Personality Disorder Individuals Research Articles

Relationship between Two Dimensions of Object Relations and Group Psychotherapy Attendance Rate in Borderline Personality Disorder Individuals

Aim: Recent studies showed that the quality of object relations in patients with personality disorders predict individual psychotherapy attendance rate. However, associations between these variables have led to inconsistent results for group psychotherapy. The aim of the present study was to verify whether two dimensions of object relations are associated with rates of attendance at group psychotherapy sessions. Methods: Thematic Apperception Test narratives of forty-one outpatients with borderline personality disorder (BPD) enrolled in a psychodynamic group therapy over a period of one year were rated on two variables of the Social Cognition and Object Relations Scale (SCORS): affective quality of representations and emotional investment in relationship. Results: Results indicated that these two affective dimensions of object relations were positively correlated with rate of attendance at group psychotherapy sessions after controlling for age of the participant. Conclusion: These results suggest that the quality of object relations could be a potential predictor for group therapy attendance. The results are discussed by taking into account the particular aspects of relational issues in group psychotherapy as opposed to individual psychotherapy.

Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy)

Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy)

870 – The prevalence of personality disorders in psychiatric outpatients with an intellectual disability

Introduction The diagnosis of personality disorder (PD) in individuals with an intellectual disability (ID) is clinically relevant, but there is little research on the subject. Because the impact of PD on both patients and carers is substantial, it is important to increase the understanding of how ID and PD co-occur. Objectives The aim of the present study was to examine the prevalence of all axis II DSM-IV-TR PD diagnoses in a well- defined sample of ID out-patients in two specialized secondary care ou-patient treatment centers, in the Netherlands. Special attention was paid to borderline ID (70≤Total IQ Methods The present study was a cross-sectional medical chart review. On January first, 2011, 599 patients were registered at the two centers. Diagnostic information was available for 576 patients. Diagnoses were based on Dosen's integrative approach and formulated according to the DM-ID. Results 194 patients (33.7%) were diagnosed with a PD. PD NOS (19.1%) was most common, followed by borderline PD (8.7%). Patients with borderline ID were most likely to be diagnosed with a PD (43.7%). 85.1% of patients diagnosed with a PD had at least 1 co-morbid axis I diagnosis. PTSD was the most common co-morbid disorder (23.7%). Conclusion Diagnosed according to strict criteria, PDs often occur in ID out-patients, mostly together with axis I disorders. Importantly, PDs and PTSD often co-occur in this group, indicating special care needs and signifying an interesting direction for further research.

Socioeconomic-Status and Mental Health in a Personality Disorder Sample: The Importance of Neighborhood Factors

This cross-sectional study examined the associations between neighborhood-level socioeconomic-status (NSES), and psychosocial functioning and personality pathology among 335 adults drawn from the Collaborative Longitudinal Personality Disorders Study. Participants belonged to four personality disorder (PD) diagnostic groups: Avoidant, Borderline, Schizotypal, and Obsessive Compulsive. Global functioning, social adjustment, and PD symptoms were assessed following a minimum two-year period of residential stability. Residence in higherrisk neighborhoods was associated with more PD symptoms and lower levels of functioning and social adjustment. These relationships were consistent after controlling for individual-level socioeconomic-status and ethnicity; however, the positive association between neighborhood-level socio-economic risk and PD symptoms was evident only at higher levels of individual-level socio-economic risk. Our findings identify NSES as a candidate for explaining some of the variability in symptoms and functioning among PD individuals.

Avoidant personality disorder in individuals with generalized social anxiety disorder: What does it add?

Avoidant personality disorder (AvPD) has a high level of symptom overlap and comorbidity with generalized social anxiety disorder (GSAD). We examined whether the presence of comorbid AvPD adds significant clinically relevant information for individuals seeking treatment for GSAD. Results suggested that AvPD was significantly associated with poorer quality of life and greater disability in univariate, but not multivariate analyses. Endorsement of more AvPD symptoms was associated with increased disability, increased risk of intimacy, and lower social support, even after covariate adjustment. Specifically, AvPD item 3, hard to be “open” even with people you are close to, was most strongly correlated with quality of life and disability. A binary diagnosis of AvPD alone adds little beyond a marker of greater GSAD severity and depression among patients with GSAD, while a specific feature of AvPD not captured by the GSAD diagnosis, namely emotional guardedness, may be associated with greater impairment.

Supplemental Material for The Structure of Personality Disorders in Individuals With Posttraumatic Stress Disorder

Supplemental Material for The Structure of Personality Disorders in Individuals With Posttraumatic Stress Disorder

Antisocial Behavioral Syndromes and Additional Psychiatric Comorbidity in Posttraumatic Stress Disorder Among U.S. Adults: Results From Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

Despite the relatively high prevalence of antisocial personality disorder (ASPD) in individuals with posttraumatic stress disorder (PTSD), associations of ASPD with clinical presentation of PTSD, including additional comorbidity, have not been investigated. To present nationally representative findings on associations of DSM-IV ASPD versus syndromal adult antisocial behavior without conduct disorder before age 15 with additional psychiatric disorders among U.S. adults with PTSD. Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (n=34,653). After adjustment for sociodemographics and additional comorbidity, both antisocial syndromes were significantly associated with bipolar I, attention-deficit/hyperactivity, substance use, and paranoid, schizoid, histrionic, and obsessive-compulsive personality disorders among respondents with PTSD. Odds of major depressive and generalized anxiety disorders were significantly reduced among men with ASPD. Interventions targeting PTSD may require attention to co-occurring antisociality and additional comorbidity.

The incidence of personality disorders among substance dependents and non-addicted psychiatric clients

Resistance against treatment, severity of symptoms and relapse to substance addiction can be resulted from low attention and sometimes inattention to existence of personality disorders in substance dependent individuals in rehabilitation clinics. In order to study and compare the incidence of personality disorders in substance dependents and non-addicted psychiatric clients, Millon Clinical Multiaxial Inventory (MCMI) II was administered on 75 substance dependent males and 75 non-addicted psychiatric male clients. Age, gender, education level were controlled in both group of Clients.Findings show that the rate of personality disorder prevalence in substance dependent individuals was 45.3% in compare with 25.3% for the non addicted clients. Results of t-tests analyses indicate that the prevalence rate of personality disorders (specifically, borderline and anti-social personality disorders) in substance dependent individuals is significantly higher than this ratio in non-addicted psychiatric clients. Meanwhile, there was no significant difference between the two groups in narcissistic personality disorder. In conclusion, this study highlighted the importance of paying attention to personality disorders and their related treatments along with other approaches in treatment process of substance dependent individuals. Other implications are discussed.

Dealing with personality disorders in individuals who have learning disabilities

Using a tailored approach to treat patients with co-existing conditions improves outcomes and relationships with the care team, says Ron Tulloch

A longitudinal study of personality disorders in individuals with and without a history of developmental language disorder

Traditionally developmental language disorders (DLDs) have been studied with focus on psycholinguistic and cognitive implications, and little is known of the long-term psychosocial outcomes of individuals diagnosed with a DLD as children. The objective of this study was to compare the prevalence rates and types of personality disorders (PDs) in a clinical sample of 469 individuals diagnosed as children with DLD, with PDs in 2,345 matched controls from the general population without a known history of DLD, using data from the nation-wide Danish Psychiatric Central Register (DPCR). The average observation time was 34.7 years, and mean age at follow-up was 35.8 years. Of the 469 individuals with DLD, 23 (4.9%) were known in DPCR with a PD diagnosis, compared with 51/2,345 (2.2%) in the control group (P =0.0007). Variables at assessment in childhood (gender, IQ, presence of a receptive language disorder, and degree of receptive and expressive language disorder) were not associated with a PD diagnosis in the DPCR at follow-up. Our results provide additional support to the notion that DLD is a marker of increased vulnerability to the development of a PD in adulthood and emphasizes that more research is needed to understand the links between a diagnosis of DLD in childhood and a PD in adult years.

Language and the Modulation of Impulsive Aggression

Language and the Modulation of Impulsive Aggression

Catechol-O-methyltransferase Val158Met genotype in healthy and personality disorder individuals: Preliminary results from an examination of cognitive tests hypothetically differentially sensitive to dopamine functions

A functional polymorphism of the gene coding for Catechol-O-methyltrasferase (COMT), an enzyme responsible for the degradation of the catecholamine dopamine (DA), epinephrine, and norepinephrine, is associated with cognitive deficits. However, previous studies have not examined the effects of COMT on context processing, as measured by the AX-CPT, a task hypothesized to be maximally relevant to DA function. 32 individuals who were either healthy, with schizotypal personality disorder, or non-cluster A, personality disorder (OPD) were genotyped at the COMT Val158Met locus. Met/Met (n = 6), Val/Met (n = 10), Val/Val (n = 16) individuals were administered a neuropsychological battery, including the AX-CPT and the N-back working memory test. For the AX-CPT, Met/Met demonstrated more AY errors (reflecting good maintenance of context) than the other genotypes, who showed equivalent error rates. Val/Val demonstrated disproportionately greater deterioration with increased task difficulty from 0-back to 1-back working memory demands as compared to Met/Met, while Val/Met did not differ from either genotypes. No differences were found on processing speed or verbal working memory. Both context processing and working memory appear related to COMT genotype and the AX-CPT and N-back may be most sensitive to the effects of COMT variation.

The relationship between impulsive verbal aggression and intermittent explosive disorder

Intermittent explosive disorder (IED) is the sole psychiatric diagnostic category for which aggression is a cardinal symptom. IED focuses on physical aggression, but researchers have argued for the inclusion of verbal aggression (VA) (e.g., arguing, threatening) as a part of the IED criteria set. The utility of VA in identifying clinically relevant aggression, however, is unknown. IED participants were compared to individuals without a marked history of physical aggression, but who report frequent (two or more times a week) VA, and non-aggressive personality-disorder individuals on behavioral and self-report measures of aggression, self-report measures of related constructs (e.g., anger, affective lability), and a clinician assessment of psychosocial impairment. Both the IED and VA groups were more aggressive, angry, and clinically impaired than personality-disorder individuals, while the IED and VA groups did not differ from each other on these measures. These results support the clinical importance of frequent VA for future iterations of the IED criteria set.

Remitted depression moderates self-injurious behavior in personality-disordered research volunteers

The moderating effects of depression on self-injurious behavior among personality-disordered individuals ( N = 40) were examined. Self-injurious behavior (SIB) was assessed using a well-validated laboratory measure. Remitted depression was associated with greater sensitivity to self-aggressive cues, indicating that remitted depression may be a risk factor for SIB.

Risk Factors for Suicide Completion in Borderline Personality Disorder

Borderline personality disorder is a major risk factor for suicidal behavior, yet prediction of suicide completion remains unclear. It has been proposed that impulsivity and aggression interact to increase suicide risk. Death by suicide in borderline personality disorder, then, may be the result of impulsivity, a core feature of the disorder, interacting with violent-aggressive tendencies. Using a case-control design, this study investigated clinical and behavioral risk factors for suicide completion in borderline personality disorder. One hundred twenty subjects meeting DSM-IV criteria for borderline personality disorder, 50 controls and 70 who died by suicide between 2001 and 2005, were investigated by means of proxy-based interviews using structured diagnostic instruments and personality trait assessments. Borderline personality disorder suicides had fewer psychiatric hospitalizations and suicide attempts than borderline personality disorder controls. Borderline personality disorder suicides were also more likely to meet criteria for current and lifetime substance dependence disorders. They had higher levels of current and lifetime Axis I comorbidity, novelty seeking, impulsivity, hostility, and comorbid personality disorders, while exhibiting lower levels of harm avoidance. Most importantly, borderline personality disorder suicides were more likely to have cluster B comorbidity. Impulsivity and aggression interacted to predict suicide, though not after controlling for cluster B comorbidity. Borderline personality disorder individuals who die by suicide differ from those borderlines typically encountered in acute psychiatric settings. Our results suggest that the lethality of borderline personality disorder suicide attempts results from an interaction between impulsivity and the violent-aggressive features associated with cluster B comorbidity. Further, the anxious trait of harm avoidance appears to be protective against suicidal behavior resulting in death.

Personality Disorder in Primary Care: Factors Associated with Therapist Views of Process and Outcome

Assessment and treatment of personality disorder (PD) is a key issue in UK mental health service provision (NIMH report, 2003), but there is limited information on individuals with personality disorder presenting to primary care mental health services. This study investigates the characteristics of PD in individuals receiving cognitive behaviour therapy (CBT) following GP referral and its relationship with therapist ratings of treatment process and outcome. One hundred and forty-eight participants completed the Millon Multiaxial Clinical Inventory (MCMI-III: Millon, Davis and Millon, 1997). Therapists completed a measure of therapy process and outcome (TPOQ) on 100 participants. Key therapy and process questions were answered for 60 participants who attended a minimum of five therapy sessions. MCMI- III indicated a rate of PD of 56.4%. Factor analysis of PD scales identified two factors: inward looking/emotionally distanced, and aggressive/acting out. For clinical syndromes (CLS), the factors were general psychopathology and substance abuse. TPOQ had two factors: therapeutic alliance and complexity in therapy. Regression analyses indicated that only those PDs contributing to the inward looking/emotionally distanced scale score were associated with therapeutic alliance problems. Conversely, complexity in therapy was only predicted by general psychopathology and not by personality disorder. This study identified high rates of personality disorder in primary care referrals to a clinical psychology service. It also indicated that relationships between the presence of personality disorder and therapist ratings of treatment difficulties were only associated with certain types of personality disorder. These findings are discussed in relation to service and therapy planning in mental health.

The relation among perfectionism, obsessive-compulsive personality disorder and obsessive-compulsive disorder in individuals with eating disorders

Perfectionism and obsessionality are core features of eating disorders (ED), yet the nature of their relation remains unknown. Understanding the relation between these traits may enhance our ability to identify relevant behavioral endophenotypes for ED. Six-hundred seven individuals with anorexia and bulimia nervosa from the International Price Foundation Genetic Study were assessed for perfectionism, obsessive-compulsive personality disorder (OCPD), and obsessive-compulsive disorder (OCD). No differences were found across ED subtypes in the prevalence of OCPD and OCD, nor with the association between OCD and OCPD. Perfectionism scores were highest in individuals with OCPD whether alone or in combination with OCD. Perfectionism appears to be more closely associated with obsessive-compulsive personality symptoms rather than OCD. The pairing of perfectionism with OCPD may be a relevant core behavioral feature underlying vulnerability to ED.

Neuroimaging and personality disorders

Within the past several years, neuroimaging research on personality disorders has begun to develop. Personality disorders can be thought of as trait-like dysfunctional patterns in cognitive, affective, impulse control, and interpersonal domains. These domains of dysfunction have been linked to specific neural circuits. Developments in brain imaging techniques have allowed researchers to examine the neural integrity of these circuits in personality-disordered individuals. This article reviews the neuroimaging literature on borderline personality disorder, antisocial personality disorder (including psychopathy) and schizotypal personality disorder. Functional and structural studies provide support for dysfunction in fronto-limbic circuits in borderline and antisocial personality disorder, whereas temporal lobe and basal striatal-thalamic compromise is evident in schizotypal personality disorder.

Difficulties in the Assessment of Personality Traits and Disorders in Eating-Disordered Individuals

There are compelling reasons to examine personality variables in the eating disorder (ED) field but many impediments to the collection of useful data. In addition to the conceptual and methodological difficulties associated with personality assessment in the general case, the EDs present a number of special problems. These include patients’ young age at onset and evaluation, the “state” effects of semi-starvation and chaotic eating, denial and distortion in self-report, the instability of ED subtypes, and the intrusion of eating and weight concerns into a wide range of apparently unrelated domains. Although there is substantial support for the clinical view that personality variables are linked to anorexia nervosa (AN) and bulimia nervosa (BN), the identification of stable traits and Axis II disorders in individual patients should be deferred until after the initial phase of treatment. The former name of the first author is Kelly M. Bemis.

Initial Development of a Measure of Emotional Dysregulation for Individuals With Cluster B Personality Disorders

Individuals with DSM-IV Cluster B personality disorders are at particular risk of violence toward self or others. Emotional dysregulation is likely to be a factor in such incidents and is a central issue addressed in therapies with personality-disordered individuals. This article reports findings from a study that developed an original 18-item measure of emotional dysregulation and administered the scale to 100 participants diagnosed with Cluster B personality disorders or traits. A 13-item scale (the General Emotional Dysregulation Measure or GEDM) reflecting general emotional arousal and dysregulation of negative affect was derived using principal components analysis. The GEDM demonstrates good reliability and validity and correlates significantly with other established measures of affect. This measure is seen as potentially useful in clinical social work practice and in future investigations of the relationships among emotional dysregulation, personality disorders, substance abuse, and violence.