Personality Disorder Examination Research Articles

Deliberate Self-harm in Nondepressed Substance-dependent Patients

The lifetime diagnosis of substance dependence syndrome is a major risk factor for attempting suicide. The systematic study of various risk factors of suicide in substance-dependent patients in Indian population will have far-reaching implications about the understanding of disorder. The objective was to study the sociodemographic and clinical factors associated with deliberate self-harm (DSH) in nondepressed substance-dependent patients. Participants included 60 male inpatients (30 patients with DSH and 30 without DSH) fulfilling International Classification of Diseases, Tenth Revision Diagnostic Criteria for Research for substance dependence syndrome, aged between 18 and 60 years, with Hamilton Depression Rating Scale score fewer than 7. They were assessed using Addiction Severity Index, Presumptive Stressful Life Event Scale, State-Trait Anger Expression Inventory, Lubben Social Network Scale, International Personality Disorder Examination, Risk Rescue Rating Scale, and Global Assessment of Functioning. Patients with DSH had significantly higher rates of opioid dependence (P < .05), risk of isolation (P < 0.001), the number of life events (P < 0.001), anger trait and anger expression (P < 0.001), personality disorder (P < 0.05), the number of substance use problems and lower social functioning (P < 0.001), as compared with those without DSH (P < 0.001). There was no significant correlation between Risk Rescue Rating Scale with sociodemographic and clinical variables. The study demonstrated that patients with opioid dependence, high risk of isolation, the greater number of life events, higher anger trait and anger expression, personality disorder, low social functioning, and greater number of substance use problems have risk for DSH.

Usefulness of the International Personality Disorder Examination screening questionnaire for borderline and impulsive personality pathology in adolescents

The aim of this study was to analyze the usefulness of the International Personality Disorder Examination Screening Questionnaire (IPDE-SQ) for identifying DSM-IV and ICD-10 Borderline and Impulsive personality disorders (PD) in Spanish adolescents. MethodThe DSM-IV and ICD-10 IPDE-SQ screeners were used and compared with the diagnoses obtained with the IPDE semistructured interview in a sample of 125 adolescents treated in a psychiatric department. ResultsFor primary screening, the cutoff point with the best combination of sensitivity and specificity for ICD-10 impulsive and borderline PDs was obtained with three positive items, whereas for DSM-IV borderline the best PD cut-off was five positive items. For secondary screening, the best option would be one item above the cut-off points proposed for primary screening. ConclusionThe 3-item cut-off point in the IPDE-SQ produces a high proportion of false positives on impulsive and borderline PDs in clinical adolescents. We propose several cut-off points, depending on whether the study is designed to perform primary or secondary screening.

Axis II Disorders and Cigarette Smoking Among Adults From the General Population

The present study examined whether personality disorders (PDs) are associated with cigarette smoking, and the possible influence of nicotine dependence, sociodemographic variables, and the presence of any lifetime Axis I mental disorder in these relationships. The sample was made up of 1,081 adult participants from the Spanish general population and was stratified by smoking status (519 smokers and 562 nonsmokers). PDs were assessed by means of the International Personality Disorder Examination Questionnaire, Module DSM-IV. Results indicated that participants with a paranoid, a narcissistic, a borderline, an antisocial, or an obsessive-compulsive PD had a higher probability for being smokers and for being nicotine-dependent. The only exception was the schizoid PD, because participants with this Axis II disorder had a lower probability for being nicotine-dependent smokers. The association between PDs and smoking was maintained even after adjusting for all covariates. Findings are discussed in relation to the influence of Axis II disorders on smoking cessation interventions.

Creatividad y rasgos de personalidad en estudiantes universitarios: estudio transversal de asociación

IntroductionThis study was carried out to assess the relationship between character traits and creativity in a sample of students from a public university in Bogotá. MethodologyA random sample of 157 students from the Universidad Nacional de Colombia. The two instruments used for measuring character traits and creativity were the International Personality Disorder Examination (IPDE) and the Abbreviated Torrance Test for Adults (ATTA). Additional information about gender, psychopathological antecedents, current academic period and academic average have been recorded. Robust regression methods have been used to analyze the relationship between creativity and character traits. ResultsCreativity and narcissistic traits were associated. In a multivariate model, other variables showing a relationship with creativity were found, i.e., male gender, mental illness family antecedents, number of academic periods completed, and a high academic average. ConclusionsRelationship between creativity and narcissistic traits had not been reported in previous. Longitudinal studies using more accurate scales should be undertaken to determine the validity of these findings.

Dependencia de Opiáceos tipo II o antisocial: utilidad del Modelo Psicobiológico de Cloninger en adicciones

The aim was to analyze the relationship between Cloninger's dimensions and Personality Disorders (PD) (with DSM-IV criteria) in opiate dependents. The study was Cross-sectional. The sampling of 196 patients with opiate dependence was consecutive. All were receiving treatment in an inpatient detoxification unit. Cloninger's Temperament and Character Inventory (TCI), International Personality Disorders Examination (IPDE) and a Substance Use Questionnaire were used. Character's dimensions as Self-directness and Cooperation were related with PD when scored low. Opposite to Cloninger descriptions, high scores of Self-transcendence were related with presence of PD. Related to temperamental dimensions, cluster A was related with low scores of Reward Dependence (RD) and cluster C with high scores of Harm Avoidance (HA). Otherwise, in cluster B, while Borderline PD had high scores of Novelty Seeking (as high HA), the Antisocial PD only were related to low scores of RD. RD dimension seems useful to differ from presence or absence of Antisocial PD, also when alcohol consumption is considered. Cloninger's Model of Personality is useful in drug dependents for the definition of the different PD, as well as for probable PD's aggregation. This model also helps to create subtypes in opiate dependents as the antisocial or type II.

Relationship between personality disorder dimensions and verbal memory functioning in a community population

Based on the Baltimore Epidemiologic Catchment Area (ECA) follow-up survey, we examined relationships between dimensions of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) personality disorders and both subjective and objective memory functioning in a community population. Our study subjects consisted of 736 individuals from the ECA follow-up study of the original Baltimore ECA cohort, conducted between 1993 and 1996 and available for assessment in the Hopkins Epidemiology Study of Personality Disorders from 1997 to 1999. Subjects were assessed for DSM-IV personality disorders using a semi-structured instrument, the International Personality Disorder Examination, and were asked about a subjective appraisal of memory. Verbal memory function, including immediate recall, delayed recall, and recognition, were also evaluated. Multiple linear regression analyses were used to determine associations between personality dimensions of DSM-IV Axis II traits and subjective and objective memory functioning. Scores on schizoid and schizotypal personality dimensions were associated with subjective and objective memory dysfunction, both with and without adjustment for Axis I disorders. Borderline, antisocial, avoidant, and dependent personality disorder scores were associated with subjective memory impairment only, both with and without adjustment for Axis I disorders. This study suggests that subjective feelings of memory impairment and/or objective memory dysfunction are associated with specific personality disorder dimensions.

Personality-based latent classes of posttraumatic psychopathology: personality disorders and the internalizing/externalizing model.

Prior research using the Brief Form of the Multidimensional Personality Questionnaire (MPQ-BF; Patrick, Curtin, & Tellegen, 2002) has shown evidence of 3 temperament-based subtypes--termed internalizing, externalizing, and simple PTSD--among individuals with symptoms of posttraumatic stress disorder (PTSD; Miller, Greif, & Smith, 2003). This study sought to replicate and extend research in this area by conducting a latent profile analysis of higher order temperament scales from the MPQ-BF using a new sample of 208 veterans with symptoms of PTSD. Results suggest that a 3-class solution reflecting internalizing, externalizing, and simple subtypes of posttraumatic psychopathology provided the best fit to the data. The externalizing subtype was characterized by features of antisocial, borderline, histrionic, and narcissistic personality disorders on the International Personality Disorder Examination (Loranger, 1999) as well as low levels of constraint and high levels of negative emotionality on the MPQ-BF. In contrast, individuals in the internalizing class exhibited features of schizoid and avoidant personality disorders, low levels of positive emotionality, and high levels of negative emotionality. The simple subtype was defined by low levels of comorbid personality disorder features and relatively normal personality profiles. Findings support the reliability of this typology and support the relevance of the internalizing and externalizing model to the structure of personality disorders.

Sociodemographic and clinical characteristics of Roma and non-Roma psychiatric outpatients in Greece

Objective. Differences in psychiatric symptoms are often reported between minority and majority groups. The aim of this study was to compare Roma psychiatric outpatients who are Greek citizens living in Thrace (Greece) with outpatients belonging to the ‘majority Greek group’ with respect to socio-demographic characteristics, psychopathological symptoms and psychiatric diagnoses. Design. A sample of 122 Roma and 132 majority Greek patients visiting the Outpatient Psychiatric Clinic at the University General Hospital of Alexandroupolis, Greece, were examined with the Structured Clinical Interview for DSM III-R (SCID-I), the International Personality Disorder Examination (IPDE) and the Derogatis Psychiatric Rating Scale (DPRS). Only those with a psychiatric diagnosis were retained in the analyses. The two groups of patients were compared in relation to their socio-demographic characteristics, their diagnoses and their scores on the DPRS symptom dimensions. Results. In comparison to the majority group, Roma patients were younger, more often women, less educated, married, parents of more children, without social security coverage; The Roma group had higher scores on many DPRS symptom dimensions such as somatisation, hostility, sleep disturbance, phobic anxiety, psychoticism, psychomotor retardation, hysterical behaviour and abjection–disinterest. In addition, Roma women presented psychotic and bipolar disorders less often than the majority group women. Symptoms did not differ by ethnic group for those seeking medical certification. Conclusion. Roma patients face serious social problems and show greater levels of symptoms than the majority group. The limitations of this include that the sample was not representative of the general psychiatric patient population and language, as well as other cultural and educational barriers, might have obscured important aspects of the Roma people's psychopathology.

Editorial introductions

Editorial introductions

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.

The influence of personality disorders on the use of mental health services in adolescents with psychiatric disorders

ObjectiveThe aims of this study were to explore the influence of personality disorders (PDs) in Spanish adolescents with Axis I psychiatric disorders on their use of mental health services and to analyze the risk of having a comorbid PD in relation to psychiatric service use. MethodsThe Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases, Tenth Revision (ICD-10) modules of the semistructured interview International Personality Disorders Examination were administered to a sample of 112 adolescent psychiatric patients (mean age = 15.8 years; SD, 0.8; range, 15-17; 79% women) at the point of initiating treatment. On the basis of the interview, subjects were divided into two groups: a PD group (PDG) and a non-PD group (NPDG). After 3 years of treatment, clinical records were retrospectively analyzed. ResultsThe PDG showed a significantly higher number of psychiatric admissions (P < .001), days per psychiatric admission (P < .001), and psychiatric emergencies (P < .010) than the NPDG, although the number of outpatient consultations was not significantly higher. Logistic regression analysis showed that the probability of belonging to the PDG rather than the NPDG increased with each psychiatric admission (odds ratio [OR] = 1.67 for DSM-IV criteria and OR = 1.59 for ICD-10 criteria), after controlling by sex, age, and comorbidity (Axis I disorders). ConclusionsPatients with comorbid PD used more inpatient and emergency psychiatric services than did patients without a PD. Large number of psychiatric hospitalizations suggests the likelihood of a PD being present.

Clinical Considerations for Long-acting Injectable Risperidone's Use on Cocaine Dependence and Dual Diagnosis

Introduction The aim of this study was to evaluate the prognosis of patients with cocaine dependence and dual diagnosis when long-acting injectable risperidone (LAIR) is used in their treatment. Method Open, one-arm, and naturalistic study of a 12-week follow-up was carried out. Fifty-seven patients were recruited during 1 year, when they consecutively started to receive treatment for cocaine dependence at 4 addictive behavior units and a prison in Spain. The questionnaires used were International Personality Disorder Examination, Impulses Control Scale of Ramón y Cajal, Symptom Check List-90-R, and Visual Analog Scale for Craving. Results 91.2% were men, with an average age of 33.7 years; 66.8% were single, 36.8% were unemployed, and 36.8% were with primary education. Personality disorder was shown by 39.3% (25% borderline and 12.5% antisocial). All received a conventional treatment and LAIR, with an average dose of 34.2 mg. Of the sample, 66.6% completed the study, showing a statistically significant improvement in impulsiveness, psychopathology, craving, and health emergencies. However, only 18.9% of the sample remained totally abstinent, whereas 21.6% showed one consumption during the following period. Abstinence from cocaine was not related to social-demographic variables or to the LAIR dose, nonetheless the diagnosis of borderline personality disorder had the worst prognosis. Conclusions Although cocaine dependence has no specific pharmacological treatment, approaches to treating inpatients and outpatients could include LAIR because of its efficacy on other frequently related mental illnesses (dual diagnosis). However, borderline personality disorder and cocaine dependence could be an exception, maybe because mood instability prevails over impulsivity and other antipsychotic responding symptoms.

Concordance between personality disorder assessment methods

Studies have criticized the low level of agreement between the various methods of personality disorder (PD) assessment. This is an important issue for research and clinical purposes. Seven hundred and forty-two participants in the Hopkins Epidemiology of Personality Disorders Study (HEPS) were assessed on two occasions using the Personality Disorder Schedule (PDS) and the International Personality Disorder Examination (IPDE). The concordance between the two diagnostic methods for all DSM-IV PDs was assessed using standard methods and also two item response analytic approaches designed to take account of measurement error: a latent trait-based approach and a generalized estimating equations (GEE)-based approach, with post-hoc adjustment. Raw criteria counts, using the intraclass correlation coefficient (ICC), κ and odds ratio (OR), showed poor concordance. The more refined statistical methods showed a moderate to moderately high level of concordance between the methods for most PDs studied. Overall, the PDS produced lower prevalences of traits but higher precision of measurement than the IPDE. Specific criteria within each PD showed varying endorsement thresholds and precision for ascertaining the disorder. Concordance in the raw measurement of the individual PD criteria between the two clinical methods is lacking. However, based on two statistical methods that adjust for differential endorsement thresholds and measurement error in the assessments, we deduce that the PD constructs themselves can be measured with a moderate degree of confidence regardless of the clinical approach used. This may suggest that the individual criteria for each PD are, in and of themselves, less specific for diagnosis, but as a group the criteria for each PD usefully identify specific PD constructs.

Psycho-education with problem solving (PEPS) therapy for adults with personality disorder: a pragmatic multi-site community-based randomised clinical trial.

BackgroundImpairment in social functioning is a key component of personality disorder. Therefore psycho-education and problem solving (PEPS) therapy may benefit people with this disorder. Psycho-education aims to educate, build rapport, and motivate people for problem solving therapy. Problem solving therapy aims to help clients solve interpersonal problems positively and rationally, thereby improving social functioning and reducing distress. PEPS therapy has been evaluated with community adults with personality disorder in an exploratory trial. At the end of treatment, compared to a wait-list control group, those treated with PEPS therapy showed better social functioning, as measured by the Social Functioning Questionnaire (SFQ). A definitive evaluation is now being conducted to determine whether PEPS therapy is a clinically and cost-effective treatment for people with personality disorderMethodsThis is a pragmatic, two-arm, multi-centre, parallel, randomised controlled clinical trial. The target population is community-dwelling adults with one or more personality disorder, as identified by the International Personality Disorder Examination (IPDE). Inclusion criteria are: Living in the community (including residential or supported care settings); presence of one or more personality disorder; aged 18 or over; proficiency in spoken English; capacity to provide informed consent. Exclusion criteria are: Primary diagnosis of a functional psychosis; insufficient degree of literacy, comprehension or attention to be able to engage in trial therapy and assessments; currently engaged in a specific programme of psychological treatment for personality disorder or likely to start such treatment during the trial period; currently enrolled in any other trial. Suitable participants are randomly allocated to PEPS therapy plus treatment as usual (TAU) or TAU only. We aim to recruit 340 men and women. The primary outcome is social functioning as measured by the SFQ. A reduction (i.e., an improvement) of 2 points or more on the SFQ at follow-up 72 weeks post-randomisation is our pre-specified index of clinically significant change. Secondary outcomes include a reduction of unscheduled service usage and an increase in scheduled service usage; improved quality of life; and a reduction in mental distress.DiscussionPEPS therapy has potential as an economical, accessible, and acceptable intervention for people with personality disorder. The results from this randomised controlled trial will tell us if PEPS therapy is effective and cost-effective. If so, then it will be a useful treatment for inclusion in a broader menu of treatment options for this group of service users.Trial RegistrationInternational Standard Randomised Controlled Trial Number - ISRCTN70660936

Retrospective Evaluation of Attention Deficit Hyperactivity Disorder with the Wender Utah Rating Scale in a Sample of Spanish Prison Inmates

The aim of this study is to determine the prevalence of childhood history of attention deficit hyperactivity disorder (ADHD) in a sample of prison inmates. This is a descriptive, cross-sectional study, which consisted of a sample of 100 inmates from penitentiary centers in Madrid. The instruments used were the Wender Utah Rating Scale (WURS), the International Personality Disorder Examination, and a questionnaire of demographic, penitentiary, and toxicological data. For statistical analysis, the SPSS program was used with confidence interval estimation of 95%. The mean score of the WURS was 65.7 points. Fifty percent of the sample surpassed the cut-off point of 32 for the 25 best discriminative items in the Spanish validated version. A significant association was found between a childhood history of ADHD and antisocial and borderline personality disorders. The disorder was also found to be associated with autoaggressive behavior, more probability to be sanctioned in prison, and have a history of substance dependence.

The relationship between personality disorders and mental health, substance use severity and quality of life among injecting drug users

To determine the relationship between personality disorders (PDs) and substance use severity, mental health symptoms and disorders and quality of life (QoL) among injecting drug users (IDUs). A cross-sectional study of 103IDUs accessing a needle and syringe program and a primary health centre in Melbourne, Australia. Presence of PDs was assessed using the International Personality Disorder Examination ICD-10Screener. Axis I mental health disorders, psychological distress and QoL were also assessed. Ninety per cent of participants scored positive for one or more PD. Having a Cluster A or Cluster B PD was associated with greater severity of substance use. The presence of a current mental health disorder was associated with all types of PD except dissocial PD. Only Cluster C PDs were associated with self-reported levels of psychological distress. Cluster C PDs were more strongly associated with substance use, mental health and QoL variables than Cluster A or B, although the number of PDs present had the strongest associations with these variables. IDUs had high rates of PD symptoms, which were associated with the presence of concurrent mental health disorders, more severe levels of psychological distress and substance use and low perceived QoL. IDUs require comprehensive models of care, including access to mental health practitioners with expertise in co-occurring disorders.

Study of neurocognitive endophenotypes in drug‐naïve obsessive–compulsive disorder patients, their first‐degree relatives and healthy controls

Obsessive-compulsive disorder (OCD) is a debilitating heritable neuropsychiatric condition. Attempts to delineate genetic contributions in OCD have met with limited success, with an ongoing search for neurocognitive endophenotypes. In this study, an attempt has been made to study and compare the neurocognitive functioning of patients with OCD, their first-degree relatives (FDRs) and healthy controls. A cross-sectional design study was carried out with thirty dyads of patients with OCD, their FDRs and thirty matched healthy controls and screened using Mini International Neuropsychiatric Interview, Verbal Adult Intelligence Scale, Yale Brown Obsessive-Compulsive Scale, Montgomery Åsberg Depression Rating Scale, International Personality Disorder Examination (Anankastic personality scale).Tests of National Institute of Mental Health and Neurosciences Neuropsychological Battery were used to assess domains of attention, verbal memory, visual memory, set-shifting, response inhibition, planning and visuoconstructive abilities. spss version 14.0 was used for descriptive and analytical data analysis. There were no statistically significant differences between patients with OCD and their FDRs on neurocognitive domains of delayed verbal recall, set-shifting, response inhibition and visuoconstructive abilities (P > 0.05) which were impaired compared with healthy controls. Significant differences (P < 0.05) on domains of attention, planning time and visual memory were noted between FDRs and patients. The present study supports set-shifting and inhibitory control and proposes visuoconstructive abilities and delayed verbal recall as potential endophenotypes for OCD.

Interaction of personality disorders with other co‐occurring psychiatric disorders

T. Widiger presents a thoughtful and balanced overview of the bidirectional ways that personality and psychopathology can influence each other. He focuses first on the differential effects that various personality types might have on the development of specific psychiatric disorders, suggesting some phenotypic similarities between personality traits (referring to the five-factor model, FFM) and features of specific disorders, such as selected eating disorders. In the clinical context of the growing interest in prevention and early intervention, it is valuable to consider whether or not certain personality types might be thought of as predictive patterns, to bring early attention to those with heritable risk for specific illnesses that might emerge during adverse environmental circumstances. Widiger does not differentiate here between personality types characterized by the FFM and personality disorders as defined by DSM-IV-TR, but similar arguments have been made about the influence of Axis II disorders on the course of Axis I disorders. In particular, a recent paper by Skodol et al 1 reported that, in a large nationally representative sample of adults with major depressive disorder (MDD), borderline personality disorder (BPD) strongly predicted persistence of MDD over time and was more strongly predictive of persistent depression than the co-occurring presence of Axis I disorders. Widiger then reviews the influence of psychopathology on personality. He contends that personality assessment will be inaccurate if carried out when a patient is experiencing an acute symptomatic episode of illness. There is some controversy about this assertion, however. Morey et al 2, for example, recently reported that personality disorders can be validly diagnosed during depressive episodes. Regarding the interactive dynamics over time, Widiger cites a report from the Collaborative Longitudinal Personality Disorders Study (CLPS), published in 2003, in which Gunderson et al 3 suggest that remission of BPD may often follow resolution of an Axis I disorder. However, the CLPS group subsequently reported that, over 3 years, the rate of remission of BPD was not affected by whether or not patients had co-morbid MDD, whereas time to remission of MDD was significantly prolonged in patients with co-occurring BPD 4. Similar findings were described in a 10-year follow-up study from the same research group 5. Widiger’s summary of studies indicating that personality disorders can be understood as extreme variants of the FFM is a helpful conceptual model, one that is familiar in the medical world and similar to medical conditions such as hypertension. However, the argument that many DSM-defined personality disorders exist on a spectrum linking them to major Axis I categories is more controversial. Here, the evidence is most persuasive that patients with schizotypal personality disorder share some biomarkers and some degree of genetic risk with those at risk to develop schizophrenia. The evidence is more controversial regarding the link of other personality disorders to Axis I categories. The recognition that psychopathology, particularly if severe and persistent, can alter or shape personality is certainly persuasive in many clinical situations. How, or whether even to try, to diagnose the presence of a personality disorder in certain patients, such as patients with early onset severe and persistent schizophrenia, is certainly a legitimate question. However, even in these cases, there almost always is a “person” who has been there all along, prior to the development of the Axis I condition, and it will help us to sustain hope and a recovery framework to remember that. Sometimes the interconnectivity of conditions can be quite thorny. I recall one patient to whom I administered the Personality Disorder Examination, a semi-structured clinical diagnostic interview for DSM-defined personality disorders. I began with the usual introductory instructions that I was interested in what she was like most of her adult life, not just during a period of illness such as depression or substance abuse. She said “stop”, which I did, and she informed me that she was 35 years old, that this was her first hospitalization for severe alcoholism, and that the last time she remembered being sober was when she was 12. In a case like this, we could only learn “who she is” over time, and then only if she achieved and maintained sobriety. These and many other issues are nicely assembled in this welcome paper by Widiger, which points us in important directions for further study.

Short self-reported sleep duration and suicidal behavior: A cross-sectional study

Prior studies on the association between sleep disturbances and suicidal behavior did not explore whether or not short sleep is a marker of suicide intent, lethality or risk. Cross-sectional. Suicide attempters (SAs) (n=434). Controls included 83 psychiatric inpatients who have never been SAs, and 509 healthy controls. Short sleep was defined by self-assessment as ≤ 5 h per day. The MINI and the DSM-IV version of the International Personality Disorder Examination Screening Questionnaire were used to diagnose Axis I and Axis II diagnoses, respectively. Suicide intent and lethality were evaluated through the Beck's Suicidal Intent Scale (SIS) and the Risk-Rescue Rating Scale (RRRS), respectively. Beck's Medical Lethality Scale (BMLS) was administered to assess the degree of medical injury, and the SAD PERSONS mnemonic scale was used to evaluate suicide risk. Chi-square tests and logistic regression analyses explored frequencies of short sleep in 3 samples. Chi-square tests explored whether or not suicide intent, lethality and risk were greater in SAs with short-sleep versus those without short-sleep. Short sleep was more prevalent in SAs than in psychiatric controls only in males. In female SAs, short sleep was significantly associated with several SIS items and high scores in the SAD PERSONS. Sleep duration was assessed only by self-report. The association between short sleep and suicidal behavior may be partly explained by confounders. Short sleep may be a marker of severity of suicidal behavior among female SAs.

Can Epidemiology Translate Into Understanding Major Depression With Borderline Personality Disorder?

Can Epidemiology Translate Into Understanding Major Depression With Borderline Personality Disorder?