Personality Disorder Patients Research Articles

Physical multimorbidity in psychiatric patients with personality disorders: Insights within the ICD-11 framework

ObjectiveRecent research has revealed poor physical health among individuals with personality disorders (PDs). We aimed to compare chronic physical illnesses (CPI) and chronic physical multimorbidity (CPM) prevalence between the general population (GEP) and PD patients, and to explore the relationship between CPM and various aspects of PD, predominantly within the ICD-11 framework. MethodsThis cross-sectional study included 126 PD patients and 126 matched controls from the GEP. Patients were evaluated for the ICD-11 PD severity and maladaptive personality domains, subjective emptiness, and reflective functioning. CPI was assessed using a standardized self-report questionnaire. ResultsPD patients had a higher mean number of CPIs (2.05 vs. 1.02) and a more frequent CPM occurrence (49.2% vs. 26.2%) compared to the matched controls (p < .001). The ICD-11 PD severity (OR = 1.143, p = .007) and maladaptive domain Negative affectivity (OR = 4.845, p = .002), and poor reflective functioning (OR = 1.694, p = .007) were significant predictors of CPM, independent of sociodemographic, clinical and lifestyle factors. Negative affectivity showed the most robust effect on CPM, while smoking did not significantly mediate these relationships. ConclusionOur study found increased CPM burden in PD patients and a link between CPM and various PD aspects under the ICD-11 framework, highlighting the need for more integrated healthcare.

Training in cognitive reappraisal normalizes whole-brain indices of emotion regulation in borderline personality disorder.

Borderline personality disorder is the prototypical disorder of emotion dysregulation. We have previously shown that borderline personality disorder patients are impaired in their capacity to engage cognitive reappraisal, a frequently-employed adaptive emotion regulation strategy. Here we report on the efficacy of longitudinal training in cognitive reappraisal to enhance emotion regulation in borderline patients. Specifically, the training targeted psychological distancing, a reappraisal tactic whereby negative stimuli are viewed dispassionately as though experienced by an objective, impartial observer. At each of 5 sessions over 2 weeks, 22 borderline (14 Female) and 22 healthy control (13 Female) participants received training in psychological distancing and then completed a widely-used picture-based reappraisal task. Self-reported negative affect ratings and functional magnetic resonance imaging (fMRI) data were acquired at the first and fifth sessions. In addition to behavioral analyses, we performed whole-brain pattern expression analyses using independently-defined patterns for negative affect and cognitive reappraisal implementation for each session. Borderline patients showed a decrease in negative affect pattern expression following reappraisal training, reflecting a normalization in neural activity. They did not, however, show significant change in behavioral self-reports. To our knowledge, this study represents the first longitudinal fMRI examination of task-based cognitive reappraisal training. Using a brief, proof-of-concept design, the results suggest a potential role for reappraisal training in the treatment of borderline patients.

Personality disorder coverage, prevalence, and convergence: do the DSM-5's two models of personality disorder identify the same patients?

Research on the Alternative DSM-5 Model for Personality Disorders (AMPD) in DSM-5's Section-III has demonstrated acceptable interrater reliability, a largely consistent latent structure, substantial correlations with theoretically and clinically relevant measures, and evidence for incremental concurrent and predictive validity after controlling for DSM-5's Section II categorical personality disorders (PDs). However, the AMPD is not yet widely used clinically. One clinician concern may be caseness - that the new model will diagnose a different set of PD patients from that with which they are familiar. The primary aim of this study is to determine whether this concern is valid, by testing how well the two models converge in terms of prevalence and coverage. Participants were 305 psychiatric outpatients and 302 community residents not currently in mental-health treatment who scored above threshold on the Iowa Personality Disorder Screen (Langbehn et al., ). Participants were administered a semi-structured interview for DSM-5 PD, which was scored for both Section II and III PDs. Convergence across the two PD models was variable for specific PDs, Good when specific PDs were aggregated, and Very Good for 'any PD.' Results provide strong evidence that the AMPD yields the same overall prevalence of PD as the current model and, further, identifies largely the same overall population. It also addresses well-known problems of the current model, is more consistent with the ICD-11 PD model, and provides more complete, individualized characterizations of persons with PD, thereby offering multiple reasons for its implementation in clinical settings.

The Correlation Between Peripheral Blood MicroRibonucleic Acid Expression Level and Personality Disorder in Patients with Schizophrenia

The Correlation Between Peripheral Blood MicroRibonucleic Acid Expression Level and Personality Disorder in Patients with Schizophrenia

Head-to-head comparison of the alternative model for personality disorders and Section II personality disorder model in terms of predicting patient outcomes 1 year later.

The present study investigated the predictive validity of Criterion A and B of the Alternative Model for Personality Disorders (AMPD) compared to the DSM-5 Section II personality disorder (PD) model in predicting patient outcomes 1 year after initial assessment, in a hetero-method longitudinal design. A clinical sample of 84 participants were administered both traditional Section II and AMPD interviews by two independent interviewers. One year after assessment, disability (World Health Organization Disability Assessment Schedule 2.0) and symptom severity (Brief Symptom Inventory) were assessed. The Section II PD model did not predict disability (R² = .01) nor symptom severity (R² = .03). The AMPD model, on the other hand, predicted both disability (R² = .23) and symptom severity (R² = .29) 1-year postinitial assessment. Both Criterion A and B were significant predictors, but when jointly combined only Criterion A remained significantly predictive of both disability and symptom severity while Criterion B did not. Criterion A thus appears to capture core vulnerabilities of personality-disordered patients that are related to future functioning and symptom severity. Implications for clinical practice are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Early maladaptive schema, attachment style, and parenting style in a clinical population with personality disorder and normal individuals: a discriminant analysis model

IntroductionResearchers have shown various variables’ role in forming personality disorders (PD). This study aimed to assess the role of early maladaptive schema (EMS), attachment style (AS), and parenting style (PS) in discriminating between personality disorders and normal individuals.MethodsIn this study, 78 personality disorder patients and 360 healthy volunteers aged 18–84 were selected using convenience sampling. They completed the Schema Questionnaire-Short Form (SQ-SF), Revised Adult Attachment Scale (RAAS), and Baumrind’s Parenting Styles Questionnaire (PSI). Data were analyzed using discriminant analysis with IBM SPSS 25.ResultsThe results showed higher mean scores in all early maladaptive schema domains, insecure attachment styles, and authoritarian parenting in the personality disorder group than in the normal group. Also, discriminant analyses revealed that the function was statistically significant and could distinguish between the two groups and a compound of essential variables, disconnection, impaired autonomy, and secure attachment, respectively, discriminating two groups. Given that all components were able to distinguish between the two groups.ConclusionTherefore, intervention based on these factors early in life may help reduce the characteristics of personality disorders. Also, considering the role of these factors, treatment protocols can be prepared.

Bayesian Decision-Making Under Uncertainty in Borderline Personality Disorder.

Bayesian decision theory suggests that optimal decision-making should use and weigh prior beliefs with current information, according to their relative uncertainties. However, some characteristics of borderline personality disorder (BPD) patients, such as fast, drastic changes in the overall perception of themselves and others, suggest they may be underrelying on priors. Here, we investigated if BPD patients have a general deficit in relying on or combining prior with current information. We analyzed this by having BPD patients (n = 23) and healthy controls (n = 18) perform a coin-catching sensorimotor task with varying levels of prior and current information uncertainty. Our results indicate that BPD patients learned and used prior information and combined it with current information in a qualitatively Bayesian-like way. Our results show that, at least in a lower-level, nonsocial sensorimotor task, BPD patients can appropriately use both prior and current information, illustrating that potential deficits using priors may not be widespread or domain-general.

Dream themes and rejection sensitivity of individuals with and without borderline personality disorder: a comparative study

Objectives: This study aims to determine how the dream themes of borderline personality disorder patients differ from those of without borderline personality disorder diagnosis and the mediating role of rejection sensitivity in this differentiation process. Methods: The convenience sampling method was used in the study, and the participants were 79 female borderline patients diagnosed with semi-structured interviews with criteria of DSM-5 and 79 female individuals who had not received a psychological diagnosis before and at the study interviews. Sociodemographic Information Form, Dream Themes Scale, Borderline Personality Questionnaire, and Rejection Sensitivity Scale were used in the study. Linear Regression Analysis, Hierarchical Regression Analysis, and Independent Groups T-Test were used during the investigations. Results: Borderline personality disorder patients scored higher in all sub-dimensions of the dream themes scale and rejection sensitivity scale than the control group. Borderline personality traits predicted rejection sensitivity. Borderline personality traits and rejection sensitivity together predicted dream themes. Borderline personality predicts anxiety dreams, fear dreams, and experience dreams, and rejection sensitivity mediates these predictive relationships. Conclusions: The dreams of borderline personality disorder patients have negative content covered by the impact of experiences sub-dimension on dream themes, as they contain reflections of negative content in beliefs, thoughts and emotions related to their daily lives. Rejection sensitivity plays a mediator role in borderline patient’s dreams. The study results show that it would be beneficial not to ignore the content of dreams in patients with borderline personality disorder, considering the relationship of negative dreams with daily functioning, dissociative symptoms, self-harming behaviors, and suicide attempts. Results also indicate that it might be beneficial to target rejection sensitivity to reduce aggravating dream contents.

Cirugía bariátrica: patrones de comportamiento y trastornos de personalidad en el preoperatorio

Introduction: Bariatric surgery has become an increasingly common procedure, especially for patients with morbid obesity who have obtained unsatisfactory results from conventional treatments. Objective: To evaluate the occurrence of behavioral patterns and personality disorders in patients in the preoperative period of bariatric surgery. Materials and methods: Cross-sectional study carried out with 146 patients from a medium-sized clinic, a reference in the execution of bariatric surgeries in the Midwest region of Minas Gerais, Brazil. Data collection was performed using the psychological instrument entitled Factorial Personality Battery. Descriptive analysis and data association were performed. Results: Half of the participants presented high or very high scores for greater propensity to develop depression and anxiety, showing a close relationship with personality disorders, especially with behavioral patterns of effort and dedication. Discussion: The patterns of effort and dedication behavior are protective factors in the postoperative period, taking into account the adaptations and new habits necessary for a good recovery and maintenance of weight loss. Conclusions: The dysfunctional patterns of behavior that stood out most are related to greater difficulty in perceiving the positive side and ease in perceiving the negative side, leading to a more intense experience of suffering, in addition to difficulty in making decisions and facing routine challenges. Screening behavioral patterns and personality disorders preoperatively is necessary for adequate patient monitoring and successful bariatric surgery.

Borderline Kişilik Özellikleri, Aşk Mitleri ve Aşk Biçimleri

Individuals who show borderline personality traits but have not yet experienced these traits at the level of personality disorder patients might still have more destructive relationships compared to others in relation to their attitudes towards love (“passionate love (eros),” “altruistic love (agape)”, “possessive love (mania)”, “game playing love (ludus),” “friendly love (storge)”, “pragmatic love (pragma)”). It is predicted that the destructive relationships that individuals with borderline personality traits establish in line with their attitudes towards love may be related to some love myths (for example, "people who are in love can hurt the ones they love," "love forgives everything"). The purpose of this study was to determine whether romantic love myths play a mediating role in the attitudes toward love held by people who exhibit a high degree of borderline personality traits (BPT). Therefore, 492 participants, 220 males (44.7%) and 272 females (55.3%) aged 18-45 years, living in Istanbul and voluntarily participated in the research, were given the Borderline Personality Scale, Romantic Love Myths Scale, Attitudes Towards Love Scale and a form with personal information created by researchers was submitted. The obtained data were analyzed by applying Pearson Correlation analysis and hierarchical regression analysis. As a result of the findings, it was seen that the relationship between BPT and attitudes towards love was mediated by romantic love myths. The results of the study are important in showing that a change can be achieved in romantic relationship styles by targeting unrealistic beliefs in psychotherapy processes in the field of romantic relationships, which is one of the areas where individuals with borderline personality traits have difficulty.

Evaluation of Asymmetric Dimethylarginine, Malondialdehyde, and Vitamin Levels of Borderline Personality Disorder Patients With and Without Self-Mutilation.

Believing that oxidative stress may be increased in borderline personality disorder (BPD) patients with self-mutilating behaviors (SMB), we aimed to measure serum asymmetric dimethylarginine (ADMA) and malondialdehyde (MDA) levels in these patients. The study included 60 patients diagnosed with BPD and 30 healthy controls. BPD patients were divided into two groups: 30 female patients with SMB and 30 female patients with no-self-mutilating behavior (NSMB). ADMA, MDA, vitamin A, and vitamin E levels were analyzed. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were conducted with the participants. Serum ADMA and MDA levels were higher in SMB and NSMB group compared to control group. Serum vitamin E levels were also lower in the SMB group compared to the control group. Positive correlations were determined between both ADMA and MDA, and between BDI and BAI scores. Also, BAI scores were statistically higher in SMB group compared to NSMB group. It was discovered that levels of ADMA and MDA, which reflected oxidative stress, were elevated in patients with BPD who exhibited SMB. Accordingly, future studies should investigate the role of oxidative stress in a more comprehensive way in terms of the different mechanisms underlying and treatments involved in borderline personality disorder.

Personality disorders and schizophrenia spectrum disorders in the Italian forensic psychiatric population: clinical features, pattern of violence and treatment

Starting in 2015, the Residencies for Execution of Security Measures (REMS) became the place of treatment and care for dangerous offenders who were acquitted due to a mental disorder in Italy. Schizophrenia spectrum disorders (SSD) and personality disorders (PD) are the most common psychiatric disorders among REMS patients. This study aimed to identify and describe potential clinical, therapeutic, and criminal-related differences in REMS patients with SSD and PD. A sample of 528 REMS patients extracted from a previous observational retrospective study underwent secondary analysis. The group of PD patients (n = 150) comprised more females (p < 0.001) and had a higher frequency of substance abuse (p < 0.001) than the SSD group (n = 378). The SSD group was more frequently admitted to the REMS due to homicide/attempted homicide (p < 0.001). Among SSD patients, we found a higher recognition of criminal irresponsibility (p < 0.001). Patients with PD were more likely to engage in violent behavior in the REMS than their SSD counterparts (p < 0.001). Patients with SSD were more likely to receive antipsychotic polypharmacy (p < 0.05) and a higher dose of antipsychotics (p < 0.001). These initial results provide empirical evidence to support the need for personalized forensic treatment paths.

Countertransference in the treatment of patients with personality disorders: A longitudinal study

ABSTRACT Objective This study examines how therapist emotional response/countertransference (CT) develops during treatment for patients with personality disorders (PDs) and how pre-treatment patient factors (severity of personality pathology, PD category, level of symptom distress) predict CT responses. Secondly, we explored associations between patient clinical outcome and CT. Method A longitudinal, observational study including 1956 patients with personality pathology treated at psychotherapy units within specialist mental health services. Therapists’ emotional response was repeatedly assessed by the Feeling Word Checklist—Brief Version (FWC-BV) with three subscales—Inadequate, Confident, and Idealized. Results Levels of Inadequate CT were lowest and stable over time while Confident and Idealized increased over time. Greater severity of personality pathology and borderline PD predicted higher initial Inadequate, lower initial Confident and decreasing Inadequate over time. Antisocial PD predicted decreasing Confident. Number of PD criteria had higher impact on therapist CT than level of symptom distress. Clinical improvement was associated with decreasing Inadequate. Conclusion Therapists reported predominantly Confident CT when working with PD patients. More severe personality pathology, and borderline PD, specifically, predicted more negative CT initially, but the negative CT decreased over time. Patients who did not improve were associated with increasing Inadequate.

An Overview of Schizotypal Personality Disorder: Etiology Treatment

The article summarizes and analyzes some of the previous studies on schizotypal personality disorder to explain the etiology, genetic aspect such as Catechol-O-methyltransferase (COMT which is situated on chromosome 22q11) and calcium voltage-gated channel subunit alpha1 C (CACNA1C rs1006737); environmental aspect such as risky factors affecting an unnormal brain development like and psychological trauma, and chronic stress, and the treatment (Metacognitive treatment; RuminationFocused Cognitive Behavioral Therapy; Medication treatment) of schizotypal personality disorder are also discussed. Both methods, Metacognitive treatment, and RuminationFocused Cognitive Behavioral Therapy, in their respective cases, improved symptoms in schizotypal personality disorder patients. However, although research on medication treatment shows that although some medicines, like Risperidone and Haloperidol, can also improve schizotypal personality disorder symptoms, they are also accompanied by the side effects. Moreover, the analysis shows that the present research on managing schizotypal personality disorder encounters issues such as insufficient sample size and absence of repeated experiments. These results of prior studies still need further verification before they can be used in practice.

Innovative advertising design strategies on consumer psychology and BPD patients

BackgroundAdvertising plays a crucial role in modern commercial society as a means of information transmission. It not only affects consumers’ purchasing decisions but may also have a particular impact on their mental health. This study explores in depth how innovative advertising design strategies affect consumer psychology, focusing on their potential impact on patients with borderline personality disorders.Subjects and MethodsThe experiment used three methods: questionnaire survey, psychological experiment, and in-depth interview to select 800 consumers, including 100 diagnosed borderline personality disorder patients, for a 6-month observation experiment. The Borderline Personality Disorder (BPD) self-test was used to evaluate the patient’s status. The experimental data was statistically analyzed using SPSS 26.0.ResultsResearch shows that innovative advertising design strategies can significantly enhance consumers’ interest and willingness to purchase products, with 80% of respondents indicating an impulse to purchase after being influenced by such advertisements. However, for 60% of patients with borderline personality disorder, such advertisements may trigger impulsive purchases and emotional instability, and patients report feeling more anxious and unstable.Conclusions Innovative advertising design strategies significantly impact consumer psychology, promoting their willingness to purchase. Still, they may also have adverse psychological effects on specific groups, especially patients with borderline personality disorders.

In search of hidden threats: A scoping review on paranoid presentations in personality disorders.

Recent diagnostic developments suggest that paranoia is a transdiagnostic characteristic common to several personality disorders rather than a personality disorder per se. Nonetheless, empirical literature fails to provide comprehensive and univocal findings on whether and how paranoid presentations relate to different personality disorders. In the present scoping review, we map the empirical literature on paranoid presentations in personality disorders, considering the entire spectrum of paranoid manifestations (i.e., the paranoia hierarchy). In selecting original quantitative studies on paranoid presentations in personality-disordered patients, we screened 4,433 records in PsycArticles, PsycInfo and PUBMED. We eventually included 47 eligible studies in the review. Our synthesis indicates consistent empirical evidence of a wide range of paranoid presentations in Paranoid, Schizotypal and Borderline personality disorders. Conversely, little empirical literature exists on paranoid presentations in other personality disorders. Preliminary findings suggest broad-severity paranoid presentations, ranging from milder to severe forms, in Paranoid, Schizotypal and Borderline personality disorders. There is also some evidence of milder forms of paranoia in Avoidant, Antisocial and Narcissistic personality disorders. Conversely, there is poor evidence of paranoid presentations in Schizoid, Histrionic, Dependent or Obsessive-compulsive personality disorders. Research gaps and recommendations for improving empirical research on paranoid presentations in personality disorders are discussed.

Contrasting social knowledge and theory of mind patterns in adults with personality disorders, schizophrenia spectrum disorders, and healthy controls

ABSTRACT Introduction Personality disorders (PD) and schizophrenia spectrum disorders (SSD) are distinct conditions displaying common symptoms, like impairments in social cognition, that make them hard to distinguish, especially in severe cases. To date, few studies have compared theory of mind skills in these two disorders, and none have compared social knowledge skills. This study aims to compare the social cognitive abilities of patients with these conditions. Method Non-parametric analyses of covariance were used to compare severe PD patients (n = 37), SSD patients (n = 44), and healthy controls (HC; n = 49) on the Social Knowledge Test and two measures of theory of mind: the Reading the Mind in the Eyes Test and the Combined Stories Test, which incorporates items from various widely used tests. Results While no significant group differences were found on the Social Knowledge Test, SSD patients performed lower than the HC group on both theory of mind tests. PD patients only had lower performance than the HC group on specific items from the Combined Stories Test. Conclusions PD and SSD patients demonstrated distinctive patterns of social cognitive impairments, with items of greater complexity or with an affective orientation being the most discriminant for PD.

Altered emotional response pattern related to complex trauma in patients with borderline personality disorder.

This work aims to demonstrate, through the International Affective Picture System (IAPS) responses, an altered emotional pattern in borderline personality disorder (BPD) patients and to find a specific emotional response pattern by understanding their relationship with traumatic experiences and attachment bonds towards their primary caregivers. A total of 50 BPD patients and 39 control patients were evaluated using the IAPS, and its assessment was carried out through the Self-Assessment Manikin (SAM). Paternal and maternal attachment bonds as well as traumatic experiences in BPD patients were evaluated. Statistical associations were analysed in the different variables. Significant differences between BPD and control patients were found in all emotional response components for pleasant, unpleasant and neutral images (p < .01), with one exception, the arousal in pleasant images. Patients' experience of traumatic experiences was positively related to scores on the happiness component of pleasant imagery (p = .057) and on the arousal component of unpleasant imagery (p = .058). Poorer maternal bonding in BPD patients was significantly related to lower scores on happiness (p < .01) and dominance (p < .05) components of pleasant imagery and all emotional response components for unpleasant imagery (p < .01). The results of the study confirm an impaired emotional response pattern in patients with borderline personality disorder (BPD), showing an emotional response to pleasant images similar to that of depression, while the pattern found to unpleasant images could be related to the complex trauma observed in these patients, which includes PTSD experiences such as sexual abuse and attachment trauma experiences.

Substance Use Disorder, Alexithymia, and Personality Disorders, What is the Link? Pilot African Study

Alexithymia and personality disorders are common in substance use (SUD) patients. This association remains understudied and is considered to hurt the course and management of substance use disorder patients.&lt;strong&gt; &lt;/strong&gt;To determine the prevalence of personality disorders (PD) and alexithymia in addiction care patients. Besides, we targeted investigating a possible link between alexithymia, different personality disorders and clinical aspects of substance use disorder including severity. This cross-sectional study was conducted in the Addictology Center of the university hospital of Fez. We recruited 54 patients with a confirmed substance use disorder according to the DSM 5 criteria. We used the psychometric scales of alexithymia (TAS-20) and the personality assessment scale (PDQ-4+). The average age of our sample was 27.07 ± 8.22. The percentage of poly-consumers of psychoactive substances was around 93%. The alexithymia patients constituted 48% of the sample. We found a significant association between alexithymia and the severity of SUD p-value of 0.033. Alexithymia appeared to be significantly associated with ‘Cluster A’ of personality disorders p-value of 0.013 and more specifically with paranoid personality disorder p-value of 0.022. The mean PDQ-4+ score was significantly higher in the alexithymia group of patients (TAS-20 score ≥62) p-value of 0.047. 89% reported at least one specific personality disorder. Our results showed a significant association between the presence of a specific personality disorder and the existence of a severe substance use disorder p-value of 0.01. We also found that ‘Cluster A’ of personality disorder diagnoses are significantly frequent within the severe subgroup of SUD p-value of 0.042. Our study suggested an overrepresentation of alexithymia and personality disorders in patients followed for SUD. It showed a direct link between alexithymia and personality disorder on the one hand, and the severity of the substance use disorder on the other. Extensive studies are required to fully elucidate the weight of alexithymia in SUD and PD. Such investigations would improve the therapeutical approach and the outcome.

Differences of chronological seasonality in drug overdose.

To investigate the association between seasonality and intentional drug overdose (IDO), a commonly seen method of self-harm in daily emergency medicine practice. Cases of IDO were retrospectively selected using the International Classification of Diseases (ICD)-10 coding system (codes T36-T50), in patients who attended the Emergency Department of MacKay Memorial Hospital between January 2018 and August 2019. Data regarding age, sex, arrival time, marital status, vital signs, comorbidities, psychiatric history, social conflicts, substance of overdose, and length of hospital stay by season, were analysed using Student's t-test and χ2-test. Of all included cases (n = 196), IDO occurred most frequently in spring (32.1%), particularly in male patients (28/49 male cases). First-time IDO occurred most frequently in spring (51/133 first-time cases) and most spring cases were first-time IDO (51/63 spring cases). Repeat IDO occurred most frequently in autumn (20/63 repeat cases). Female conflict with father and/or boyfriend, and personality disorder in patients who overdosed, showed seasonality with a spring peak. Hospital admission rate was highest in winter (10/45 winter cases [22.2%]). Episodes of IDO exhibited seasonality, with a spring peak, particularly for male patients, female patients in conflict with father and/or boyfriend, and those with personality disorder. Clinicians should pay close attention to the abovementioned patient groups.