 participants of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) study. First, differences in sociodemographic characteristics and prevalence of personality disorders were analyzed according to problem-gambling severity and suicidality status. Second, we performed a logistic regression to assess among the relationship between problem-gambling severity and DSM-IV Axis II psychopathology according to suicidality level. ResultsAt-risk or problem/pathological gambling groups showed higher rates of a wide range of personality disorders compared to non-gamblers. Logistic regression showed that at-risk pathological gamblers had a higher odds ratio for any personality disorder in the group with no history of suicidality, particularly for cluster-B personality disorders. Odds ratio interaction analysis identified the relationship between problem-gambling severity and personality disorders, particularly those in cluster B, differ according to suicidality status. ConclusionsOur findings suggest a complex relationship between suicidality, problem-gambling severity and personality disorders. The stronger relationship between problem-gambling severity and personality disorders in people with no suicidality as compared to some suicidality suggests that some of the relationship between greater problem-gambling severity and Axis II psychopathology is accounted for by increased suicidality. The findings have implications for clinical interventions targeting suicidality in individuals with gambling disorders.

The validity of two diagnostic systems for personality disorder in people with intellectual disabilities: a short report

PurposeOver the last ten years, there has been greater interest in the diagnosis of personality disorder (PD) in people with intellectual and developmental disabilities (IDD). One important characteristic of a diagnostic system is that it should have validity as a contribution to utility. PD has been found to have a predictive relationship with violence and the purpose of this paper is to review two methods for the diagnosis of PD in offenders with IDD in order to evaluate the utility of the diagnoses.Design/methodology/approachIn total, 212 offenders with ID were recruited from three settings – maximum-security, medium/low security and community services. Diagnoses of PD in the case files were compared with a structured system of diagnosis based on DSM-IV traits.FindingsThere were significant differences between the two systems with a significantly higher frequency of PD diagnosis in the community forensic setting in the structured assessment system. There was no relationship between the case files diagnosis of PD and future violence but there was a significant predictive relationship between the structured diagnosis of PD and future violence with an AUC=0.62.Research limitations/implicationsAs with all such studies, the research is limited by the quality of the case files available to the researchers.Practical implicationsOnly the structured assessment of PD had utility for the prediction of violence. Reasons for the differences between the systems are discussed and suggestions made on how a diagnosis of PD can be structured for the busy clinician.Social implicationsThe accurate diagnosis of PD has important implications since the PD is a crucial addition to any violence risk evaluation.Originality/valueThis study is the first of its kind to review the way in which clinicians assess PD.

Validation of a Brief Screening Instrument for Emotionally Unstable and Dissocial Personality Disorder Characteristics in Community Service Users with Intellectual Disabilities

Personality disorder characteristics can be a complicating factor among people with intellectual disabilities (ID). Persons exhibiting such features are associated with risk for violence and service instability. The purpose of this paper was to study an evaluative tool for personality disorders in people with ID and mental health disorders in community-based services. A new staff-rated instrument, the Personality Disorder Characteristics Checklist (PDCC; Taylor & Novaco, 2013) [1], was used. This tool is designed to screen for ICD-10 dissocial and emotionally unstable personality traits. In the study, the instrument was assessed for both its reliability and validity. Fifty-two randomly selected patients with ID in the specialist habilitation services in Norway were scored on the PDSS. The male/female proportion was 30/22 and the mean age was 36.8 (SD = 13.4). The internal consistency of the PDCC was found to be very good. Supportive evidence for concurrent and discriminant validity was obtained in conjunction with other relevant staff-rated instruments. There were twenty-three patients who screened above cut-off for the diagnostic criteria of a personality disorder and two patients previously diagnosed with personality disorder. This demonstrates that such disorders are present in people with ID. It also suggests that such characteristics may have been neglected in the past in providing services to this population.

Personality disorder and intellectual disability – concept and prevalence

Purpose – The range of prevalence of personality disorder (PD) found in people with intellectual disability (ID) has been reported as vast, and has included data from dissimilar settings. The purpose of this paper is to review the reported prevalence of PD in the general population of people with ID, and to consider how different and changing ideas about PD have affected these rates. Design/methodology/approach – Cross-sectional studies of the prevalence of PD in people with ID were identified. The quality of the studies was considered, along with how cases of PD were identified. Findings – Six studies were included. The reported prevalence of PD in people known to have ID ranged from 0.7 to 35 per cent. Possible reasons for this wide range included different views of PD and methods of assessment. Research limitations/implications – The wide range of findings suggests that methodological differences are significant. Consideration to how clinicians should respond to the overlap of impairment between ID and PD may improve the conceptual clarity of PD, informing future epidemiological research. Originality/value – This review was limited to studies of samples likely to be representative of the general ID population. The range of prevalence estimates was narrower than previously reported, and more likely to reflect the true prevalence rate of PD amongst people who have ID. Consideration was also given to how different ideas of PD led to different methods and may have contributed to variance in the results.

Lasting personality pathology following exposure to catastrophic trauma in adults: systematic review.

By definition, personality disorders (PDs) are evident in late childhood and adolescence, but evidence for personality pathology occurring after adolescence is unclear. We aimed to review extant literature on personality change following exposure to catastrophic trauma in adults in order to identify the prevalence and clinical features of any long-term personality pathology. Relevant studies were identified by searching three bibliographic databases (MEDLINE, EMBASE and PsychINFO) from inception to November 2011 using terms related to personality and trauma. No prospective studies that investigated long-term personality change following exposure to trauma in adults were found. Two retrospective studies reported the prevalence of enduring personality change of 2.6% and 6% (weighted prevalence 4.6%, 95% confidence interval 3.4-6.3%), and one study reported 20% increase in adult-onset antisocial behaviour following exposure to trauma. Findings from cross-sectional studies that examined the prevalence of PDs in people exposed to catastrophic trauma reported that Cluster C and Cluster A were the most common with avoidant, paranoid and obsessive-compulsive PDs among those most frequently reported. A minority of adults who are exposed to severe trauma appear to go on to develop significant personality pathology. The observed personality disturbance is multifarious and more extensive than the prototype described in ICD-10.

The Treatment of Complex Dual Disorders: Clinicians’ and Service Users’ Perspectives

Introduction: The present study examined how both clinicians and service users experience existing treatments for Dual Disorders (DDs), namely the co-occurrence of a Severe Mental Illness (SMI) and a Substance Use Disorder (SUD). The literature indicates that many individuals with DDs present with an even more complex clinical portrait, which often includes additional pathologies or stressors, such as cluster B personality disorders, Post-traumatic Stress Disorder (PTSD) or trauma history, and depression. Treatment for these individuals is complicated by these mitigating factors and it is not clear whether extant treatments for DDs are successful with this population, and how they could be improved. Objective: This study aimed to explore the specific issues, successes and difficulties regarding the treatment of complex DDs, according to both clinicians’ and service users’ perspectives. Methods: A qualitative design was used in this exploratory study in order to best grasp the complexity of this clinical issue. Thirty clinicians and program directors specialized in the treatment of DDs, and 31 individuals diagnosed with complex DDs participated respectively in three and four focus groups conducted in various settings. Collected data were coded using a mixed open and closed coding procedure. Results: All participants expressed both positive and negative views on existing treatments. Clinicians and clinical directors expressed various issues, principally: powerlessness, dealing with personality disorders in people with DDs, seeking a common treatment vision, and services issues (notably housing). The main themes emerging in the service users’ interviews pertained to exclusion from services, personalised treatment plans, medication, and therapy. Conclusion: Although creative, personalised treatments were noted, it is clear to all clinicians, clinical directors and service users that existent services are not efficiently equipped for dealing with complex DDs. More integrated treatments, more comprehensive trainings and better access to adapted services would improve treatment outcomes for individuals diagnosed with complex DDs.

Antisocial personality disorder in people with co-occurring severe mental illness and substance use disorders: clinical, functional, and family relationship correlates

Antisocial personality disorder (ASPD) is an important correlate of substance abuse severity in the addiction population and in people with co-occurring serious mental illness and addiction. Because family members often provide vital supports to relatives with co-occurring disorders, this study explored the correlates of ASPD in 103 people with co-occurring disorders (79% schizophrenia-schizoaffective, 21% bipolar disorder) in high contact with relatives participating in a family intervention study. Clients with ASPD were more likely to have bipolar disorder and to have been married, but less likely to have graduated from high school. ASPD was associated with more severe drug abuse and depression, worse functioning, and less planning-based social problem solving. The relatives of clients with ASPD also reported less planning-based problem solving, worse attitudes towards the client, and worse mental health functioning. Client ASPD was associated with less long-term exposure to family intervention. The findings suggest that clients with ASPD in addition to co-occurring disorders are a particularly disadvantaged group with greater illness severity, more impaired functioning, and more strained family relationships. These difficulties may pose special challenges to delivering family intervention for this group.

Diagnosing personality disorder in people with learning disabilities

Diagnosing personality disorder in people with learning disabilities

A systematic review of personality disorder amongst people with intellectual disability with implications for the mental health nurse practitioner

This paper reviews and summarises the literature on assessment, diagnosis and management of personality disorder in people with intellectual disability. It will proceed to argue the implications of a mental health nurse practitioner in clinical practice. Personality disorder is a potentially severe and disabling condition causing significant distress as well as presenting considerable challenges for service providers. Diagnosis in people with intellectual disability is controversial. However, it is considered that this population is at greater risk of these disorders. There is, however, little research on which to base clinical interventions or service planning. Systematic review. A literature search of electronic data was undertaken in April 2007 using CINAHL, AMED, Medline, PsycINFO, EMBASE and Cochrane Library. Other sources included Google Scholar, hand searching of reference lists and texts and search of relevant websites. The literature on personality disorder in intellectual disability is notable for its paucity. The limited evidence available suggests that this population is at greater risk of personality disorder and that assessment and diagnosis is complex and often overshadowed by the intellectual disability. Few papers address treatment, there are no trial-based studies and it has not been established whether results can be extrapolated from research in the general population. The issue of personality disorder in people with intellectual disability is shrouded in controversy with a dearth of robust evidence to inform assessment or therapeutic care. Personality disorder does, however, provide a basis for decisions on type and intensity of support required for this population who have significant levels of unmet need. Some people with an intellectual disability and personality disorder can live in the community with specialist support. The mental health nurse practitioner has the potential to provide people with dual diagnostic support needed to enhance the capacity of the service system to meet the needs of this complex and difficult population.

Dependencia de la cocaína y trastornos de personalidad. Análisis de su relación en una muestra clínica

Objective The personality disorders in people with cocaine dependence are frequent and they interfere in the treatment of these persons. Few studies analyze this relationship in Spain. The present study aims to evaluate the presence of personality disorders in persons with cocaine dependence that are in treatment in Centers of Drug Dependence in Galicia (Spain) and to know if there are differences among both groups, with and without personality disorders, in relation to sociodemographic characteristics, psychopathology and drug consumption. Material and methods We use the MCMI-II to analyze the probability of presence of personality disorders. One hundred and two patients with cocaine dependence were included in the study. Results An important percentage of subjects present one or more personality disorder (66.6%), and they differ of the group without personality disorders in psychopathological characteristics (depression, anxiety, etc.). Conclusions The important prevalence of personality disorders in cocaine dependence persons indicates the evaluation to the beginning of treatment.

Personality disorders in people with learning disabilities: follow‐up of a community survey

A sample of community-based service users with intellectual disability (ID) was re-examined after 5 years to determine the impact of a diagnosis of personality disorder (PD). Seventy-five of the original 101 participants were followed up. Of these, 21 people had a PD identified during the original study. Compared with controls, people with a PD were significantly more likely to receive central nervous system (CNS) drugs, have more contact with psychiatric services, show increased offending behaviour, score higher on the Aberrant Behaviour Checklist and score above the threshold on the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD). Participants with PD recorded were more likely to have a recorded psychiatric disorder, have contact with specialist teams, and have more hospital admissions. People with ID and PD are able to live in the community with specialist support but improved assessment, diagnosis and support services need to be targeted more effectively to them.